MANY Western women (and men) are shocked that so many young and healthy Chinese urban women never consider anything but a Caesarian-section (C-section), major abdominal surgery, for what is likely to be their one and only child.

Very few Chinese mothers-to-be say they want to be fully conscious during that primal maternal experience when she brings new life into the world.

"Just knock me out and hand me my perfect baby when I wake up" - that seems to sum up the feeling of most women, who are mostly single children and generally averse to discomfort.

The reasons for selecting unnecessary C-sections are numerous - fear of labor pains, scheduling convenience, the desire to regain their figures fast (no matter which way, it takes a long time), and even the desire to plan the birth for an auspicious period or lucky day (ji ri).

Quite a few people think that a baby born by C-section is more intelligent than natural-birth babies because the head isn't squeezed in the birth canal.

"Most mothers-to-be are just too afraid of the delivery they learn about through scary stories from TV or friends," says Dr Song Yuehua, chief physician of the Shanghai No. 1 Maternity and Infant Health Institute. "What they need is long-term professional guidance to show them the real picture of natural delivery."

C-sections are not as safe and painless as women think, she says.

Dr Song was commenting on findings, expected to be released soon, that 50-60 percent of births in Shanghai and big cities are by C-section.

A report by the World Health Organization early this year said almost half the new mothers in China, more than 46 percent, are choosing C-sections, many of them unnecessary. It considers a rate of more than 15 percent to be excessive.

The report is based on investigation of more than 100,000 mothers in nine Asian countries. The average C-section rate for Asian countries is 27.3 percent; while the rate in China is more than 46 percent.

Lucy Chen, a 27-year-old office worker, is eight months pregnant and preparing for the "blessed event."

Although she is perfectly healthy and the baby is fine, she plans to have a C-section.

She read about normal vaginal child birth and C-sections, talked to friends and, of course, to a doctor. The physician said natural childbirth would be possible and had advantages. Spinal blocks can be used for pain.

"I know that with natural delivery I will probably recover more quickly," says Chen, "but I just don't think I can take the pain. Many female friends told me it was much more painful than anything they had ever experienced in their life."

C-sections, which are major abdominal surgery, are recommended for women with various problems such as high blood pressure, heart disease, kidney inflammation, diabetes, obesity or very low weight.

They are also recommended if the fetus is unusually large, is in a difficult position or has other problems.

Yet, most Chinese women are asking for quick and painless (under anesthesia) surgery regardless of their condition. Most doctors don't press the case for natural delivery, knowing there could be unforeseen complications.

Dr Song says nearly half of her patients do not need C-sections.

Fear of pain is the major reason women chose C-sections. Though they know the C-section wound and internal organs will hurt and recovery will be more difficult, they prefer not to spend a long time in painful labor.

Jennet Wang, a 30-year-old mother chose to deliver her son by C-section two years ago to avoid a "double cut" - the lateral incision to enlarge the birth canal that doctors routinely make in natural births - and the abdominal incision if natural delivery fails.

A difficult natural delivery could lead to a C-section.

Vicky Yang, 27, went through natural delivery a year ago and said the labor pains were not as bad as people had said.

"You can totally get used to the pain as it gradually increases," she says.

Women also worry natural delivery will hurt their sex lives, but doctors assure them not to worry; these issues can be resolved.

Dr Song says there are other misconceptions: Children delivered by C-section are more clever than those born naturally, and C-sections mean the mother will regain a perfect figure more quickly than those who choose natural childbirth.

Both not true. They point out that pregnancy itself stretches the body, and everyone changes.

"Some families choose C-sections if they want their baby born on ji ri (lucky days), which is not wise, but it is not rare," says Dr Song.

"Abdominal delivery is not as safe and painless as most people believe," says Dr Song. "The risk of complications and infection from abdominal delivery are usually much higher than from natural delivery."

Heavy bleeding inflammation, problems with healing and endometriosis are more common in women who have C-sections. The pressure of the birth canal helps babies get rid of water in their lungs and breathe on their own. C-section babies need more attention in this regard, she says.

After a C-section, a woman usually cannot get out of bed for a day, while mothers who have a normal natural delivery can get out of bed earlier. Mothers who get C-sections also take longer to lactate.

In the Chinese medical system, most women don't have a regular obstetrician who follows them through their pregnancy; lack of a relationship and good knowledge of a patient's history also make doctors reluctant to suggest natural delivery, says Dr Song.

But when it comes to delivery, women do choose a doctor for C-section and give him or her a red envelope of cash in advance to express thanks and ensure the smallest possible scar.

Establishing a long-term relationship and doctor-patient trust will encourage healthy pregnancies and deliveries, says Dr Song.

Many hospitals in Shanghai offer package services for mothers-to-be, including the Shanghai No. 1 Maternity and Infant Health Institute. Women can see one group of doctors throughout the pregnancy for regular exams, scans and delivery.

The doctors provide ongoing advice about health, exercise, nutrition, blood pressure, blood sugar and fetal weight. They are in a better position to recommend natural delivery than doctors who do not have a relationship with the patient.

Since the program began in 2008, the rate of C-sections at the institute dropped by 10 percent in the fourth quarter of 2009.