Can You Request a C-Section?

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Caesarean section is the most common surgery in the world. According to the Harvard School of Public Health, about one in 20 babies were born by C-section in the U.S. in the 1970s. Today the number is one in three, an increase of 500 percent.

There are many reasons why more women are having C-sections. One reason is the hospital you choose. Some hospitals have C-section rates below 20 percent and others have C-section rates over 50 percent. Another reason that may surprise you, is what the American College of Obstetricians and Gynecologists (ACOG) calls “C-section delivery on maternal request.” This is also called an elective C-section.

In the U.S. elective C-sections are still rare, less than three percent of all deliveries, but they may be increasing. In China, about one in four pregnant women have elective C-sections. Elective C-sections are not done for any medical reason. There are basically two reasons why women request an elective C-section. One is convenience. The other is fear of labor and vaginal delivery, which ACOG says is the most common reason.

Risks and Benefits of Elective C-Section Versus Planned Vaginal Delivery

According to ACOG, a review of studies that compared the risks and benefits of elective C-section to planned vaginal delivery did not provide enough information to recommend one over the other. Based on over 1,000 studies, these were the conclusions:  

  • The risk of serious bleeding was less in elective C-section than vaginal delivery.
  • Hospital stay was longer after elective-C section than vaginal delivery.
  • Although short-term risks are about the same for both types of delivery, long-term risks are higher for elective C-section.
  • If a woman plans to have more than one pregnancy, she should be advised that risks of complications go up with each additional C-section.
  • Babies born by C-section have a higher risk of breathing problems than babies born by vaginal delivery.
  • Premature delivery increases risks to a baby, so elective C-section should not be done before 39 weeks of pregnancy.

Although it’s possible to have a vaginal delivery after a C-section, odds are strongly against it. According to the Harvard School of Public Health, about 90 percent of women who have one C-section will need a C-section for any future pregnancies. These are the complications that are known to increase with each additional C-section:

  • Placenta previa, an abnormal position of the placenta that can lead to severe bleeding
  • Placenta accreta, which is a placenta that grows too deeply into the womb and may cause severe bleeding)
  • Gravid hysterectomy, which is removal of the uterus due to pregnancy complications

Other Reasons to Avoid C-Section

A few recent studies might sway your decision away from elective C-section:

A recent study from Canada found that women who had a planned C-section were about twice as likely not to start breastfeeding, than women who had vaginal birth. If these women did start, they were about 60 percent more likely to stop before 12 weeks.

According to recent review in the British journal Lancet, there is growing evidence that babies born by C-section have different hormonal, physical, and bacterial exposure than babies born vaginally. This may cause changes in a baby’s immune system. Studies suggest these changes may result is an increased risk for allergies, skin rash, asthma, and childhood obesity.

Bottom Line on Elective C-Section

ACOG concludes that elective C-section can be an option for some women. These are their current guidelines:

  • If a woman requests a C-section due to fear of labor and vaginal delivery, she should be told about her options for pain control and emotional support, including prenatal education classes.
  • Vaginal delivery should be recommended for an uncomplicated, low risk pregnancy.
  • Women should be advised that electing C-section now will make it highly likely a C-section will be needed for any future pregnancy, and each C-section increases complication risks.
  • If a woman still wants an elective C-section, factors should be considered that weigh in favor of C-section over vaginal delivery such as older age, being overweight, having significant fear and anxiety, and not wanting to have future pregnancies.
  • Finally, if a woman and her doctor agree on elective C-section, the procedure should not be done before 39 weeks.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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