Reducing cesarean rates at what cost to women?

Yesterday, I was browsing the website 'mybirth.tv' to see what they had to say about elective cesareans. On my first search, the video clip that came up was this one: elective caesarean

The woman being interviewed had had two vaginal deliveries and she had torn during both of them (the second birth making the first tear even worse). Fearful that her third pregnancy could result in even further damage, she requests an elective cesarean.

The Royal Sussex County Hospital however, is taking measures to reduce its cesarean section rate, and although in the end, the video shows that this woman does have a cesarean, just listen to what the hospital has to say to her during her maternal request consultation.

Vaginal reconstructive surgery versus planned cesarean surgery
It is suggested that she may want to consider operative perineal repair after the birth in order to avoid a cesarean, and the midwife says, '...if they had a terrible time last time, they haven't thought about the things they could do differently next time and still have a vaginal birth.'

What many obstetricians and midwives don't always appreciate is that the number one goal for every pregnant woman is not necessarily 'natural birth.' On the contrary, a healthy outcome for baby and mother is most likely top of the list. Efforts to reduce cesarean rates for the sake of reducing rates is of great concern to me because I genuinely believe that that in some cases, women and babies are bearing the physical and psychological cost of such arbitrary policies.

I don't believe in underestimating the risks of cesarean surgery - that would be irresponsible. But to underestimate the risks of vaginal delivery is, in my opinion, just as bad.