 There is a clear sense in which expanding women's voluntary access to cesarean deliveries increases women's autonomy: it gives women more options. Some of the ethical literature on this issue (Minkoff and Chervenak 2003, Schwartz 2004) takes it as obvious that incorporating CDMR into obstetrical practice would enhance patient autonomy, and then asks whether this advantage is offset by the harm of unnecessary surgery. But others have argued that autonomy consists of more than choice, and that in social context, making CDMR routinely available might actually impede women's autonomy (Bergeron 2007, Kukla et al. 2009). In a context where doctors have high cognitive and social authority, and technological intervention and management are associated with safety, the offer of CDMR will not be a neutral offer but one that has performative force and a normative valence: it will not merely report on an option, but may well alter the woman's preferences and her understanding of what counts as a socially sanctioned choice. Furthermore, the act of offering CDMR may itself contribute to the normalization of technologically intensive birth and medicalization. If, over time, cesarean section is routinely offered as an option, then it may become the norm, as women will feel that the more predictable and expertly managed option is the more responsible choice. And, as cesarean deliveries become increasingly normalized, obstetricians' skills at vaginal delivery might attenuate, in turn creating more need for cesarean deliveries and eventually perhaps making vaginal delivery a choice out of reach for most women (Little et al. 2008).