I intend to have a c-section because I don't want to risk an episiotomy, future incontinence, and brain damage to the baby. The main risk to the child, respiratory problems, only lasts for about a year (far better than the permanent brain damage vaginal birth can cause). I also believe the respiratory problems can be avoided if the child is properly suctioned after birth.

Pain management doesn't have anything to do with my decision. I'm sure there will be some posts saying choosing an elective c-section is selfish. I disagree, for the reasons stated above. Also, I'd like to point out that trying to avoid a 4th degree tear to your genitals and permanent incontinence seems like self-protection, not selfishness.

I have four children: three births were "natural," one C-section, two with midwives and two with episiotomies, one of which severed sphincter muscles. I didn't just have urinary incontinence. I had fecal incontinence. And I had miserable surgery to repair those muscles, repair a rectocele (muscle wall between vagina and rectum) and a total rebuilld of the perineum, which was basically nonexistent.

Would I have chosen a C-section each time had I known this could happen? You bet.

All of the women in my biological family have had vaginal delivery. I have asked them about the tearing and any problems they had after the baby was born, in my particular family none of my female relatives had any adverse effects to delivering a baby vaginally. My mom also said that frequent sex late term made her believe that this was the reason she did not tear for her first delievery. She refused pain medication and the episiotomy and birthed me, her first child in less than 10 hours, my younger brothers basically popped out in less than 5. So since the doctors can't agree and I have read the pro's and con's for each type of birth, knowing my family history and after watching my husband's reaction to his hernia surgery, I will avoid a c-section at all costs. Sure, while I know that a hernia is differnt from a c-section, it's still an incision in the same location cutting through muscle, then stiching you back up.

So the only thing I would do if you are a person debating the choice, talk to your female relatives and ask them what their births were like, many emergency c-sections, plan for one of your own. No problems giving birth, perhaps vaginal would be better.

Elective c-sections are a forgone conclusion and sure, women should be allowed to make that choice since it is available. But for doctors to blame the boom in c-sections on women who, like previous poster Fontaine, choose them out of fear or as others do out of convenience, is dishonest.

Doctors push women down the path to c-sections, whether women are aware of it or not. Doctors freak out when a woman is pregnant beyond 40 weeks, even though that 40 weeks was (gasp!) never a medically determined number -- it's just tradition. Furthermore, doctors don't send panicky first-time parents home after they mistakenly show up at the hospital in false labor or the very, very early stages of it. Instead, they push them down the path of inductions, which end in a high rate of c-sections.

Most doctors refuse to deliver breech babies vaginally, requiring mothers to schedule surgery a week or two BEFORE their due date, refusing to allow her to even go into labor. Breech birth can be safe, many midwives will handle them. But most doctors have never even seen a breech delivery, much less attended one. Also baffling are doctors who don't allow twins to be delivered vaginally. Most egregious, I believe, are the doctors and hospitals who are refusing to allow women to birth vaginally after a prior c-section (it has been proven safe, but the medical community won't acknowledge that).

Nurses, doctors and hospitals also can refuse to allow women to push the baby out in some position other than lying down flat on her back. For those fearing the ugly tears, stuck babies and permanent incontinence, this lying down position is frequently to blame -- not the vaginal birth itself. That and medicine's most questionable procedure, the episiotomy. "Purple pushing," where the fully-dilated mom is told to take a deep breath and push to a count of 10 to bring the baby down the birth canal, can result in a poorly positioned baby emerging too quickly and wrecking things on the way out too. It's safer and more effective to let the mother push when she feels like it or let the baby descend on its own. It requires patience, however.

All of this is backed up not just anecdotally (which is of little value) but also by studies and good statistical analysis. Start with Henci Goer's "A Thinking Woman's Guide to a Better Birth." But don't start with ACOG's findings. And don't rely on the pregnancy canon of "What to Expect When You're Expecting" or "The Girlfriend's Guide." These authors are unsympathetic at best, hostile at worst, to women wanting to give unmedicated vaginal deliveries a whirl and women who question their doctors.

So much of the media, Salon included, has focused on the birthing "choice" debate in terms of elective c-sections only and rely on OBs and their professional organizations to supply convincing data. But this "debate" neglects the real trend that with this new choice (c-sections), another choice is being taken away (the choice to birth vaginally under a variety of circumstances).

I think it's a hidden crisis and one that feminists -- not just pregnant women and midwives -- should focus attention on. Not whether it's OK to have a c-section -- it IS OK -- but whether it's OK to NOT have one too.

I am a nurse-midwife, and I've seen complications in all types of deliveries--and would like to note that the vast majority of deliveries by any method go perfectly well. So I don't want anyone to be overly frightened of either a vaginal birth or a cesarean birth.

Still, I'm sure the NIH panel took this into account, and still came up with an equivocal result, but I wanted to offer more information for Broadsheet readers about what exactly the complications in future pregnancies are.

Cesarean section for any indication has been shown to increase the risk of stillbirth (pregnancy loss after 20 weeks) in future pregnancies, the risk of infertility (i.e., that there are no future pregnancies), and the risk of placenta previa in future pregnancies. In placenta previa, the placenta implants over the cervix; it precludes a vaginal delivery, which to someone predisposed toward an elective cesarean is no big deal, but it can also lead to life-threatening blood loss for both mom and baby, inadequate oxygen delivery to the baby, and preterm delivery (with its major attendant risks to the baby). In other words, the complications are not the sort to simply be relieved by another cesarean.

Again, the numbers are small, but significant. Most people who have a cesarean conceive just fine afterwards. We all have very different internal calculations of risk... i.e., does a small risk of a fourth-degree tear in this pregnancy scare you more or less than a small risk of a very serious problem in a future pregnancy?

Again, I'm sure the panel had a full overview, but I was surprised that the recommendation is only for women who want large families as opposed to women who would like even one subsequent child. And of course, women who are having their last child, if the first one was successfully delivered vaginally, usually have an easier time of it the second or third time, so they may be unlikely to choose a cesarean anyway. (Of course, anything can happen at any time; I'm speaking in the aggregate.) But it holds to the point that perhaps the best candidates for elective cesarean may be women who are having their first and only child, admittedly a more common choice nowadays. I'd be interested to know if that is previous poster Claire Fontaine's situation.

Also, having had a child (vaginally) I know the potency of personal stories and the cold distance of statistics regarding one's decisions and considerations of risks. But while the previous poster had a good point to consider your family history, I would suggest guarding against the personal stories of those to whom you are not related. They are psychologically very powerful--maybe too powerful?--but as far as your own body, very weak evidence for decision-making. I know that women need to use this forum to discuss their own experience, but I hope these individual testimonies can remain in perspective for others.