Cesarean delivery carries roughly three times the negative-experience rate of spontaneous vaginal delivery across the available survey and outcomes literature: 19% of cesarean-delivery women in a large Scottish postal study reported dissatisfaction with their birth (Porter et al. 2007, n=1,661), compared to 7% of women in a national Swedish cohort who rated their birth — predominantly vaginal — as a negative experience one year later (Waldenström et al. 2004, n=2,541). The PTSD literature corroborates the direction: spontaneous vaginal birth produces the lowest postpartum PTSD rates of any delivery mode (1.8% at 6+ months, Ginter 2022 integrative review), while emergency cesarean sits at the top (4.8%), with elective cesarean and instrumental vaginal between them.
The critical within-group caveat is that unplanned cesareans drive most of the negative signal. Konheim-Kalkstein & Miron-Shatz (2021) found 73% regret among 227 US women with unplanned cesareans as their only birth — but the regret was predominantly inaction-flavored, centering on not having advocated for themselves during labor, rather than regretting the surgical procedure itself. Women who chose a planned elective cesarean fared far better: Coates et al. (2021) found 85% were satisfied with their decision-making process. The 19% average action-side rate masks a distribution that runs from roughly 15% for planned cesarean to 73% for unplanned — depending almost entirely on whether the procedure was chosen or imposed by circumstances.
Long-term data push the gap wider. A 2017 follow-up of a US prospective cohort found that at 10 or more years after delivery, women who delivered vaginally reported statistically higher fulfillment and lower distress scores than those who delivered by cesarean section. This trajectory fits the Gilovich inaction-versus-action pattern: the shorter-term satisfaction advantage of elective cesarean (control, predictability, pain management) tends to erode at decade-scale follow-up, while the physical and psychological outcomes of uncomplicated vaginal birth accumulate in the positive direction. The absence of direct “regret about not having a cesarean” survey data from vaginal-delivery populations is itself informative: the construct is rarely studied because the experience is relatively rarely reported.