Experts say guidelines out of step with trend toward elective C-section. (Pelvic Floor Protection at Issue).

ST. LOUIS -- Practice guidelines discouraging scheduled elective cesarean section are out of step with increasingly liberal attitudes toward the procedure on the part of rank-and-file ob.gyns., panelists asserted at the 12th International Pelvic Reconstructive and Vaginal Surgery Conference.

Many ob.gyns. are persuaded that elective C-section protects a woman's pelvic floor and thereby prevents future problems with incontinence and prolapse. And they believe that large numbers of patients would opt for the procedure if fully informed about the risks and benefits of cesarean section and vaginal delivery.

"I'm all in favor of the C-section. ... I personally think a woman has a right to decide how she wants her baby delivered. And I feel like more and more of my colleagues are saying the same thing," said Dr. Sebastian Faro, professor of ob.gyn. at the University of Texas, Houston.

To underscore the point, he asked for a show of hands as to how many members of the large audience would provide a cesarean section to a woman who wanted an elective one. A majority of hands shot up.

"Women can choose to have a breast implant, so why can't they choose to have a C-section if they don't want to go through the process of labor? It's their body," argued Dr. Octacilio Figueiredo Netto, an ob.gyn. at Londrina (Brazil) State University.

He cited the Brazilian experience as evidence suggesting C-section prevents pelvic floor injury. Brazil has a sharply demarcated two-tiered health care system.

The vast majority of private-practice patients routinely opt for cesarean section; in some obstetricians' practices, the rate is 90%. In public-sector patients, however, cesarean ...