Without a medical indication, do not ask for a cesarean, and do not schedule surgery to pick a date

The World Health Organization’s position is that once a place’s cesarean rate passes 10%, there is no evidence that deaths of mothers and newborns keep falling. When a cesarean is needed, it must be done. Choosing a date or avoiding pain as the reason means taking on one more major abdominal operation.

Cost

No money spent. The hard part is standing up to what people at home say

Benefit

WHO statement in 2015: when the cesarean rate in a population rises to about 10%, maternal and newborn deaths fall. Above 10%, there is no evidence that mortality improves further. WHO also stresses that every effort should be made to provide cesareans to women who need them, not to hit a particular rate

Notes

When medicine truly requires it, a cesarean is life-saving — do it; do not tough it out. What to avoid is surgery when medicine does not require it, for example fear of pain, picking an auspicious time, or gaming the child’s school-entry age. A cesarean is a major abdominal operation. One pooled comparison of cesarean with vaginal birth found that after a cesarean, in a later pregnancy placenta previa OR 1.74, about 70% higher; placenta accreta OR 2.95, about 3 times; placental abruption OR 1.38; stillbirth OR 1.27. That directly affects whether you want a second child. On the other side, people who had a cesarean later have less urine leakage and pelvic organ prolapse. These all come from follow-up record studies; the authors say you cannot conclude from them that the cesarean caused the difference

Sources · 2

1. World Health Organization (2015). WHO Statement on Caesarean Section Rates（WHO/RHR/15.02）. who.int/publications/i/item/WHO-RHR-15.02
2. Keag OE, Norman JE, Stock SJ (2018). Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Medicine, 15(1), e1002494. doi.org/10.1371/journal.pmed.1002494