Moms-to-be used to look down on c-sections with disdain or fear, feeling they interfered in the natural process of childbirth. For their part, doctors were taught to avoid a c-section unless it was absolutely necessary. But times have changed — a lot: These days, some women are opting for a surgical delivery even when it isn’t medically a must.
Those in favor of elective c-sections (also known as cesareans) argue that women should have a say in how they give birth. Although c-sections pose more risks to mothers (such as post surgery bleeding or infection), they reduce birth-related risks to the baby and potential long-term side effects of vaginal deliveries, such as incontinence, for moms. "There is no evidence to refute the statement that the safest delivery method for a baby is by elective c-section at 39 to 40 weeks," says W. Benson Harer, Jr., M.D., former medical director for Riverside County Regional Medical Center, in Moreno Valley, California. "Cesarean delivery is also more protective of the pelvic organs, with less risk of problems for the mother in bowel and bladder control."
But not everyone agrees. According to Carl Weiner, M.D., professor of obstetrics, gynecology, and reproductive sciences at the University of Maryland in Baltimore, "those conclusions have been poorly studied and may well be wrong." What's more, the process of labor itself may be beneficial to babies. "It's not clear why, but babies born by c-section have an increased risk of breathing problems," he says.
Opponents also warn that a woman's desire to have a cesarean may be motivated by questionable factors, such as the convenience of scheduling the baby's birth or fear of labor. And they argue that more c-sections will drive up the costs of obstetrical care. But a study in the American Journal of Obstetrics and Gynecology finds that the costs are similar: A vaginal delivery in which oxytocin (such as Pitocin) was used to induce labor was about equal to an elective c-section in women having a first birth. The use of an epidural and oxytocin together, in fact, was more costly than an elective c-section.
What's not up for debate is that more women want to be heard in the delivery room. A study by Health Grades, Inc., a company that compiles health care quality ratings, found that patient-choice c-sections increased 27 percent from 2001 to 2003.
Beth Howard is a freelance writer.