Minimize the risk of breathing difficulties

For your baby, the biggest concern with an elective cesarean is that their lungs may not have fully developed prior to delivery, leading to respiratory distress and possibly NICU treatment when they're born. When studies such as last December's Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study from Denmark warn of increased risks with elective cesarean delivery compared with vaginal delivery, cesarean choice is labeled by many medical professionals, journalists and women as a selfish and dangerous road to travel.

NOT SO...
In fact, if you follow the advice given by numerous medical professionals and national health institutions (listed with live links below), and wait until your baby's gestational age has reached 39 weeks, the risk of respiratory is significantly reduced. For example, the Danish study above found that the risk of serious respiratory morbidity was 0.1% for PVD and 0.2% for elective cesarean at 39 weeks - a negligible difference, and you can read a full explanation of this in my March 2008 British Medical Journal Rapid Response: Further evidence of reduced infant morbidity with cesarean delivery on maternal request at 39 weeks EGA.

REMEMBER...
Even at 39 weeks, cesarean delivery is not 100% risk-free (but then no birth choice is), but next time you read a highly publicized media report on research into adverse respiratory outcomes with elective cesareans, read the small print. Does the study analyze a large pool of babies born as early as 36 or 37 weeks (or even earlier)? If so, it's likely that many of those babies were delivered early due to medical reasons or the onset of early labor. If you choose cesarean delivery with no medical indication, your doctor will advise you to wait until lung maturity is established before they begin surgery.

RELATED RESEARCH

*2008 Neonatal Mortality and Morbidity Rates in Late Preterm Births Compared With Births at Term, McIntire D et Leveno K
Late preterm births are common and associated with significantly increased neonatal mortality and morbidity compared with births at 39 weeks. Preterm labor was the most common cause (45%) for late preterm births.
*2008 Elective Cesarean Delivery, Neonatal Intensive Care Unit Admission, and Neonatal Respiratory Distress, Yee et al
Elective cesarean delivery beyond 270 days of gestational age (384/7 weeks) significantly reduced the risk for NICU admission or respiratory distress.
*2008 Is 38 weeks late enough for elective cesarean delivery? Matsuo et al
The incidence of IRDS following elective cesarean delivery at term was found to range between 7.4% and 8.4% for 37 weeks, 4.2% and 4.4% for 38 weeks, and 1.2% and 1.8% for 39 weeks in previous studies, but ultrasound was not routinely used for the dating in these studies. In our study, scheduling elective cesarean delivery at 38 weeks was not found to be associated with an increased risk of severe neonatal complications. This is most likely due to routine ultrasound dating early in the first trimester of pregnancy.
*2007 Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study, Hansen et al
Our results also suggest that a significant reduction in neonatal respiratory morbidity may be obtained if elective caesarean section is postponed to 39 weeks' gestation.
*2007 Respiratory stress syndrome (RDS) in newborn in 35-38 gestational weeks, delivered by cesarean section, Ginekol A
*2007 Timing of planned repeated caesarean section: An enigma, Abouzeid et al
The percentage of consultants who preferred to do caesarean section at 39 weeks or more gestational age in patients with previous one, two, three or more and a classical caesarean section were 93.6%, 87.3%, 71.3% and 35.9%, respectively.
*2006 NIH statement, USA
The severity of breathing difficulties can be reduced by waiting at least 39 weeks before having a cesarean.
*2005 Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial, Stutchfield et al
Antenatal betamethasone and delaying delivery until 39 weeks both reduce admissions to special care baby units with respiratory distress after elective caesarean section at term.
*2004 NICE guideline, UK
Timing of planned CS: CS should be carried out after 39 weeks’ gestation to decrease the risk of respiratory morbidity.
*2004 Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery, Zanardo et al
A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy... After 39+0 wk, there was no significant difference in RDS (respiratory distress syndrome) risk [between elective caesarean delivery and vaginal delivery].
*2004 An audit of neonatal respiratory morbidity following elective caesarean section at term, Nicoll et al
A reduction in neonatal respiratory morbidity can be achieved by delaying elective caesarean section until 39 weeks gestation.
*2003 Neonatal clinical outcome after electivecesarean section before the onset of labor at the 37th and 38thweek of gestation, Yamazaki H et al, Pediatrics International
The incidence of breathing difficulty was significantly higher in the infant group born in the first half of the 37th week of gestation than in the latter group... An elective cesarean before the onset of labor early in the 37th week of gestation should not be routinely undertaken.
*2001 Life-table analysis of the risk of perinatal death at term and post term in singleton pregnancies, Smith GC
Delivery at 38 weeks' gestation was associated with the lowest risk of perinatal death.
*1999 Delaying planned caesarean delivery until 39 completed weeks of gestation: the experience of a district general hospital, Ojidu JI
It has become clear that delaying elective cesarean delivery until 39 completed weeks of pregnancy decreases neonatal respiratory morbidity...
*1998 Elective cesarean section is preferred after the completion of a minimum of 38 weeks of pregnancy, Graziosi et al
Most of neonatal respiratory morbidity could have been avoided by postponement of the at-term elective caesarean section until a certain gestational age of at least 38 complete weeks. An elective caesarean section should not be performed before that period.
*1995 Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section, Morrison et al
A significant reduction in neonatal respiratory morbidity would be obtained if elective caesarean section was performed in the week 39+0 to 39+6 of pregnancy.