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 wide within-group variation: planned/elective cesarean carries markedly less dissatisfaction than unplanned cesarean, where Konheim-Kalkstein & Miron-Shatz found 73% regret — depending almost entirely on whether the procedure was chosen or imposed by circumstances.
The direction is consistent with the Gilovich inaction-versus-action pattern: the shorter-term satisfaction advantage of elective cesarean (control, predictability, pain management) reflects known short-horizon benefits, while the negative-experience and PTSD data above suggest the psychological costs of operative delivery are what compound rather than fade. Long-term, decade-scale survey data directly comparing fulfillment or regret by delivery mode remains sparse in the literature — an evidence gap rather than a null finding. 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.