Promoted by the media as the hippest way to have a baby, and advertised by obstetricians as guaranteeing the fitness of the "honeymoon passage", Caesarean sections are increasingly presented as just another way of giving birth.
Like all operations, Caesareans have become much safer. They have also become more common. With one in five Irish babies delivered by section, the operation is rapidly becoming normal. As Caesareans proliferate, they have been domesticated - like no other major operation - through language.
For those of us without a background in medicine, the term "section" - meaning to divide by cutting - almost obscures the surgery, while "Cesar", the American shorthand, makes it sound like the name of a cuddly family dog.
Doctors have made the operation user-friendly, allowing partners to come into the operating theatre and offering regionally anaesthetised epidurals or spinal blocks, both of which enable mothers to remain awake during the operation and hold their babies immediately.
"Patient request" is increasingly cited by doctors as a factor in the spiralling rates, although this has not been seen to influence obstetric practice in the past. While the true demand for the surgery is unknown, there is increasing discussion of women's "right to choose".
There seems to be an increasing willingness among obstetricians to perform medically unnecessary Caesareans. These are defended on the grounds of maternal choice. But what does maternal choice mean? To what extent do the use of language and the quality of the information provided affect women's "choices" in childbirth?
In a recent Australian survey, doctors defined women's refusal to consent to a "trial of scar" as maternal choice. The term means trying to give birth vaginally after a Caesarean. The gospel was, once a Caesarean, always a Caesarean. But the safety of vaginal birth after a Caesarian is now established.
The Australian paper was called "Patient Preference: The Leading Indication For Elective Caesarean Section In Public Patients". The language of "maternal choice", not to mention "patient preference", is clearly being extended to cover some obstetric grey areas.
So are women who have had Caesareans being told they can give birth vaginally? And who, except a masochist, would opt for a procedure with so daunting a name as "trial of scar"? In the face of rising Caesarean rates here and abroad, patient demand may be as good a defence as any. Meanwhile, demand is being created.
There is evidence that, particularly in the UK, women are being told that having Caesareans will enable them to plan their deliveries, "protect the pelvic floor" and "avoid an emergency section".
If you opt for a Caesarean, all you need is a compliant obstetrician and a healthy bank balance. Obstetrics is one of the only medical specialities to perform major operations on demand, in the absence of medical necessity.
Is a Caesarean "almost as safe" as a vaginal birth, as is frequently claimed? To have a Caesarean section is to undergo major abdominal surgery. A Cambridge study indicates that women are unaware of the risks, especially for the baby. Caesarean complications are a leading cause of obstetric litigation in the Republic, according to the Institute of Obstetricians and Gynaecologists.
Haemhorrhage - usually necessitating hysterectomy - wound infection and injury to the urinary tract are the most common causes of lawsuits.
In 1999, a 34-year-old woman, described as having "no risk factors other than a Caesarean section", died in a Dublin hospital when her heart stopped after a clot developed in her lung. Her death, a report commented, highlights "the increased risk of thromboembolic disease following abdominal delivery".
Regional anaesthetic, whether spinal or epidural, is better for both mother and baby. Babies born under general anaesthetic tend to do less well after birth than those born under regional anaesthetic. They are more likely to have breathing difficulties, need more active resuscitation and be admitted to intensive care.
Mothers who had Caesareans under general anaesthetic have reported frequent headaches and neckaches. They may also be at risk of postnatal depression; the emotional fallout from being unconscious during delivery, and being separated from the baby during the first hours after birth, is well documented.
Spinal blocks are rapidly becoming the anaesthetic of choice in Britain. Research on more than 60,000 Caesareans in the UK in 1997 showed that regional anaesthetics were used in more than three-quarters of cases. "Single-shot spinals" accounted for 47 per cent, more than double the proportion of epidurals. Spinals are less toxic than epidurals, as they involve low doses of local anaesthetic. According to some anaesthetists, the quality of the "block" is better and faster-acting than that of an epidural.
If you have an epidural, choose an experienced anaesthetist. There is a small risk of "dural tap", when the needle goes too far into the spinal canal and punctures the dura mater, the protective sheath around the spinal cord, causing a leak of the liquid that bathes the cord and brain. The risk depends on the skill of the anaesthetist. Dural taps can result in headaches that last for several days.
Neither epidurals nor spinal blocks can be guaranteed to provide adequate pain relief. Both, particularly epidurals, may need to be supplemented with intravenous painkillers, or even augmented with a general anaesthetic.
British women receiving epidurals or spinal blocks for Caesareans run a significant risk of ending up under general anaesthetic. In 1997, 11 per cent of regional anaesthetics for UK Caesareans were "converted" to general anaesthetics.
In the past, Caesarean hysterectomies, in which the womb, ovaries or both are removed following Caesarean sections, were very rare. The procedure now seems to be on the increase. St George's Hospital in London has reported a tenfold increase in the incidence of Caesarean hysterectomy in young women over the past decade. Many link the increase to the rise in Caesareans.
While women who have had emergency Caesareans may feel dissatisfied, depressed, anxious or lose self-esteem, the picture in relation to Caesarean by choice is unclear. Contact between mother and baby is generally restricted during the first 24 hours, and many mothers suffer as a result. Breastfeeeding is made more difficult by post-operative pain and by decreased mobility. In one study, which asked women how they felt three months after their operations, 35 per cent said they had not fully recovered.
Last year, an obstetric conference was held in Kansas City with a view to "mainstreaming" Caesarean sections. One paper was called "Elective Caesarean At Term (38 Weeks) As A Cost Control Measure".
The decision to perform an elective Caesarean is increasingly portrayed as one "shared" between obstetrician and patient, but nobody knows how many Caesareans are being done on demand. One Scottish study of 23 maternity units said that one in five "elective" Caesareans was "associated" with "patient request". (Caesareans are either "elective", done before the onset of labour, or "emergency", performed in labour. The "election" has historically been an obstetric one.)
So what's wrong with childbirth? Research carried out at the National Maternity Hospital, on Holles Street in Dublin, shows that women who formerly received oxytocin to accelerate labour are more likely to request a repeat Caesarean than those who have not received oxytocin.
Could Caesareans be an exit strategy on women's parts - from the way we actively manage labour? There is no evidence to support the notion that Caesareans are better than vaginal births - for mothers or their babies - and plenty to show that they are worse. While Caesareans are clearly a godsend for those who need them, they can be hazardous for those who do not. Don't look for it unless you need it.