The trend, which has helped drive the number of C-sections to record highs, has caught experts by surprise. Some worry that too many women are letting convenience and comfort get in the way of assessing risk. Others applaud the fact that women are taking more control over the choice of how to give birth to their children. Women also are more aware of the risks of vaginal delivery.

Up to 18 percent of all C-section births may be the result of maternal choice, according to a National Institutes of Health panel that studied the issue this spring.

The elective surgeries have helped derail a national goal to lower C-section rates by 2010. Instead, in 2004, nearly one in three babies was born by C-section, up from one in five a decade ago. In Arizona, a record one-quarter of births were C-sections last year.

The increase defies the natural childbirth movement of past decades, when women were urged to forgo spinal blocks and other forms of anesthesia during labor.

"Quite honestly, we don't know all of the reasons why woman are requesting Caesareans," said Dr. Mary D'Alton, chief of obstetrics and gynecology at New York Presbyterian Hospital.

Elective C-sections are planned events, which give working mothers predictability and allow them to wrap up work projects before their baby's birth and before taking maternity leave. Even mothers who don't work outside the home may request a C-section so they can set up child care while they're in the hospital.

The health panel determined that more women are requesting elective C-sections because they may have delayed childbirth and now are juggling careers that require more predictability.

Some women fear that even if they are healthy, they may not be able to deliver vaginally because it is too painful or difficult. Even when given pain medicine, labor may stop, requiring a C-section.

"From the beginning, I was pro C-section just because I had a feeling she was a large baby: 9.3 pounds," Zuniga said. "I've seen women smaller than me have 10-pound babies. I just didn't want to go through that. I knew the risks of having a C-section, and I also knew the risks of having a prolonged delivery."

Because vaginal births can cause lacerations and other damage, some women wind up with "pelvic floor dysfunction," which leads to urinary and fecal incontinence. But studies proving that vaginal births cause incontinence are inconclusive.

In some cases, a woman who delivered her first child via a C-section doesn't want to have a later vaginal birth, fearing her uterus will rupture.

In Arizona, the average charge of a vaginal birth without complications was about $6,609 last year; the average charge of a C-section was $12,406, according to the Arizona Hospital and Healthcare Association.

However, in the long run, patients and employers could pay higher premiums, said Susan Pisano, spokeswoman for America's Health Insurance Plans.

More doctors today say they believe patients should have a say in the matter. They also think fewer malpractice lawsuits result from C-sections.

"The school of thought has always been that natural is better, and medicine has always been very paternalistic," said Dr. Jamal Mourad, an obstetrician with Southwest Women's Care in Mesa and Ahwatukee.

Obstetricians began to change their thinking when a policy statement was issued in 2003 by the American College of Obstetricians and Gynecologists. It found that elective C-sections are ethical, though doctors should discuss risks of both types of deliveries.

Dr. Harry Watters, an obstetrician in Chandler, said it's rare that he advises women against an elective C-section. When he does, it's usually because her sole reason is convenience.

"If a mom says, 'My sister is going to be in town so I want to have my C-section now,' I don't think that's a good indication," Watters said. "We have done that once or twice, but we've required them to go out and get a second opinion first."

The health panel's study didn't conclude whether elective C-sections are beneficial or harmful. But it made two recommendations: They shouldn't be performed before 39 weeks of gestation, and they shouldn't be done if a woman wants more than two children because the surgery could lead to an early hysterectomy.

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