I think many women are choosing c-sections to avoid urinary incontinence at a later age.
I wonder if some of the “new” concern has to do with advanced maternal age. With so many woman postponing childbirth, I’d expect more complication.
As you age, you don’t stretch like you used to. Muscles tear easier. A twenty two year old could bounce back from a c-section and have very small risk of a rupture with a VBAC, I wonder how much the risk increases if you are 38? I know that there is a lot of increased risk if the children are close together. (I’m not sure, but I think 27th Evil’s case is close enough that they’d have done a c)
On of my girlfriends gave birth at 40 for the first time. She wanted a non-medicated vaginal birth, for a number of reasons (mostly gestational diabetes), her OB recommended a c-section - I believe she actually had to switch OBs. She almost got what she wanted - there was some medication involved eventually. But she then was rushed into surgery and had her birth canal reconstucted while being given blood for blood loss. I’d never heard of this birth complication before, but apparently, her vagina shedded “like tissue paper” - a situation they figure was due to her age more than any other factor. (that should scare aurelian. Yep, people used to die in childbirth. Mostly due to infections post birth. But other complications. In fact they still do die in childbirth, just not often nowadays here in the US).
I also wonder how much spontaneous tearing increases with age? I didn’t have an episitomy (my OB believes that they just give the tear a place to start - like cutting the edge of a peice of material), but I certainly tore anyway. My cousin didn’t have one with her first, and tore so badly that her “marital relations” were non existant for over six months. With her subsquent children the OB did one - to give the tear a place to start - tearing into the anus is bad - and she didn’t tear any more.
The point I was trying to make (and it was my fault for being unclear) is that choosing a midwife or family practice doctor for one’s FIRST birth might increase one’s chances of avoiding that first c-section.
Just to make sure we’re on the same page here, this is certainly not what I am advocating.
I don’t know how “many” you’re talking about, but I am not sure this is a great strategy. One of the risks of a c-section is damage to one’s bladder and ureters. My bladder tore.
Well, if they do choose this, I hope they are choosing it after looking at the evidence for themselves and making an informed choice. I hope, more specifically, that they’re not following some off-the-cuff comment their OB makes. I mean, and I’ve said this before and it always apalls people when they hear it, my original OB offered me an elective cesarean so sex would be better for my husband and I wouldn’t get all stretched out down there! Boy, that was real medical!
I did have a certain amount of urinary incontinence after my VBA2C, however it resolved within 2 months as muscle tone returned (I had not had any after my 2 cesareans, or in fact during any of my pregnancies). I must assume it returned everywhere: my husband has not complained about me being all stretched out. 
However, I did get to enjoy a lot of performance anxiety and insecurity about my body being changed for the worse, courtesy that SOB’s comment, after my daughter was born. Boy, his legacy just goes on and on. :mad:
Anecdotally, I had a 4mm tear with my daughter at age 42, no tearing (or episiotomy, as I had home waterbirths with midwives) with my son at age 43. Perhaps I have a delightfully young and springy vagina. The issue, I think, cannot be put down to simple and universal factors such as age or weight or any one-size-fits-all matter, as we’ll all different as are our bodies.