Pros and Cons: Elective C-Section

Women opting for elective cesarean sections must balance risks against benefits.

Jan. 7, 2009 — -- In the last decade, the number of cesarean sections — or C-sections — performed in America has nearly doubled. In fact, in the country today, approximately 30 percent of all babies born in the United States are delivered by C-section.

A study published in the New England Journal of Medicine finds that more than a third of C-section are performed too early -- before 39 weeks -- putting newborns at greater risk for a variety of health problems.

While many of these C-sections are medically indicated, the study found that more than half are done on an elective basis. 36 percent of women having elective C-sections scheduled their delivery before the recommended 39 weeks, making babies more likely to visit the intensive care unit, have infections and develop respiratory distress.

Researchers say that elective C-sections are safest for the baby when done between 39 to 41 weeks of gestation and that women considering elective C-sections should wait until that point for the safest delivery.

Though surgical know-how has grown with the increased use of C-sections, doctors say it is still important for women to weigh all possible risks against possible benefits when opting for the procedure.

The Web site provides a physician panel-reviewed list of pros and cons of both vaginal birth and C-sections:

Vaginal Birth

Pros: Less risk of maternal hemorrhage, infection, blood clots, damage to internal organs

Less risk of baby having specific respiratory problems (TTN and persistent pulmonary hypertension)

Baby potentially less likely to develop allergies, asthma, or lactose intolerance

Shorter hospital stay (one to three days) and quicker physical recuperation

In later pregnancies, labor may be shorter and offer quicker delivery

Mother may breast-feed more effectively

Mother much less likely to require c-section in subsequent pregnancies

Cons: Fear of childbirth may cause maternal distress

Risk of oxygen deprivation to baby due to cord compression or problems during delivery

Risk of perineum tearing (from first degree slight tear to fourth degree extensive tearing into rectum)

Risk of additional trauma to baby when passing through birth canal, or from forceps or vacuum extraction

Labor, with the need for frequent vaginal examinations, can be traumatic for some women, especially those who have been sexually abused.

Risk of unforeseen complications during labor such as hemorrhaging

Risk of pelvic organ prolapse after delivery (uterus, bladder, or bowel protrudes into the vaginal canal, causing discomfort and possible incontinence)

Rare: Increased risk of postpartum sexual dysfunction, particularly pain during intercourse, for first three months after delivery if the mother had an episiotomy or experienced a tear.

Elective Cesarean

Pros: Can be more convenient for a woman and reduce her stress about anticipation of labor

Possible decreased risk of incontinence

Possible decreased risk of sexual dysfunction for first three months postpartum

Reduced risk of oxygen deprivation to baby during delivery

Reduced risk of birth trauma to baby sometimes sustained from passing through birth canal, or from forceps or vacuum extraction

Women feel a greater sense of control knowing when their baby will be born, and can plan for family help, a baby nurse, furniture delivery, work leave, and so forth.

Cons: Possible pre-term delivery if due date calculation is inaccurate

Rare: Possible infant injury when the doctor makes the uterine incision

Risk of damage to the mother's bowels and/or bladder

Increased maternal blood loss and risk of needing a transfusion

Risk of complications from anesthesia (pneumonia, allergic reactions, low blood pressure)

Slightly higher mortality rate for the mother

Twice the risk of infant mortality

Higher risk of infection and blood clots for the mother

Decreased bowel function after surgery

Risk of lower Apgar scores for the baby

Longer hospital stay (three to five days) and longer recovery period

Possible complications with breast-feeding

Possible increased likelihood of clinical postpartum depression

Potentially more expensive — your insurance may not cover an elective cesarean

Internal scar tissue may cause problems in future c-sections

In later pregnancies, risks to the mother increase, whether she delivers by VBAC or cesarean

For more information, visit