Like most mothers, Anna Sabba hoped for a straightforward delivery when she went into labour with her first child. But 20 hours later, exhausted and with the baby still not born, doctors decided to do an emergency section. Sabba, 32, remembers only the fear: "It was really scary - I was shaking so much. I felt totally out of control, I'd not had any time to mentally prepare myself for this, and suddenly I was about to be cut open."

So when she found herself pregnant again, two years on, she decided to play safe. "I thought I'd ask for an elective section - that way, at least I'd know what to expect," says Sabba, who lives in Manchester. But her consultant in Manchester, Louise Byrd, had other ideas.

This month, several primary care trusts announced that they would be offering cash incentives to hospitals in a bid to reduce the number of surgical deliveries - and the frontline targets are women like Sabba, who have already had one caesarean and opt for another in their next pregnancy.

Central Manchester University Hospitals NHS Foundation Trust has had a policy for some time under which obstetricians are expected to at least question a woman's decision to go for a repeat caesarean if there is no clear medical reason. Reducing the number would, they argue, spare thousands of women from the trauma of a major operation they may not actually need. "Everyone should have a thorough explanation of the pros and cons," says consultant obstetrician Phil Bullen of the Manchester trust.

When labour goes relatively smoothly, there are psychological and emotional advantages to vaginal birth, says Byrd. "A normal delivery can be a wonderful experience, with benefits not only for the woman but for her child," she says. "Women need to be reminded of this. It can seem an 'easy option' to simply agree to elective surgery - but it's vital that we, as medical practitioners, take the opportunity to discuss a woman's choice and see how we might work together to encourage her to aim for a vaginal delivery. Choice is important - but it must be informed."

The problem for doctors is that they may persuade a woman to go for a vaginal delivery, only for the situation to change during labour and for a caesarean section to become inevitable anyway. Rachael Keith, 32, who lives in Cheshire, found herself in precisely this situation when she gave birth five months ago to her second child Dylan. She had had an emergency section with her daughter Matilda two years ago, and wanted to have a planned section second time around, but was talked out of it by her consultant. "I explained I didn't want a second horrific experience - they had to get Matilda out so quickly I had to have a general anaesthetic, which was awful. I thought by planning it I'd be far more in control, and would be able to anticipate what was going to happen, which would make it all a lot easier to handle.

"But the obstetrician seemed to be thinking only about her statistics, and she did everything she could to dissuade me." Keith tried for a vaginal birth but in the event her labour failed to progress, and she ended up with another emergency caesarean.

"I feel my instincts were right: I should have been allowed to elect for a section," says Keith. "I'd be the first to agree that hospitals should be reducing the caesarean rate, but not by railroading women and refusing to hear their point of view."

According to the latest figures, and despite previous attempts to reduce them, caesarean sections are still on the increase - up from 24.3% to 24.6% in 2007-2008. And while emergency sections account for about half of all operations, the other 50% are pre-planned.

For NHS managers, there is clearly a financial incentive to reducing the amount of surgery - caesareans cost on average around £2,700, compared with around £1,400 for a vaginal birth, not to mention the bill for extra days in hospital afterwards. But there is safety as well as cost at stake - giving birth in an industrialised nation like the UK is a very safe process but all the same, giving birth by caesarean is more dangerous than giving birth vaginally. A report in the British Medical Journal said a caesarean raised fourfold the risk of serious complications including haemorrhage, infection and uterine rupture.

Targeting second-time-around mothers in a bid to reduce caesareans has its critics - some argue that health bosses should take a long, hard look at the procedures that lead to the high number of first-time-around emergency sections, since there's a growing body of evidence that suggests many of these could be avoided by better support in labour, and by the sort of one-to-one care that many maternity units struggle to provide.

But things worked out well for Sabba: Connie, now 10 months, was born after a normal labour. "Dr Byrd was great - she didn't just say 'Don't' when I said I wanted a section. She realised that what I needed was confidence, and she helped me gain that confidence. She told me the baby was in a good position, and that there was every chance I could deliver normally this time around. Towards the end of my pregnancy, she saw me every few days. She talked me through all my worries, which helped enormously."

The outcome couldn't have been better, says Sabba. "I've never had a sense of triumph like it. The skin-to-skin contact right after the birth was amazing - completely different from after my caesarean, when the baby was wrapped in a towel and just shown to me. Also, after Connie, the recovery was so much easier which was a real help, since I was looking after a baby and a toddler at the same time.

"Psychologically, I feel Connie's birth has made me stronger. I'm less scared about things."