Is elective Cesarean section as safe as vaginal birth?

Our experts face off. Chime in with your own comments.

Yes, says Mary D'Alton, M.D., chairwoman of obstetrics and gynecology at Columbia University College of Physicians and Surgeons and of a government panel studying C-section on maternal request.

A C-section on maternal request is perfectly reasonable because many women who plan an unassisted vaginal delivery don't end up having one. Instead, they may have an emergency C-section, which increases the risk of infection, hemorrhage, complications from anesthesia and potential neurological problems for the infant. Another possibility is a vaginal birth with vacuum or forceps, which increases the likelihood of incontinence in the mother and trauma to the infant. If a woman plans to have three children at most and schedules the procedure at a gestational age of 39 weeks or later, an elective C-section could be a good option. While each additional scar on the uterus increases the chance of placental problems in future pregnancies, this is likely only an issue for women who want large families. I don't believe there is such thing as an "ideal" C-section rate; the ideal is to optimize the health of the mother and baby.

No, says Deanne Williams, C.N.M., executive director of the American College of Nurse-Midwives.

The majority of the time, a vaginal birth guided by proven "best practices" is safest and puts the needs of the healthy mother and baby first. These practices include no induction of labor, no routine rupturing of the bag of waters, support from a caring individual (especially a doula), mother-guided pushing in an upright or side-lying position, no routine epidurals or episiotomies, cautious use of forceps and regular pelvic-floor-muscle exercises before and after birth. A C-section is major abdominal surgery and places the woman at risk for lifelong complications. In future pregnancies, it puts her and her baby in danger from a ruptured uterus, hemorrhage and/or emergency hysterectomy. Even if she has no more children, internal scarring can make future reproductive or pelvic surgeries more difficult. If increasing numbers of women have unnecessary Cesarean deliveries, tragedy awaits the woman who needs an emergency C-section but must wait because all the operating rooms are full.