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The Canadian health system is paying a high cost for pregnant women who are "too posh to push," a study released yesterday suggests.

The report by the Canadian Institute for Health Information shows that hospitals typically spend 60 per cent more to care for a woman who has a cesarean section, or about $4,600, compared with $2,800 for a vaginal birth.

The soaring rate of cesareans shows the influence of Hollywood stars, said Jan Christilaw, head of specialized women's health at the Women's Hospital of British Columbia.

"All these celebrities seem to have cesarean sections because they seem to have this idea that it's better, and it's not," Dr. Christilaw, who was an advisor for the report, said.

The number of C-sections in Canada rose to about 25 per cent of all births in 2002-2003, from 17 per cent a decade earlier, the report says. Canadian hospitals spent more than $1-billion on childbirth costs in that year.

The C-section rate in trendsetting British Columbia last year was between 27 and 30 per cent, Dr. Christilaw said. The rate was 35 per cent in the United States.

"We know there's pressure in that direction. You can just imagine what happens if we take another jump up from where we are now to 35 per cent. It's going to be disastrous for the system."

During a C-section, a surgical incision is made through the abdominal wall and uterus in order to deliver the infant.

The preference for C-sections is "almost silly," she said.

"If you think you're going to have a better figure if you have a C-section rather than a vaginal birth, you're realistically wrong. It'll take longer for your abdominal muscles to get back into shape and, of course, you'll have a scar on your abdomen."

As for the notion that C-sections maintain vaginal muscle tone, "we know that by six months, women who have vaginal births have just as strong pelvic floors as women who have C-sections," Dr. Christilaw said.

"There's really no suggestion when you look at the statistics for the whole population that having a C-section is actually going to make sex better for you in the long run."

Then there's convenience: "You have a busy life, you check into the hospital on Friday at 5 o'clock, have your C-section and you're done as opposed to having to wait for the natural process to get started some time over a two-week period.

"It may take 12 to 24 hours before you have your baby. You never know when that's going to happen. If you're flying your mother-in-law in from Australia, well it's not too convenient."

Dr. Christilaw questions whether doctors should be interfering with a natural process to suit a woman's social schedule.

"I think what these data say is, look, there's a very good reason to suggest that we should be trying to do the best we can to make normal births the best possible experience for women.

"If we don't, we will have hell to pay in terms of the costs of birth."

She stressed that C-sections are sometimes medically justified, such as in some cases of multiple birth, but they should not be done unnecessarily.

"We are very good at what we do in Canada. We have the lowest maternal mortality in the world. We have very low neonatal mortality.

"But having said that, our intervention rate has gone up a lot in the last 20 years and especially in the last five years. I think we have to keep a close eye on that."

Even so, the study also found that women are generally spending less time in hospital when giving birth than they did 20 years ago. In 1984-1985, the average length of stay for all deliveries was more than five days. This dropped to three days in 1994-1995.

More recently, this trend has stabilized somewhat. The average length of stay in 2003-2004 was about two days for vaginal births and four days for cesareans.