No evidence for 'too posh to push' argument

06/10/04

Dr Foster's case notes: Social class and elective caesareans in the English NHS BMJ Volume 328, p 1399

There is no evidence to support the "too posh to push" argument, according to an analysis of NHS hospital data by Dr Foster in this week's BMJ.

Over the past two decades, the rising rate of caesarean section delivery has led to concern that many caesareans are unnecessary. Some experts have blamed the rising rate on wealthy women requesting caesareans to avoid pain and problems associated with natural delivery thus the phrase "too posh to push."

Researchers examined NHS hospital episode statistics data from 2001-2 and determined the social and economic status of mothers, based on place of residence.

They found that women living in the poorest areas of England were significantly less likely to have an elective caesarean, but otherwise increasing affluence was not associated with having an elective caesarean.

These figures did not include births in private hospitals but, as there are only three private maternity hospitals in England, the relatively small numbers of deliveries involved is unlikely to affect the results, say the authors.

"Our results suggest that it is not so much a case of "too posh to push" within the NHS; it may be more a case of "too proletarian for a caesarean," they conclude.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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