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Beyoncé and Jay-Z’s baby girl Blue Ivy Carter arrived Saturday. Rumor  has it that Beyonce Knowles may have chosen to have an elective C-section.

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An increasing number of women are weighing these issues. The number of American first-time moms who have chosen to deliver by cesarean — with no medical need to do so — rose by 67 percent between 1991 and 2001, according to a 2005 study in the British Medical Journal.

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Though the numbers may be growing, elective c-sections are still a tiny percentage of total deliveries — 2.55 percent in 2003, according to HealthGrades, an organization focused on improving health-care quality.

Still, the practice of elective cesareans is controversial among healthcare providers. The debate spilled into the public eye in 2003 when the American College of Obstetricians and Gynecologists (ACOG) issued a statement essentially approving elective c-sections. In a bow to patient autonomy, the ACOG took the position that doctors may ethically perform an elective cesarean that’s medically unnecessary as long as they feel it’s “in the best interest of the patient.”

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That position sparked heated opposition from a number of women’s healthcare organizations, including Lamaze International, the American College of Nurse-Midwives, and the International Cesarean Network. Those groups argue that birth is a natural physiological process that should be allowed to unfold naturally unless there’s a strong medical reason for surgical intervention. Some critics even question how many elective c-sections patients truly choose and how many are “convenience surgeries” pushed by medical professionals who don’t want their vacations or weekends interrupted by a spontaneous delivery. Meanwhile, non-elective cesareans have been on the rise. In 2004, the overall U.S. cesarean rate (including medical intervention and elective) was more than 29 percent of all births — up from about 20 percent in 1996.

Are some women deciding that, with such a strong likelihood of ending up with a c-section anyway, they might as well schedule it? Studies have shown that overweight or obese woman are two to three times more likely to have an emergency cesarean due to factors such as a large baby or failure to progress. Is a c-section scheduled in advance a better option? But then again, it can also be a more difficult surgery for an overweight woman, and there may be a higher chance of the incision site not healing properly. And many obese women give birth vaginally with no problems.

The ACOG says that the evidence to support the possible benefits of elective cesarean is still incomplete, and that there isn’t enough data yet to compare elective c-sections with vaginal births in healthy women. Some experts believe patients aren’t truly equipped enough to make a decision because they don’t have medical knowledge of what major surgery is like.

The upshot? It’s still your choice — and a tough decision to make on your own.

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