Risk benefit ratio for natural birth and elective cesarean section

The benefit of a cesarean section with absolute indications for mother and child is undisputed so that a natural birth is usually not even considered. Since an elective section as an intervention has become very safe the list of indications has considerably increased and the majority of the rise in cesarean sections is due to the elective category. This requires a careful evaluation of the risk benefit ratio of a natural birth compared to delivery by an elective cesarean section. Based on the incidence of rare but severe maternal complications preference should be given to natural birth. Criteria such as protection of the pelvic floor are not evidence-based to justify a prophylactic birth by cesarean section. The positive effect of the stress of vaginal birth, which are predominantly to the benefit of the child, are increasingly taken into consideration debates about the optimal mode of delivery at term. The importance for adaptation of the newborn is undisputed whereas longterm effects, such as protection against allergies and asthma in postnatal life are not evidence-based. The complexity of the decision between the two modes of delivery requires objective and expert counselling to allow the couple to give informed consent. The basic attitude of the couple towards the event of birth must be taken into account. When no medical reasons can be given as indications for the cesarean section, ethical conflicts between mother and child and potential forensic consequences must be considered.