Supporters of elective C-section acknowledge that there are risks and that a woman must be fully informed before making a choice, but that doesn't mean she shouldn't be able to choose. "There's less morbidity from C-section than there is from breast implants," says Brent W. Bost, M.D., a gynecologist in Beaumont, Texas, who has published research on elective C-sections. "We'll let women have a breast augmentation, plastic surgery and liposuction, which all have risks involved simply to look better; why will we not let them choose cesarean section?" The C-section risk data doesn't apply to elective C-sections, adds Bost, who performs about two dozen elective C-sections a year, since it comes from lumping together all C-sections. There is a difference between scheduled surgeries performed on healthy moms and those done on moms in less stable condition (for example, who've gone through hours of labor first or who have endometritis). "You've got to remember that elective C-section is a different animal," he says. "You have to compare apples to apples."

The fact that no large-scale studies have been done to compare apples to apples is what concerns nurse-midwife McCartney. "Before physicians jump in and say there are no problems with C-sections, I'd like to see a study comparing a healthy vaginal delivery to a healthy C-section," she says. "Most people think the study has been done already and it hasn't. Women think they're having an opportunity to make a choice, but what they're really getting is their provider's opinion."

Donna McDonald, a 31-year-old obstetrical nurse in Lexington, Mass., says she felt like she had all of the information she needed when she decided to schedule a C-section for her first baby last year. As a nurse, she had seen postpartum women with urinary incontinence, hemorrhoids and protruding uteruses from pushing, rectal tears, and episiotomies that had been sewn too tight. But what influenced her the most was witnessing her sister's traumatic labor and delivery, which included three hours of pushing and an episiotomy. "After I saw what she went through, I said my experience has to be very different," she says.

Choosing a C-section gave McDonald, a self-described "control freak," a sense of, well, control over the delivery. "I was concerned about birth trauma and wanted to avoid forcing my baby out," she says. "I felt the safest thing for my baby was a C-section where my doctor, who I completely trust, could be in control." The surgery went smoothly. Even the recovery, which so many people had warned her would be painful, was easier than she expected. "People told me I was crazy -- that the recovery was going to be so much harder -- that I would be laid up and need help, but I found it the opposite," she says. "When my husband and I got home I was a little bit sore and I couldn't do laundry and vacuum -- I pretty much stayed on the couch -- but I think that every postpartum woman needs relaxation time the first couple of weeks anyway."

Not all women look back on their scheduled C-sections so fondly. Many women who are forced into a C-section for medical reasons have found the recovery so painful that they question why a woman would choose to have the surgery. Stephanie Higgins, 24, had planned to have a drug-free natural delivery, but when her baby was three weeks late and estimated to be over 11 pounds, her doctor recommended that she schedule a C-section. "I feel like I missed out on an easier, more natural process," says Higgins, who couldn't get out of bed or pick up her newborn -- who, it turned out, only weighed in at 8 pounds, 15 ounces -- for days because of the pain from her cut stomach muscles. More distressing than the soreness was that she had difficulty nursing. "Since my body had not gone through labor, it took longer for my milk to come in," she says. "My baby was hungry and I had nothing for her for a good five days. It was a really difficult experience." While Higgins believes that women should have a choice how they deliver, she wishes she had been able to stick to her original birthing plan. "People say, 'I wouldn't want to go through the pain of childbirth,' but there's a lot of pain with a C-section -- and I had an uncomplicated one. The recovery was much more difficult than anyone I knew who had a vaginal delivery."

Proponents of elective C-section are more interested in talking about the mother's long-term health than the weeks after the baby is born. "The first few weeks after you have the baby is a lot different than the rest of your life," says Bost. Studies have associated vaginal delivery with higher risk of lasting consequences, including pelvic organ prolapse and urinary or fecal incontinence. "In a vaginal delivery, you stress the vagina out of proportion and then expect the muscles to come back and respond, but they may not," says Bost. "Some of us are beginning to suspect that vaginal delivery may also damage the walls of the vagina and decrease vaginal lubrication for intercourse and may also damage the nerves in the vagina that make arousal for women more pleasurable."

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