The National Health Service in the UK is considering giving women the right to choose a c-section, even when there is no medical need. That seems appropriate to me.
My reasoning goes like this. Yes, caesarians are risky, as all abdominal surgery is risky. However, mere risk alone is not enough to disallow particular activities. If it was, then none of us would ever be allowed to get into a car. Even high degrees of risk are not enough to rule out activities, such as studying volcanoes (volcanologists, especially those who study erupting volcanoes, have a very high death rate).
You might argue that caesarians can cause harm to a woman, but again, choosing an activity that causes harm to yourself is permissible. As it turns out, delivering babies vaginally can cause harm to women too, as women who have spent years and years doing Kegel exercises will tell you.
Perhaps we might worry about harm to the baby, but that only comes into play if we ascribe moral standing to the baby, and treat women merely as receptacles of precious objects. It does seem to be the case that babies are at higher risk of complications if they are delivered through a c-section, but in order to use that as a reason for refusing c-sections, we would have to say that the woman’s role in pregnancy and childbirth must be to be the best possible bearer of babies. That is, she is not important, and only the baby is important. If a woman says that she wants the best outcome for the baby, then it would be appropriate to take the risks to the baby into account when determining whether or not to have a caesarian, but only in the sense that in order to achieve the outcome she wants, that is, factors militating against that outcome must be considered.
We might be concerned about whether a c-section is medically necessary, with the underlying assumption that no medical procedure should be undertaken unless it is medically necessary. But if that’s the case, then there goes the entire plastic surgery industry, including plastic surgery or reconstructive surgery. Of course, we can defend plastic and reconstructive surgery on the grounds of psychological need, but in that case, the psychological needs of women preparing for childbirth need to be considered too, and those psychological needs may well be met by planned c-sections.
Following on from that, perhaps women choose c-sections because they are concerned about the process of labouring and delivering a baby. If that’s the case, then the answer is to provide more support for women who are preparing for childbirth, perhaps in the form of counselling and education, not just to prohibit one option for giving birth.
On the financial side, if planned c-sections are more expensive than other forms of childbirth, then given that the National Health Service in the UK is funded by taxpayers, then we might have some concerns about cost, both for the caesarian itself, and for the on-going care of mothers babies. However, it seems that allowing women to choose a c-section would just formalise existing practice, whereby women who want a c-section can already arrange to have one. Formalising the practice might well be preferable, because it would at least reduce the capriciousness of the health system, whereby women in one hospital might be able to access c-sections, but women in another might not, just because of differences in attitude.
In general, we tend to think that if someone has considered all the relevant factors, and chosen to engage in a particular activity (such as going bushwalking by themselves in the middle of winter), then that is their business. We might deplore their choice, but we don’t stop them from doing it. And if they get into trouble, we pile in resources to help them. I think that the same approach must be taken with respect to childbirth. Setting aside the matter of cost, if a woman wants to have a c-section, and she has considered all the issues, then that is her business. In fact, even if she hasn’t considered every last detail, we should still not put barriers in the way. To do otherwise is to treat women as though they were children, dismissing their fears and concerns, and telling them that they just don’t understand and that really, they had better just let the grown-up doctors and nurses and midwives make the decisions for them.
Update: Art and my Life (in comments) linked to a 2006 article by University of Orgao bioethics lecturer Claire Gallop looking at exactly the same issue: Women’s right to choose Caesarean.