What the *@#*%?

The night before their son was born, Elisa Girard and her husband shared dinner at a romantic waterfront restaurant and toasted the fact that, the next morning, they would become parents.The timing was certain. Long before she learned the gender of her growing baby, or chose his name, Girard told her doctor that she didn’t want to leave anything about his birth to chance.

As a doctor herself, Girard, now 33, had seen some women suffer from complications of labor and delivery that can include incontinence and pelvic floor weakness. She believed a C-section might be a healthier approach.But, added Girard, the chief resident in OB-GYN at St. Francis Hospital and Medical Center, “I liked the idea of having it planned in a calm atmosphere.”The era of back-to-nature childbirth is giving way to a new trend.A growing number of healthy young women across the country are putting the dates of impending Caesarean sections into their calendars, scheduling thebirth of the children with the same foresight and precision as locking downa haircut or an important meeting.

The planned C-section gained cachet among celebrity moms about four yearsago, when Time magazine dubbed former Spice Girl Victoria (Posh Spice)Beckham “Too Posh to Push.” By last year, the trend had crept so far beyond Hollywood that the American College of Obstetrics and Gynecology weighed in- telling doctors that it’s OK to perform a C-section on demand, as long ascertain safety precautions are followed.Still, purely elective C-sections remain a minor contributor to the nation’srecord Caesarean delivery rate, which hit an all-time high in 2005, the mostrecent year for which figures are available. That year, more than one-third of the 4 million babies born in the United States were delivered byC-section.

Twenty years ago, women had a dramatically different idea of control.Childbirth education classes were packed to capacity with women who wanted to give birth as naturally as possible. Anesthesia, fetal monitors and episiotomies were considered conventions of a male-dominated medical profession that wanted to take a beautifully slow and messy process and makeit quick and sterile.The thinking has changed.”I’ve lived through the era of ‘Don’t come near me with anesthesia,’ ” said Dr. Matthew L. Saidel, an OB-GYN at Hartford Hospital who has been delivering babies for decades.

Today, Saidel quips, he has patients who ask for an epidural (anesthesia) when they step off the elevator on the labor and delivery floor.Reasons for choosing a C-section vary. Professional women sometimes like to clear their business calendar before going out on maternity leave. Some try to schedule a birth so out-of-town relatives can arrive in time to help.Others have a husband in the military who may be heading for deployment overseas. Still others have religious or spiritual convictions about the timing of birth and believe that being born on a certain date or at a certain time or when the stars are in a certain alignment can set up an infant for an auspicious life. And there are some days when nobody wants to deliver. This past Sept. 11, no one scheduled a C-section delivery at St. Francis, said Laura Bailey, nurse manager of the New Beginnings Family Birth Care Unit at St. Francis. Friday the 13th is also an unpopular date.

Doctors tell women that a C-section can be safe if the mother-to-be has passed the 39-week mark of an uncomplicated 40-week pregnancy and if she is sure she does not want more than two children.After two Caesareans, the risk increases for complications that can cause uncontrollable bleeding and end with a hysterectomy or worse.But the ability to choose a C-section is so new that many questions remain.

Some studies suggest that conventional labor and vaginal delivery stimulates and strengthens a baby’s lungs better than a C-section.And a study by Yale researchers published in the October 2008 issue of the Journal of Child Psychology and Psychiatry hints that the bonds that tie a mother to her newborn may be stronger in women who deliver vaginally.

On the other side of the debate, Dr. Christine A. LaSala, a Hartford Hospital urogynecologist, said she has seen women’s bodies ravaged by multiple vaginal deliveries, including problems such as incontinence and sagging pelvic organs. LaSala scheduled a C-section when it was time to deliver her first child, a daughter, in January.”There seems to be a correlation to vaginal childbirth with these problems,”LaSala said. And, to be certain, the ability to deliver a baby surgically has saved the lives of countless mothers and their babies, especially since about 1940,when doctors began to refine the art of childbirth in hospitals.

Elisa Girard is careful to stress that the decision to have a scheduled C-section is strictly personal and says she would never encourage her patients to opt for surgery strictly out of convenience. But recently completed research suggests that more women will be able to make the choice if they wish to.Girard recently surveyed all of the nation’s resident physicians training to become OB-GYNs. Of the 459 who responded, 71 percent said they had performed an elective C-section during their residency, and 74 percent said they would be willing to perform elective C-sections once they go into practice.”The residents are the future,” Girard said. “It gives us an idea of what the trend will be.”