When most couples decide it is time to take the plunge and start trying to conceive baby, the last thing many of them think about is ending up on the operating table. Most pregnancies are normal and healthy – despite a few pregnancy signs and symptoms – and the vast majority of women should be able to have a vaginal birth. Yet, an increasing number of mothers end up delivering by c-section. The World Health Organization states that optimal c-section rates are between five and ten percent. How come the United States has a cesarean section rate that is much higher than that?

When complications do occur, cesarean sections are a life-saving measure that we should be truly grateful for. In the case of a placenta previa (a placenta that covers the cervix), or a baby that is transverse (facing the cervix sideways), for instance, there is no doubt that surgical births prevent tragic outcomes. But in 2024, c-section rates in the United States had reached 31.8 percent, a figure that has risen even further since then. Those figures well exceed the WHO’s recommended rates, and it is shockingly clear that they include many more cesareans than are medically warranted.

In 1965, when the number of c-sections in the United States was first officially recorded, only 4.5 percent of all births were c-sections. Since then, the rate has steadily risen, until it reached what is referred to by many natural birth advocates as “epidemic rates". Almost a third of all women delivering babies now gives birth by cesarean section. The question is, why?

Contrary to popular belief, most c-sections are not elective procedures requested by women who are “too posh to push” – this actually happens very rarely. According to a recent global study looking into women's birth preferences, only 15.6 percent sees cesarean birth as preferable. Emergency c-sections carried out for reasons like “failure to progress” (a slow labor), or planned surgeries for breech babies, big babies, or twin births, are much more common than elective ones. Many times, obstetricians are quick to recommend cesarean sections, because they perceive the pregnancy to be high-risk, and want to be on the safe side.

While this is understandable, and even admirable, perhaps the alarmingly high US c-section rate forces us to take a second look at the risks. Babies born by cesarean section are more likely to have breathing problems after birth, are more likely to be premature (something that comes with its own set of complications), and are much more likely than babies delivered vaginally to have problems with breastfeeding. Most of the time, vaginal births are the safest option for mothers and babies. Cesarean sections can be life-saving, but they should only be performed when medically necessary.