Elective Cesarean Section

In recent years a number of high-profile celebrities have chosen to schedule a surgical delivery rather than wait for labor and vaginal birth. As a result, pregnancy blogs are buzzing with the pros and cons of elective cesarean delivery (C-section). But it’s not just the rich and famous choosing C-section.

The rate of C-section in the U.S. has jumped by 50 percent in the past 10 years. It’s now at an all-time high of 31 percent, meaning that about one out of three babies is born by C-section. One reason for this high rate appears to be a rise in the number of women with low-risk pregnancies having elective C-sections.

An elective C-section is one that is not considered necessary for medical reasons. It’s planned before labor begins.

If you’re pregnant, you may wonder if elective C-section is an option for you. Before you phone your doctor, though, it’s a good idea to find out more about this practice.

What’s the problem with elective C-section?

One concern about elective C-sections is that they are often done too early. When a baby is born, its lungs must make the switch from being fluid-filled to being able to take in air. Natural changes that occur just before birth and during labor help prepare the baby’s lungs to make this change. The closer the baby is to the time when birth would naturally occur, the more likely it is that the baby will be able to breathe normally after birth.

A normal pregnancy is usually 40 weeks from the first day of the last menstrual period in women who have regular 28 day cycles. Guidelines recommend that a doctor wait until a baby is 39 weeks before doing an elective C-section. This helps ensure that the baby’s lungs are mature. But it can be hard for a doctor to be certain of a baby’s gestational age. Delivering a baby before 39 weeks can raise the baby’s risk of problems after C-section.

Recent research has shown that about one out of three elective C-sections is done earlier than 39 weeks. Even babies delivered at 37 or 38 weeks, although technically full term, are at increased risk for:

Serious breathing problems that require a ventilator

Low blood sugar


Prolonged hospital stays, including time in intensive care

Are there risks for the mother?

C-section is major surgery. In a C-section, a doctor cuts through the abdomen and the uterus and lifts the baby out. Compared to women who have vaginal births, women who have C-sections are more likely to have:

Problems from the surgery, such as pain, infection and blood clots

Longer hospital stays

Less contact with their babies after birth

Long-term pain due to scarring

Future infertility

Serious problems with future pregnancies, such as ectopic pregnancy, placenta previa and placental abruption

The March of Dimes does not recommend elective C-section for women who plan to have more babies. They say the risk of dangerous placental problems increases with each future pregnancy.

When is a C-section needed?

A C-section may be needed if:

You are pregnant with two or more babies.

The baby is in trouble during labor.

The placenta is blocking the cervix or becomes separated from the uterus.

The labor is not progressing normally.

The baby is very large or in the wrong position for birth.

You have a serious medical condition such as high blood pressure.

You have an infection, such as HIV or genital herpes, that could be passed to the baby at birth.

You have had a previous C-section. (It may be possible to have a vaginal birth after a C-section.)

Why do women have elective C-sections?

A woman’s desire to have her own doctor deliver her baby may be a strong factor. To ensure this, she may feel she has to schedule her delivery. Some women dread the pain of labor or are afraid of complications from vaginal birth

The high rate of sexually transmitted infections in the U.S. may also be a factor. A woman may prefer to say her C-section was elective rather than reveal that it was done to protect her baby from an infection.

In some cases, a doctor may suggest an elective C-section, citing concerns for safety or convenience.

How can I decide if elective C-section is right for me?

Discuss the decision with your doctor. Your doctor can help you weigh the risks and benefits of C-section and vaginal birth. Birth is never risk-free, but unless there is a medical need for C-section, vaginal birth is usually the safest choice for both mothers and babies.

You may also want to think about the cost. C-section is more expensive than a normal vaginal birth. Some insurance companies will not pay for a C-section that is not needed for medical reasons.

If you do choose a C-section, ask your