Cesarean birth by request

Q: My partner and I are talking about starting a family, and I’ve been exploring an elective c-section. What are the pros and cons?

A: Cesarean sections on request are sometimes called elective c-sections. But the medical term “elective cesarean” can mean any c-section done before labor begins, whether or not the procedure is done for medical reasons.

Some women may prefer to have a cesarean section instead of a vaginal birth, even without medical need. It may be appealing for both the woman and the healthcare provider to consider cesarean because it helps them plan their schedules. Some women ask for c-section because they are worried about the pain of vaginal delivery.

We do not have enough research to fully compare the risks and benefits of c-section by request with vaginal delivery. Because of this, the decision to have a c-section by request must be based on the individual needs of the woman and her baby.

Concern about pain is usually not a good reason to request c-section. Safe and effective pain management methods are available to help women cope with vaginal delivery. Some of these methods use drugs; others are drug-free. You can also get more information from a previous “Ask the Expert” column that includes a comprehensive overview of labor and delivery pain management techniques.

With any cesarean, it's important that the surgery be done at 39 completed weeks of pregnancy or later, unless there's a medical reason for delivering earlier. C-sections may contribute to the growing number of babies who are born “late preterm,” between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term.

A baby's lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with:

• Breathing
• Feeding
• Maintaining his or her temperature
• Jaundice

It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby's health. Keep this in mind if you are considering elective c-section.

When a woman is carrying just one baby, c-section by request should be performed only after 39 weeks of pregnancy. The healthcare provider may also need to check the baby's lungs to be sure they are mature.  

If you are planning to have several children, cesarean section by request is not recommended. This is because the risk of placenta previa rises with each cesarean birth.

If you are considering a c-section by request, talk to your healthcare provider and be sure you fully understand the risks and benefits. These questions may be useful when you speak to your provider.  

• What problems can a c-section cause for me and my baby?
• Will I need to have a c-section in future pregnancies?