Kate Middleton avoids 'too posh to push' label
The Duchess of Cambridge's decision to opt for a natural birth comes amid growing concern among health experts about a rising number of women undergoing caesarean sections.
By planning to have her baby the natural way, Kate avoids the "too posh to push" label often given to those who choose an elective caesarean.
One in four births in England, or 25%, are by caesarean section compared with a figure of fewer than one in 10, or 9%, in 1980.
Just over one in three mothers aged 35 years or more had a caesarean birth in 2011/12, compared with one in four aged 25 to 34, and just under one in six aged under 25 years old, according to figures from the Health and Social Care Information Centre.
The highest caesarean rate was in London at 28.5% with the lowest in Yorkshire and the Humber at 22.6%.
Among individual hospital trusts, Chelsea and Westminster Hospital NHS Foundation Trust had the highest rate of caesarean births at nearly 33% compared with the lowest rate in Shrewsbury and Telford Hospital NHS Trust at 15.1%.
Women giving birth by caesarean have a higher risk of blood clots, infection and bleeding than those undergoing a vaginal birth.
The rate of caesarean sections - at a greater cost than a natural birth - is also believed to be placing a financial strain upon the NHS and increasing pressure on medical staff.
The World Health Organisation recommends a rate of 15% of deliveries by caesarean section.
Patrick O'Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, and a consultant obstetrician and gynaecologist at University College London Hospitals, said affluence may have a small part to play in fuelling the demand for caesareans - giving rise to the expression "too posh to push".
But he said the major factors were more older mothers and growing levels of obesity.
"We know that the older you are the greater your chances of having a caesarean, and that is one big factor," he said.
"The second big factor is related - if you have other medical problems, pre-existing medical problems such as diabetes or high blood pressure when you become pregnant, you have a higher chance of having a caesarean. If the pregnant population is getting older then it is more likely that these other pre-existing medical conditions are there.
"The third factor is women's weight. We know that women who are very overweight are much more likely to have a caesarean section.
"I suspect that there is a higher chance of women asking for a caesarean in an affluent area but I think that is only a small part of the explanation. I think a bigger part of it is age."