Cesarean delivery as a result of maternal request is increasingly popular, leading to important ethical questions. One of the challenging issues is balancing respect for the autonomy of a pregnant woman with concerns of beneficence and nonmaleficence for her and the fetus. The perceived benefit of cesarean section is protection of the pelvic floor. Increased rates of respiratory morbidity in infants born by cesarean section cannot be ignored. Societal concerns of distribution of resources must be considered in ongoing discussions of this critical issue. This article reviews the current ethical debate of maternal choice and autonomy in elective cesarean delivery.