Actress Elizabeth Hurley had one. So did supermodel Claudia Schiffer. Ex-Spice Girl Victoria Beckham and singer Toni Braxton had two each. TV mom Patricia Heaton had four. They’re so popular among the upper class in Brazil that the only way you won’t get one in Rio de Janeiro, as the joke goes, is if your doctor gets stuck in traffic. What all these women had are C-sections. Not the emergency caesareans that have been performed for hundreds of years to rescue babies from women in medical crisis. Rather, they had an increasingly popular modern-day variation: planned, scheduled operations for all sorts of less-than-critical reasons. One young college student arranged her baby’s birth to avoid conflict with her final exams. Another woman was convinced a C-section would ensure that her child’s head had a nice round shape. Others are terrified of labor pains and complicated deliveries or want to avoid the wear and tear on their bodies. Some, as the British tabloids have put it, are simply “too posh to push.” Whether or not the label fits, more and more women–and not just celebrities like Madonna, actress Kate Hudson and Live with Regis & Kelly co-host Kelly Ripa–are taking charge of their childbearing these days and avoiding the vagaries of natural births. Around the world, rates of caesarean sections are soaring, far surpassing the recommendation by the World Health Organization that C-sections make up less than 15% of all births and less than 9.5% in wealthy, Westernized nations. In England, 22% of all babies are born by C-section. In Italy, the rate has climbed from 21% a decade ago to 33% today. In some private clinics in Brazil, C-section rates are as high as 90%. In the U.S., according to the Centers for Disease Control and Prevention, at least 1 in 4 babies is born by C-section–the highest rate since the government officially began keeping track–up from 10.4% in 1975. According to Dr. Samantha Collier, vice president of medical affairs at HealthGrades, a company that rates the quality of health care in the U.S., about 22% of those C-sections–or 63,000 births per year–are purely by patient choice, a 20% increase since 1999. “In the next couple of years,” says Collier, “we’re going to see this go through the roof.” All of which puts the obstetrics community in an uneasy ethical position. While C-sections are safer than ever–thanks to improvements in anesthetics, antibiotics and operating techniques over the past few decades–they still introduce real risks. In 1% to 2% of cases, C-sections lead to infection, damage to other organs during surgery or severe bleeding in the mother. They can also endanger the baby if the infant’s gestational age has been miscalculated and the child is removed from the womb too soon. Risks to the mother increase with each successive C-section, and the procedure isn’t recommended for women who plan to have more than two children. So the question for doctors is this: Should women be allowed to have C-sections just because they can?