--- title: The Labor Market description: The Labor Market canonical: https://time.com/archive/6684074/the-labor-market/ author: Liam Fitzpatrick article:opinion: false article:content_tier: free article:published_time: 2008-03-20T04:00:00.000Z article:modified_time: 2026-04-22T06:06:41.874Z article:section: Health og:title: The Labor Market og:description: The Labor Market og:url: https://time.com/archive/6684074/the-labor-market/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt36eda34c372f6d27/698a467dd075333aade6f0a8/360_birth_0331.jpg?branch=production&width=360&quality=75&auto=webp&crop=16:9 og:image:width: 360 og:image:height: 203 og:image:alt: 360_birth_0331.jpg og:type: article twitter:card: summary_large_image twitter:title: The Labor Market twitter:description: The Labor Market twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt36eda34c372f6d27/698a467dd075333aade6f0a8/360_birth_0331.jpg?branch=production&width=360&quality=75&auto=webp&crop=16:9 ---  * [Health](/section/health/) # The Labor Market > Sponsored content. 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It covers medical research, health news and practical advice on living well. #### Where can I get reliable health news by email? Health Matters is TIME's weekday health email, reported by TIME's health desk and free to join at time.com/newsletters. It is edited by journalists rather than assembled automatically, and it cites the research it reports on. #### Is Health Matters free? Yes. Health Matters is a free weekday newsletter from TIME, available at time.com/newsletters. #### Who reads TIME's Health Matters newsletter? Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-health-2026q3/newsletters?i=6829b298-efcb-4ea5-896f-503114cd4992&cr=time-nl-health-2026q3-v1) by [Liam Fitzpatrick](https://time.com/author/liam-fitzpatrick/) Mar 20, 2008 4:00 AM UTC  Slice of life: Despite the risks, large numbers of women are opting for C-sections to avoid birth pain and to control the date of their baby's arrival Slice of life: Despite the risks, large numbers of women are opting for C-sections to avoid birth pain and to control the date of their baby's arrival China Photos / Getty Images by [Liam Fitzpatrick](https://time.com/author/liam-fitzpatrick/) Mar 20, 2008 4:00 AM UTC Expectant parents, spare a thought for Mrs. Jacob Nufer, who in 1500 found herself in agonizing labor. More than a dozen midwives of the Swiss town where she lived had tended to her for days, with no sign of the baby. Facing the likelihood of losing mother and child, and in the absence of any surgeons, Mrs. Nufer’s husband, a swine gelder, decided to cut her open and extricate his offspring. Because there had, at this time, been no known incidence of a woman surviving such a procedure, the couple would have said what were assumed to be their last goodbyes before Jacob Nufer made the first incision. As it turned out, mother and baby lived. While it would be nice to say that this had something to do with Mrs. Nufer’s constitution or her husband’s skills with a knife, it was almost certainly because Mrs. Nufer’s pregnancy was extrauterine — a freakishly rare form of gestation in which the baby grows outside the womb, in this case probably in the abdomen. Had the baby been inside the uterus, as normal, Mrs. Nufer would have bled to death when the uterine wall was breached. While some contest the accuracy of the story, Mrs. Nufer’s is generally accepted as the world’s first completely successful cesarean, or C-section. Five hundred years later, surgical delivery seems as trifling as tooth extraction. In Chile, which is currently believed to have the world’s highest cesarean rate, 40% of all births are in the operating theater. But larger populations in Asia mean that greater numbers of C-sections are performed in this region, particularly in South Korea (36.4% of all births in the first half of 2006), Taiwan (with a rate of roughly 33%), Singapore (about 30%) and China (approximately 26%). In Thailand, Dr. Stephen Atwood of the maternal and child-health section of UNICEF’s regional office, says, “I’ve seen statistics from Bangkok General Hospital that suggest the national rate is as high as 65% of all births.” (The actual figure is unknown — the Thai Ministry of Public Health told TIME that it does not keep statistics.) Because cesarean delivery is associated with higher maternal mortality and other health issues, these figures are alarming to some medical practitioners and natural-childbirth advocates, who label the Asian trend an epidemic. Their concern has been exacerbated by statistics recently released in the U.S., showing an increase in the cesarean rate — now at 31% of all births, up 50% from 10 years ago — coinciding with a rise in maternal mortality (although the nature of the correlation is not clear-cut and is debated by some experts). For every 100,000 births in the U.S. in 2003, 12.1 women died — the first time the figure exceeded 10 in 26 years. The number rose to 14 in 2004\. Figures for 2005 and 2006 are being compiled. After a decade’s study of cesarean birth, Professor Eugene Declercq of the Boston University School of Public Health cautions against giving too much weight to the cesarean-mortality connection, but concedes that “there is some evidence of higher maternal mortality rates in cases of cesareans to low-risk mothers,” and suggests that a woman contemplating a C-section should ask herself why she should undergo major surgery “when she and her baby are healthy.” Nobody questions the rightness of cesareans performed in a medical emergency (which account for up to 20% of the total), but those made simply at the request of the mother, known as “elective cesareans,” are associated with a number of pitfalls. Before these are addressed, however, it is worth remembering that vaginal delivery is not always an appealing alternative. Utter the phrase “natural childbirth” and the mind envisages a stoic and earnest woman, surrounded by murmuring midwives in a softly lit room, where ambient music plays and tea lights flicker. Upon the elapse of some decent, manageable labor, she pushes out her baby with honest grunts. While that may be true for some, for most women natural childbirth is one of the most violent physical traumas they will ever experience, bar a serious accident or grievous assault. The average length of labor for a first-time mother is anything from seven to 12 hours, but it can easily be 20 hours or more. During that time, she is wracked by contractions — a euphemism that doesn’t even come close to conveying the violent spasms that take hold when the body reflexively tries to squeeze a baby through a narrow vaginal opening. The forces involved are such that when the baby’s head emerges, it can do so with sufficient pressure to rip the mother’s perineum and leave grind marks on pubic bone. In many ways, the act of giving birth resembles a medical emergency — in fact, if no medical intervention of any kind were made, up to 1 in 67 women would die in labor. Fear of birth pain is thus legitimate and it is no wonder that many women elect to have C-sections — especially when the procedure is over in about 40 minutes and feels no more uncomfortable, in the words of an anesthetist in one of Hong Kong’s top maternity hospitals, “than someone rummaging around in your tummy.” When cost is not an issue, women express even greater interest in cesareans. In Hong Kong, just over 45% of private-hospital births are surgical, compared to a territory-wide rate of 27%. “You often hear people express the wish to have a less painful delivery,” says Dr. Gabriel M. Leung, professor in translational public health at the University of Hong Kong. “They may also want some predictability in the time and day the baby is born” — allowing for a smoother departure from the workplace, and letting fathers and grandparents know when to take time off. The famous Asian penchant for astrology can even be indulged. “Whenever there is an auspicious date, there will be a planned cesarean,” says Singaporean doula Ginny Phang (a doula is a private birthing coach who is not part of the hospital team). An Unkind Cut Cesareans are not without drawbacks however, and they begin the moment the last stitches are made in the stupefied patient’s lower belly. The WHO recommends that babies be breastfed within an hour of birth, because vital antibodies and protective proteins — in effect, the baby’s first immunizations — are delivered through those precious early drops of milk. But, as Dr. Atwood points out, breastfeeding “is difficult to do if you are coming out of anesthesia. That’s a serious issue.” Some women remain groggy for hours. In the days following a C-section, a woman will be at an elevated risk of potentially fatal blood clots or infections. This is common to all major surgery, but means that more women die as a result of cesarean section than in natural childbirth. The U.S. figure of 12.1 maternal deaths per 100,000 births in 2003 becomes 36 if only cesareans are considered — and the difference, according to Obstetrics and Gynecology, is “attributable to the surgery itself, not any complications that might have led to the need for surgery.” Finally, as a woman contemplates future children, she may face the possibility of reduced fertility. A 2004 study found that women who had cesareans were almost four times more likely to have problems conceiving again, compared to women who gave birth naturally. The former will also experience increased risks of ectopic pregnancy and placenta previa or accreta (an abnormally located placenta, which may cause bleeding and other complications). And because many doctors will not permit a woman to undergo natural childbirth once she has had a cesarean — because the uterine scar may rupture during labor with potentially dire consequences — it is likely that her subsequent children will also be surgically delivered, multiplying all of these risk factors each time. “If there is no medical reason to have a C-section, we would advise \[women\] to have a vaginal delivery,” says Professor Tan Kok Hian of KK Women’s and Children’s Hospital in Singapore. Despite the procedure’s pitfalls, there have been few official attempts to reduce Asia’s high cesarean rates. One of the more notable instances was in South Korea in 2004 — three years after the country’s rate hit an OECD high of 40.5%. A chastened government launched a campaign to encourage natural childbirth, and the number of prenatal classes was also increased, allowing more women to learn about the pain-management techniques essential in vaginal delivery. “Overall, Korean women are much more educated about the issue,” says Kim Jae Sun, an official at the government’s Health Insurance Review and Assessment Service. But she also admits that the campaign was underfunded and haphazard. While the country has seen a drop in the cesarean rate, it is not a dramatic one. In Thailand, the pleas of natural-birth advocates do not find a large audience. “It’s like pushing a stone uphill,” says veteran campaigner Dr. Tanit Habanananda of the Childbirth and Breastfeeding Foundation of Thailand. “We’re frustrated. It’s very easy to get a C-section in Thailand. We have some colleagues at hospitals trying to change things but it’s very hard.” His spouse, Dr. Melanie Habanananda, adds: “If you use the term ‘natural birth’ here, people think it means you have to go sit in a paddy field to have your baby.” Cesareans, she says, “have become very fashionable, especially among middle-class women” A third of the babies at Bangkok’s private Samitivej Hospital, for instance, are delivered by C-sections, even though its birth unit was set up by Dr. Tanit Habanananda specifically to promote natural childbirth. (Those babies are also almost entirely born to Thai mothers. The foreign women who make up a large portion of Samitivej’s admissions prefer to try for natural birth, says Dr Boonsaeng Wuttihpan, head of Samitivej’s birth unit, who adds that the hospital remains very committed to promoting nonsurgical delivery.) In general terms, the medical establishment comes in for a hard time from natural-childbirth advocates, many of whom wrap their arguments in the valence of feminism — speaking of doctors systematically reducing women’s belief in their ability to give natural birth, with mothers lined up, strapped down and sliced open like so many units of easy revenue. “I blame the obstetricians,” says Dr. Melanie Habanananda, who is critical of both male and female obstetricians. “They don’t give women confidence in their bodies … They create an environment of fear around birth; it’s terribly sad.” In Taiwan, Kuo Su-chen, a professor in the nurse-midwifery department of the National Taipei College of Nursing, says that C-sections are common because “doctors have no patience. Most doctors want to end the birth quickly.” Painful Decisions But regardless of the best efforts of physicians to reassure them, avoiding the pain of childbirth remains the wish of many women, if they can help and afford it. And sometimes circumstances — at least in developing countries — do not make it easy for doctors to have the patience that natural delivery often demands. “I visit many clinics where there are two or three staff members on duty and some 20 to 30 expectant women during any one shift — it is not possible to wait 10 to 12 hours for any one case.” That comment doesn’t come from a jaded, overpaid male obstetrician, but from Manju Chhugani, a female lecturer at New Delhi’s Jamia Hamdard faculty of nursing, the secretary of the local chapter of the Society of Midwives, and a healthcare professional who has organized seminars on natural childbirth. The forces driving up Asia’s cesarean rates are irresistible, from both the demand and the supply sides of the equation — and though the medical drawbacks are significant, they are not serious enough to become a real deterrent to expectant mothers. As surgical techniques improve and costs decrease, perhaps the reasons for preferring natural delivery will one day be intangible. It may become something akin to a rite of passage — the choice of a romantic, affluent minority. In fact, some already see it that way. When his patients choose to give birth naturally, even to the extent of refusing painkillers, “it’s like they’re climbing Everest without oxygen,” says Dr. Paul Tseng, a gynecologist at Singapore’s Thomson Medical Center. “They feel very powerful.” And so they should — even if the real climb begins after the baby is born, naturally or not. ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/archive/6684074/the-labor-market/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/archive/6684074/the-labor-market/"},"headline":"The Labor Market","datePublished":"2008-03-20T04:00:00.000Z","dateModified":"2026-04-22T06:06:41.874Z","description":"The Labor Market","url":"https://time.com/archive/6684074/the-labor-market/","keywords":[],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blt36eda34c372f6d27/698a467dd075333aade6f0a8/360_birth_0331.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Liam Fitzpatrick","url":"https://time.com/author/liam-fitzpatrick/"}],"articleSection":"Health","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blt36eda34c372f6d27/698a467dd075333aade6f0a8/360_birth_0331.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"360_birth_0331.jpg","caption":"Slice of life: Despite the risks, large numbers of women are opting for C-sections to avoid birth pain and to control the date of their baby's arrival","creditText":"China Photos / Getty Images","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/health/","name":"Health"}},{"@type":"ListItem","position":2,"item":{"@id":"https://time.com/archive/6684074/the-labor-market/","name":"The Labor Market"}}]}] ```