 Ethical debate surrounds when and how women ought to be able to choose to have a cesarean delivery for non-medical reasons. Because there is no validated and universal medical code to indicate such deliveries, we do not know whether elective cesareans (typically referred to as Cesarean Deliveries on Maternal Request, or CDMRs) significantly impact the overall cesarean rate or are a rare novelty. Nevertheless, in light of several notorious cases of celebrity CDMRs, the issue has sparked intense controversy. Some worry about the prevalence of cesarean sections indicating the rise of a technological imperative in standard obstetrical practice (Burrow 2012). On the other hand, women who choose cesarean deliveries are often stereotyped as “too posh to push”, and seen as privileging their own convenience over their children's well-being and their maternal responsibilities. Empirical evidence, however, does not decisively support either birthing method. A 2006 NIH State of the Science conference assessed the available scientific evidence concerning the short and long term risks to women and infants of vaginal and surgical delivery, and concluded that there was insufficient evidence to issue a recommendation concerning the relative safety of planned vaginal and cesarean births. The most comprehensive meta-analyses reveal different risks in each case that are hard to commensurate and a dearth of high-quality data. Thus from a narrowly medical evidence-based point of view there is no justification for recommending one approach to delivery over the other (Minkoff 2006, Young Mi and D'Alton 2008).