The controversy over elective cesarean versus vaginal birth with regard to pelvic floor trauma has left many caregivers and patients confused. With the growing evidence to support the development of fecal incontinence as a result of childbirth, we believe that it is imperative to reevaluate modern obstetric practices both for the patient's benefit and for our medical-legal protection. Our attention and energy need to be focused on good informed consent regarding these risks along with improved postpartum surveillance for injury.