The debate over elective cesareans started publicly in the spring of 2000 when then-president of the American College of Obstetricians and Gynecologists (ACOG), Dr. W. Benson Harer Jr., argued for "maternal-choice cesarean" in an editorial printed in the association's journal. Doctors were forced to pick a side as more patients entered their offices with requests. From 1999 through 2002, the number of elective C-sections provided to women with no previous C-section rose almost 42 percent, accounting for more than 2 percent of more than 4 million deliveries. If more women start getting their way, that number could skyrocket. In an online survey at Newshe.com, a Web site put out by sexual health experts Drs. Laura and Jennifer Berman, when nearly 2,500 women were asked, "Would you opt for a C-section over a vaginal delivery if you had the choice?" 37 percent answered "Yes"; another 9 percent answered "Not sure."

With the recent surge in prenatal yoga classes, midwives and doulas, it may seem strange that some women are opting to medicalize their births. But if a woman can decide what kind of birth control she should use, whether to get an abortion and if she wants an epidural to ease labor pains, why shouldn't she have a say in how she delivers her baby, ask some doctors and women. Proponents point to evidence showing that when healthy women choose to have C-sections, the risks, benefits and costs are balanced between C-sections and vaginal delivery. They conclude that the choice should be the mother's. Critics -- doctors, midwives and women among them -- answer back that a C-section is major surgery with risk of complications, longer recovery and potential problems with future deliveries.

If it seems like a medical community divided, it is. It hasn't helped that ACOG, which represents more than 45,000 physicians, left the issue open to debate when, last October, its ethics committee issued an official opinion on elective C-sections. After more than a year of deliberation, the group concluded that it is ethical to provide an elective C-section if the doctor believes it is in the best interest of the woman and her fetus and if he has advised her of the risks involved. If the doctor believes a C-section would be detrimental to the health and welfare of the woman and her fetus, he is ethically obliged to refrain from performing the surgery. If the patient and doctor cannot agree on a method of delivery, he should refer the woman to another doctor. The ACOG cautioned that evidence to support the benefit of elective cesarean is still incomplete and that there are not yet extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women. In other words, the jury is still out.

Without conclusive evidence, where does this leave women who decide they want a C-section? They have little idea of how their wishes will be received by their physicians. Stories are sprinkled throughout Internet pregnancy message boards of women who have learned that they have a right to choose, but when they ask their doctors for C-sections, they are denied. It's no wonder: A recent Gallup survey of 301 female OB/GYNs showed that even women who take care of other women are sharply split. Thirty-six percent said they would not perform a C-section if a woman asked for it, 32 percent said they would, and 28 percent said it would depend on the woman's circumstances.

"I had to actually leave my OB in my last trimester to find someone who would do [the surgery], says "Millie," a contributor to the pregnancytoday.com message boards. "The entire practice I was in -- all 8 doctors -- refused to do an elective c/s for me and I would have been forced into a vaginal delivery if I had stayed there. It really does suck to be faced with no choice in how you give birth."

Risks of C-section surgery include excessive blood loss, infection, anesthesia complications, bowel blockages, and uterine adhesions that could lead to dangers in future deliveries. "C-sections are incredibly safe, but bad things can happen during medical procedures," says Dr. Jerome Yankowitz, director of the division of maternal and fetal medicine at University of Iowa College of Medicine, who is against elective C-sections unless a patient has been thoroughly counseled. "It can be unnecessary surgery analogous to liposuction. Most people have no complications, but then there are a few who do. Afterwards people think, 'Why did they do that? They weren't that heavy!'" Yankowitz says he knows of many cases of bladder damage in the mother, bad wound infections and bowel injury as a result of C-sections. Many doctors advise against elective C-section if a woman plans on having more than two children since subsequent surgeries become riskier. "Our concern is when C-sections are done a second, or third, or fourth time, you're working on a scarred area," says Marion McCartney, a certified nurse-midwife and director of professional services at the American College of Nurse-Midwives. Her organization issued a statement last fall against elective C-sections, stating that "purported benefits of cesarean section on demand are unproven and the known risks place the woman's life and reproductive future on the line."

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