No matter how you do it, there's one thing for sure, child birth is not easy. But for some women, the idea of pushing out a baby "naturally" seems less appealing then undering an "Elective Cesarean Section." Elective c-sections in the United States are gaining popularity. While there is still a lack of good data comparing elective c-sections to vaginal deliveries, currrently elective c-sections make up 2.5% of all births.

"No matter what, fear of pain in labor is not a good reason to choose a c-section," says Dr. Rebecca Nelken, a board-certified OB/GYN with fellowship training in urogynecology and female pelvic surgery. She added, "there is no difference in rates of postpartum pain, postpartum depression or maternal mortality."  So how do you decide if you should do it "au naturel" or if you should plan for an elective c-section? Dr. Nelken weighs in:

Elective C-Section PROS:

1. Protecting the Pelvic Floor
A vaginal delivery can be very traumatic to the muscles and nerves of the pelvic floor.  This trauma can lead to urinary or anal incontinence, and to a feeling of “looseness” of the vagina which may decreae sexual enjoyment for a woman and her partner.  A c-section before the onset of labor can protect the pelvic floor from this trauma.  It is important to be aware that a scheduled c-section is not guaranteed to protect against these symptoms.   Pregnancy itself does increase the risk of urinary incontinence.   It is also important for women to realize that there are good treatment options available for these symptoms and not to be uncomfortable discussing them with their doctors.

2.   No Risk of Emergency C-Section.
Emergency surgery always carries more risks than one which is planned and carried out in a controlled environment.  Although rare, there are always situations that could come up during the course of labor and delivery that would require an emergency c-section.  For example, if there are signs that the fetus is stressed, or not getting enough oxygen, an emergency c-section would be indicated.  Emergency c-section has a much higher risk of bleeding, damage to bladder or bowel, and other surgical complications than a planned c-section.  And the risk of cuting the baby during an emergency c-section is far greater than during a planned c-section.  It is impossible to know which planned vaginal deliveries will end up as emergency c-sections.

3.  Schedule
The convenience of having a planned date.  Family knows when to come.
Of course, you could still go into labor before your scheduled date.  When you get to the hospital your doctor will decide if you can still have a c-section as planned.  Most often, this will not be a problem.

4.  Avoid Failed Induction- worst of all worlds

Elective C-Section CONS:

1.  Increased Respiratory Risk for Newborns.

Elective c-section poses  an increased risk of respiratory problems for the newborn when performed before 39 completed weeks of gestation.  It is therefore important  not to perform elective c-section before 39 weeks.  If there is any uncertainty about the gestational age, then fetal lung maturity can be documented by amniocentesis.

2. Miss Out on Experience of Labor

... Believe it or not, something you might miss down the road.

3. Surgical scar. 

This is usually a horizontal scar, approximately 8-10cm, in the bikini line.

4. Longer Hospital Stay. 

Generally 4 nights after c-section vs 2 nights after vaginal delivery.

5. Complications in Future Pregnancies.

For women desiring large families, it is important to recognize that a C-section may lead to complications in future pregnancies.  The placenta may implant abnormally (called placenta accreta) which can lead to bleeding or even the need for hysterectomy.  It is also possible for the uterus to tear open (“rupture”) during future pregnancies or labor.  This can pose a risk to the fetus and mother due to bleeding, and requires emergency c-section.  There is also increased risk of bladder and bowel injury during future surgery due to increased scarring.  Although these risks are low, they increase with each subsequent c-section.  Elective c-section is therefore not recommended for women who plan to have several children.

Dr. Rebecca Nelken is  board-certified OB/GYN with fellowship training in urogynecology and female pelvic surgery.  She is an assistant clinical professor at the USC Keck School of Medicine and runs a private practice in Beverly Hills. She lives in Los Angeles with her husband and 1 year-old son.