I personally am not opposed to elective c/s (not the medical definition - I do mean purely elective, I don't want to birth vaginally non-medically indicated c/s). However, I am opposed to any situation in which a woman is not fully informed of her options and the risks and benefits of different procedures and has the opportunity to make an informed choice.
Part of the problem is that the current social communcations and understanding regarding vaginal birth is that it's scary, unpredictable, dangerous, painful, and otherwise very unpleasant. And its counterpoint is scheduled, elective c/s, which is generally presented and perceived as calm, safe, predictable, and easy (or at least, easier). That's not to say that everyone feels this way or communicates this, but the "big picture" that most first-time moms get is just that. I know I did. If I wasn't such a research junkie and felt compelled to learn everything I could, who knows - I might have been fighting for a non-medically indicated c/s. More and more FTM are.
With that kind of background color, information about natural birth - or even just vaginal birth - is pushing uphill. Under those circumstances, I feel that it should be more difficult to obtain an elective, non-medically indicated c/s than to obtain a NCB in a hospital. Instead, in my experience, the opposite is true.
Women seeking non-medically indicated elective c/s should be required to read and understand information pertaining to their choice. Women seeking NCB should be supported and while education is always important to success in NCB, I would set the bar lower.
There's more to this, though. There may come a time when it really is safer, statistically, to birth surgically than vaginally (at least for the baby - maybe not for mom, or maybe not for some time for mom). At that point, the question becomes deeply complex. Are there still other benefits to vaginal birth? Probably. Are they superior or do they justify the choice for vaginal birth?
One corner I do not want to be backed into as a birth education advocate and NCB supporter is the "Now, scheduled c/s has been proven in studies to be safer for babies than NCB. How can you justify encouraging NCB, or even allowing the option?" This is one reason why I really do support each woman's informed choice regarding the way she wants to birth. If she is ignorant and uninformed, I will not be able to respect her choice to birth surgically. And I will question (inwardly) her chance of success at NCB if she says she's "hoping for NCB" but knows nothing about it. Women have to take an active role in their care and in birthing long before labor starts if they are going to have a chance at birth experiences that are positive for them.
I know that, today, non-medically indicated c/s carries additional risk to both mom and baby, and potential long-term health complications that, IMO at least, outweigh the benefit of, say, avoiding the pain of a natural delivery (not to mention post-op pain with a c/s). However, I still recognize that a rational, informed mother may, for reasons that I may not fully understand, choose a non-medically indicated c/s. I support her right to do that, just as I support the right of women to have unassisted births. I may not understand her reasoning, but I believe patients should have a great deal of autonomy in regards to their care, and that absolutely extends to pregnant and birthing women. Ultimately, the woman should have the right to choose what is right for her and her baby, and she should be supported by HCPs in her decision.
And I think the bigger problem has absolutely nothing to do with non-medically indicated c/s by mother's request and absolutely everything to do with the kind of care provided. How many women are set up for a c/s from the beginning? I'm thinking of my co-worker's wife, who was told at her 8 wk appt that she was probably too small to give birth vaginally (she is completely normal-looking, just 5'2"). How many doctors say things like, "Well, he's estimated at 8.5 lbs already on the ultrasound, and that's an awfully big baby - and you're only 37 weeks. This baby could be 10 lbs by the time you deliver! If you want, we can just schedule a c/s for next week." It goes on and on. THAT is the erosion of patient autonomy. Even if after that you say "Oh and by the way <boilerplate boilerplate>" if you've gained a woman's trust and have already convinced her that she is going to need a c/s, or that it's the best thing to do, what real choice does she have? For the average woman, the average patient, the wiggle room to choose is practically nil at that point.
I think I'm repeating myself so I'll stop. But I don't think we can really blame the huge increase in c/s on women choosing non-medically indicated c/s, as media stories tend to. I think the bulk of that responsibility falls squarely on the shoulders of medical professionals who wield all the power in the doctor-patient relationship.
I would like to see all women better informed and more empowered. It's not an easy thing to do. And it wouldn't eliminate non-medically-indicated c/s, but that's not the point and it's not the goal, either.
Disclaimer: I made some generalizations above WRT how doctors/OBs approach patients. I feel that, as a generalization, it's rather accurate. That is not to say that there aren't great doctors out there, or non-c/s-happy OBs. I just do not think they are a large proportion of the whole. And I very strongly feel that few doctors really do a good job of ensuring patients are informed and aware of their options and risks/benefits of different procedures. A good deal of why that is is simple: they don't have the time.