"This time is going to be different," Jennifer Berman told herself when she found out she was pregnant for the second time.

Her first labor, three years earlier, had been long (18 hours)  -- and frightening. Her baby's head and shoulders got stuck in the birth canal; Max  -- born at 9 pounds, 8 ounces  -- suffered no lasting harm, but the monitoring probes inserted during labor gave Berman an infection that took more than a week to clear up. She also suffered from months of incontinence. "It was all way out of control," says Berman, a urologist at UCLA Medical Center.

So for her second baby, she decided to have a c-section. Isabelle arrived by appointment on February 11, 2003, weighing 7 pounds, 8 ounces.

One in four babies in the U.S. comes into the world by c-section, an all-time high, and rates keep rising. Now a growing number of women, like Berman, are choosing the option when it's not medically necessary.

Some doctors are in favor of giving women the choice, especially if they may be at particular risk of urinary or other complications. "While vaginal birth is a natural event, in essence what you're doing is rolling a bowling ball through the vagina," says urogynecologist Peter Sand, M.D., of Northwestern University's Feinberg School of Medicine, in Chicago. Many obstetricians, however, are reluctant to substitute surgery for vaginal birth.

As many as 22 percent of first-time, preplanned cesareans are performed for no other reason than patient choice. That's still a small number  -- less than 2 percent of all births. More often c-sections are done after labor starts, when something goes wrong. But the number of patient-choice cesareans in the U.S. shot up 20 percent, according to a recent study.

The choice is controversial and has sparked a public debate. Late last year, the American College of Obstetrics and Gynecology officially told its members that it's ethical to perform an elective cesarean.

But other groups, including the American College of Nurse-Midwives and Lamaze International, think it's a terrible idea. "Medically necessary cesareans are one thing, but to give blanket approval to elective cesareans, instead of working with a mother to have a vaginal birth, could be dangerous to the health of the mother and the baby," says Barbara Hotelling, a mom of five and the president of Lamaze International.

Why would a woman choose a c-section? Fear of labor pain is one reason; another is concern over the tearing that can occur in vaginal delivery. Still another is fear of incontinence later on due to wear and tear on the pelvic muscles. Some women mistakenly believe that a c-section will better preserve their pre-baby figure (it's pregnancy, not giving birth, that'll stretch your waistline).

For other moms-to-be, it's all about the baby: Maybe they know someone who's lost a child, or had a child permanently injured, during a difficult vaginal birth.

Doctors remain deeply divided about how much choice to give women. "Most women who come in asking for a cesarean do so because they're petrified of childbirth," says ob-gyn Kimberly Gregory, M.D., of Cedars-Sinai Medical Center, in Los Angeles. "In the past, the attitude was that these patients needed better education or counseling, not cesareans. Perhaps we're getting away from that. But I'd still feel uncomfortable if I did a procedure that was not indicated medically."

One thing is clear: For such an emotional issue as how your next baby should arrive, you'll need to understand all the pros and cons  -- for the baby, and for you.

Health writer Jessica Snyder Sachs is a contributing editor to Parenting.

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