Varying standards of care, not lifestyle choice, lie behind soaring Caesarean birth rates in England, researchers say today.
A new study rejects the idea that women are choosing the operation - typified by claims that celebrities have become "too posh to push".
Some 25 per cent of births now take place through the surgeon's knife - compared with just nine per cent in 1980.
High rates in the south of England had fuelled claims that wealth and personal vanity was driving the increase.
But researchers from the Royal College of Obstetricians and Gynaecologists say the main reason for varying rates across Britain is the use of emergency Caesarean procedures - which would not have been chosen beforehand.
Their findings are reported on-line by the British Medical Journal.
Led by Dr David Cromwell, of the London School of Hygiene and Tropical Medicine, the researchers say different practice between hospitals may reflect the absence of a clear definition of an abnormal or difficult labour - and also problems with deciding when a baby is excessively "distressed" during labour.
The findings were welcomed by the Royal College of Midwives.
Mervi Jokinen, of the RCM, said: "At last we are discussing what is really behind the high rates of caesarean sections. I am also pleased that it clearly refutes the prevailing view that it is women requesting Caesareans who are pushing up the rates."
She added: "We have a plethora of evidence that women labouring in different environments such as birth centres, midwifery-led units and in their own homes, have a lower caesarean section rate than the same women labouring in more medicalised units.
"These environments are midwifery-led ensuring that women know their midwife, get continuity of care and one-to-one care in labour; a proven way to reduce caesarean section rates."
British Medical Journal on-line October 7 2010