Topic Overview

In the past 40 years, the rate of cesarean (C-section) deliveries has jumped from about 1 out of 20 births to about 1 out of 3 births.^{footnote 1} This trend has caused experts to worry that C-sections are being done more often than needed.

Because of the risks of C-section, the American College of Obstetricians and Gynecologists recommends that planned C-sections generally be done only for medical reasons.

But some women and their partners have personal reasons for wanting to avoid labor and a vaginal birth. When a woman requests to have a C-section even though she has never had one before and there is no medical need for it, this is called an elective primary C-section.

If you’re thinking of having an elective primary C-section, it’s important to weigh what you want against the risks. You may want to talk to your doctor about reasons for and against a planned C-section.

What is a C-section?

A C-section is the delivery of a baby through a cut (incision) in the mother’s belly and uterus.

Many C-sections are unplanned. They are done because of problems that occur before or during labor. These problems might include:

• Labor that slows or stops.
• High blood pressure or other problems for the mother.
• Signs of distress in the baby. These signs may include a very fast or slow heart rate.

Why would a C-section be planned for personal reasons?

Some women have personal reasons for wanting a C-section.

• They may worry that their pain won’t be controlled.
• They may be concerned that labor will cause pelvic floor problems, such as incontinence.
• They may worry about vaginal tearing during delivery.
• They want to be sure that their own doctor delivers the baby, rather than an on-call doctor.
• They may feel shy or embarrassed about people seeing them giving birth.

It’s important to talk openly and honestly with your doctor about your wishes and concerns.

In some cases, your doctor may be able to help you feel more confident about vaginal birth. For example, your doctor could discuss the many ways to control pain during labor. Or he or she may explain how often pelvic floor problems happen and what can be done to prevent them. These discussions may change your mind about planning a C-section.

If a C-section is planned for personal reasons, experts recommend that it should be done at 39 weeks or later in the pregnancy.

What are the risks of a C-section?

Although most mothers and babies do well after C-section, it is major surgery. It has more risks than a vaginal delivery. The risks of C-section include:

• Infection of the incision or the uterus.
• Heavy blood loss.
• Injury to the mother or baby.
• Problems from the anesthesia. These may include nausea, vomiting, and a bad headache.
• Breathing problems in the baby if he or she was delivered before the due date.
• A longer hospital stay than after a vaginal birth.
• Risks for a future pregnancy. A woman who has had a C-section has a small risk of the scar tearing open during labor if she has a vaginal birth. She also has a slightly higher risk of a problem with the placenta, such as placenta previa.