I was busy doing my ironing one evening and happened to catch the last 20 minutes of a "documentary" where a film crew were following a famous woman, pregnant with her third child. It showed her meeting with her private obstetrician and anaesthetist to discuss her fear of needles. The celebrity, lets call her "K", was not worried about "being cut open", but feared the thought of a needle being put into her back, the epidural. During the discussion, the anaesthetist reminded "K" about last time when the obstetrician had put some pain killers into her rectum and when "K" looked shocked that this had happened to her, the anaesthetist added "There is nothing dignifying about childbirth!".

I felt a great sense of sadness hearing these words, but also for poor "K" who had not been aware of what had happened to her during her last caesarean section. Working as a doula and doula trainer, I hear birth stories on a regular basis from clients and I also read a lot of trainee doulas own memories of their births. To have something "done" to you, without your knowledge, is usually the main reason why women feel their births have been horrible and traumatising. I kept thinking, why is this woman choosing to have an epidural and a caesarean section? Has she been given all the facts to make an informed choice or is she handing herself over on a plate, trusting that the experts will do what is best for her and her baby?

It is difficult to answer the question why celebrities elect to have a caesarean section since every woman is unique and I don't want to generalise, but I would say that there are a couple of areas that can be identified.

I believe pregnant women are in a light state of hypnosis. They are very susceptible to anything they hear or see related to pregnancy and child birth. In society today, the press and media paint a very negative picture of childbirth and women are led to believe that having a baby is impossible without medical interventions. Childbirth in films or TV dramas is always portrayed in dramatic scenes of crisis, fear and tension. The media seem to consistently caricature childbirth as a horrendous and frightening process that anyone in their right mind would want to avoid. It is pretty difficult to get away from all the negativity. Just being pregnant and sitting on a bus will attract someone who is eager to tell a story about how somebody they knew nearly died giving birth, not to mention all the friends, family and neighbours who all have a story to tell. All this is bound to contribute toward the decision of an elective caesarean section.

Another big reason must be the fact that women want to be in control. Especially when you are a celebrity! There is so much information about pregnancy and childbirth. Women believe that having prepared and planned the birth in detail will somehow give them control. However, natural childbirth involves the primitive part of the brain where all the hormones and endorphins are produced. Women need to keep out of their "intelligent brain" and let the body take control. This is a natural process which, if the circumstances are right will happen, but a woman needs to feel safe in her environment. She also needs to be able to switch off her thinking brain and this might mean she will be acting out of character. The woman might make strange noises, start swearing or screaming and shouting. I can guess that having made a habit of being in total control, this is an area which any celebrity would find extremely difficult to deal with, especially if this was leaked to the media. A caesarean section would be seen as the only available means of staying in control.

I also believe that celebrities might be fooled into thinking that if they pay for the best maternity care in the country, they will be given the right advice and have a perfect birth. Yes, you will get what you ask for, but does that mean you will be left with a beautiful birth memory?

A postnatal client of mine had her baby at a private hospital in London with a private obstetrician. At 9 centimetres dilated, she asked for an epidural, and immediately one was administered. Anyone trained in birth physiology, will know that this request for an epidural in the late stages of labour is due to an increase of stress hormones in the body. It activates the "fight or flight" reflex and women very often ask for pain relief, say things like "I can't do it anymore!" and even try to get off the bed to go home! This is usually a good sign that things are progressing well and that the baby will soon be born. In this case, the epidural left her unable to feel when to push and the birth ended with an episiotomy and ventouse delivery. Speaking to her about her birth experience, she feels angry that they gave her the epidural at such a late stage. What she had preferred would have been someone there to tell her how well she was doing and that soon she would be holding her baby in her arms. However, she was not paying for emotional support, she was paying for medical care and that means getting what you ask for, even if it is not what you really want.

I would encourage women to find all the information they can and ask for second opinions with regards to their options. Electing to have a caesarean section is not the "easy way out". A caesarean involves major stomach surgery and the risks compared to a vaginal birth are much higher. Of course, caesareans do save babies and mothers lives, but I feel it should only be an option when there is a real need for it. I'm not interested in beating up the women who are making the choice to have an elective caesarean. I just want women to have all of the information they need to make this choice and I am not convinced that this is happening. I feel sad for women that are celebrities and trust that the care they will receive will be what is best for them because they are paying for it. Birth in not about passing or failing and every woman has got the right to choose what she wants but I would like to think that she knows exactly what it is that she says "yes" to.