Mothers-to-be used to view cesarean delivery with fear or disdain  -- it was interference in the natural process of childbirth. For their part, doctors were taught to avoid a c-section unless it was absolutely necessary. But these days, some patients are opting for a surgical delivery even when one isn't medically called for.

Proponents of so-called elective c-section or cesarean on demand argue that women should have a say in how they give birth. Although c-sections pose more risks to mothers (such as postsurgery 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, M.D., 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, 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 new 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 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 recent study by Health Grades, Inc., a company that compiles health care quality ratings, found that patient-choice c-sections increased 20 percent between 1999 and 2001.