Unpacking the global rise in C-Sections.
This article was adapted from the work of our colleagues at ANH International. Read the original here.
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THE TOPLINE
- C-section rates are rising globally—far beyond medical necessity—driven not just by clinical factors but also by cultural shifts, physician convenience, and most significantly, financial incentives that make surgical births more profitable for hospitals and doctors.
- The overuse of C-sections poses serious risks: for mothers, higher chances of infection, hemorrhage, long-term complications, and even increased mortality; for babies, breathing issues, altered gut microbiomes, and long-term risks like asthma, obesity, and immune disorders.
- Reversing this trend requires systemic change—ending profit-driven incentives, reducing unnecessary inductions, supporting midwifery and VBAC, and ensuring women receive honest, informed counseling that prioritizes safety and dignity over convenience or revenue.
Once reserved as a last resort in life-threatening cases, cesarean sections (C-sections) have evolved into one of the most routinely performed medical procedures in the world. In 1985, the World Health Organization (WHO) advised that no region should have a C-section rate above 10–15%, noting that rates beyond this range lacked medical justification. Fast forward to today, we are seeing staggering increases, with C-sections now accounting for over 32% of births in the US. You’d think that medical advancements of the last few decades would reduce, not increase, the need for surgical births. It’s important to be aware of some of the factors driving this increase in C-section births, particularly the economic incentives for hospitals and doctors.
The Paradox of Progress
While C-sections are absolutely appropriate in some situations and help save lives, their overuse carries serious risks. For mothers, these include infection, hemorrhage, blood clots, longer recovery time, and complications in future pregnancies. For babies, potential issues range from breathing problems and altered gut microbiomes to increased risks of asthma, obesity, and even neurological impairments. Yet many women are encouraged to undergo the procedure without proper informed consent.
This rising trend raises urgent questions: are there cultural shifts or medical factors responsible for the increase in C-sections? Why are so many healthy pregnancies being treated as high risk? Why are women being induced prematurely or steered toward surgery without clear medical necessity? And more alarmingly, what role does financial incentive play in this pattern?
Follow The Money: Financial Incentives Behind the Scalpel
Over the last few decades, C-section rates in the US have increased substantially. In 1996, 20.7% of births were C-sections; in 2023, the figure was 32.4%—representing a 156% increase. So, what changed?
Beyond clinical convenience and cultural factors, which we’ll discuss below, the economics of childbirth reveal a troubling incentive structure that may be silently driving the C-section epidemic.
Numerous studies (here and here) have shown that cesarean births are significantly more profitable for both doctors and hospitals. On average, physicians in the US earn about 30% more for performing a C-section than for a vaginal birth. For hospitals, the difference is even more stark: reimbursement rates from insurance providers and public health programs for C-sections are estimated to be around 50% higher. These elevated costs reflect longer hospital stays, surgical and anesthesia fees, and post-operative care—all of which translate into higher revenue. This financial equation makes surgical birth not only a medical decision but also an attractive business proposition.
Recent data paints an even more unsettling picture. A 2025 US study noted a post-pandemic decline in birth rates, particularly for vaginal deliveries, while C-section rates remained largely unchanged. It also found that C-sections generated over 61% more revenue per birth than vaginal deliveries, suggesting that as hospitals face fewer births, they may be offsetting revenue losses by increasing the proportion of births conducted by C-section.
While these findings are striking, they reveal a sobering reality—childbirth, once centered on care and safety, is increasingly being shaped by profit, reducing a profound human experience to a revenue stream.
Medical Necessity or Manufactured Demand?
Several other clinical and non-clinical factors contribute to the rise in C-sections. A commonly cited clinical reason is medical necessity. Physicians often opt for C-sections when the mother has medical conditions, such as obesity, diabetes, older maternal age, or multiple pregnancies. Other times, it’s as a result of modifiable indications such as slow or difficult labor, evidence of neonatal distress or unclear heart rate, size or position of the baby, or if the birth is a first-time delivery.
Yet a 2016 study by Consumer Reports confirmed that up to half of all C-sections performed for low-risk births could have been avoided. Several studies (here and here) have linked this trend to non-clinical factors like increased C-section requests from pregnant women. With the normalization of C-section as a birthing option, more pregnant women are choosing surgical births over vaginal births even without any medical issues. The most common reason for this choice is the fear of vaginal delivery and the associated labor pain. Other expressed motivations include the preservation of the pelvic floor, the belief that C-sections are safer for mother and baby, previous traumatic birth experiences, and social, popular, and mainstream media influence.
Beyond maternal requests, surveys and interviews have also identified physicians’ attitudes to C-sections as a major contributor to the rise. According to the American College of Obstetricians and Gynecologists (ACOG), many doctors now practice what is known as ‘defensive medicine’; a situation where they choose C-section, particularly in women with a history of prior C-section, to shield themselves from potential malpractice lawsuits. As Dr. Fernando Barros aptly stated, “Physicians feel that, if they give a cesarean, they cannot be accused of not providing the best care.”
Similarly, doctors now routinely schedule healthy pregnancies for C-section for the sake of convenience. Unlike C-section, a vaginal delivery typically takes hours of labor, which sometimes requires the doctor’s physical presence and may necessitate cancelling other appointments, office hours, lunch, sleep, and personal plans. C-sections circumvent all these, allowing the doctor to birth the baby within a much shorter time via a surgery scheduled at his convenience. As one obstetrician noted in a National Public Radio interview in the US, “You’re going to pay me more, you’re not going to sue me, and I’ll be done in an hour.”
An often-overlooked precursor to C-section delivery is induction of birth, which is increasingly being normalized. Claims that induction leads to fewer C-sections rely on the results of just one study – the widely criticized ARRIVE Trial. A recent study found women, in a real-world setting, whose labors were induced at 37 weeks and women having subsequent births, were more likely to experience a C-section due their baby going into distress, than those who went into labor naturally.
There’s a lack of information about the risks of induction and women report feeling pressured/coerced into having an induction and that their views and wishes are swept aside.
Behind The Curtain: The Hidden Toll of Surgical Birth
If the risks of C-sections were limited to a single incision and clean surgical removal of the baby, the rising rates might not cause such concern. But a growing body of research tells a different story. Studies (here and here) show that C-sections—particularly elective ones—can significantly increase maternal mortality and morbidity. Compared to vaginal delivery, the risk of life-threatening complications such as severe hemorrhage, uterine rupture, cardiac arrest, sepsis, and hysterectomy is up to five times higher. These risks compound with each subsequent surgery, making repeat C-sections particularly dangerous. One study even found that the likelihood of maternal death after a C-section could be as much as 60% higher, and in certain high-risk cases, up to 700% more. These are not just numbers—they reflect real lives disrupted, families fractured, and recoveries that often stretch far beyond the hospital stay.
But the risks aren’t confined to mothers. For babies, surgical birth comes with its own hidden costs. Research (here, here and here) increasingly points to the C-section’s disruptive impact on gut development and immune system regulation. Babies born this way miss out on essential exposure to beneficial bacteria collected through their journey through the birth canal. Such bacteria play a critical role in shaping early immunity. This disruption—known as gut microbiome imbalance—has been linked to increased rates of asthma, allergies, autoimmune disorders e.g. Crohn’s and celiac diseases, and even long-term metabolic conditions like obesity. Similarly, a study by Hugo Lagercrantz found that babies born via C-section are more likely to suffer from respiratory distress. Unlike vaginal births, where contractions help squeeze fluid out of the baby’s lungs, surgical births bypass this natural process, leaving newborns vulnerable to breathing difficulties. These effects are often downplayed in clinical settings, but they shape a child’s health trajectory from their very first breath.
Charting a better course: restoring trust in natural birth
The rise in C-sections while benefiting hospitals and doctors financially, put women and babies at unnecessary risk. Surgical births without medical need can increase complications, delay recovery, and disrupt early child development.
To change course, the culture of childbirth has to undergo change and embrace evidence-based solutions that respect a fundamental, natural process that has ensured the survival of the human race thus far. A culture that includes the reintegration of midwifery, respect for individual choice and informed consent, reduction of unnecessary inductions, supporting vaginal birth after C-section (VBAC), and ensuring women receive honest, thorough counselling. Most urgently, policy makers must reverse the financial incentives driving this trend. By paying providers equally or more for vaginal deliveries, the economic bias fueling the C-section epidemic is removed.
Birth should never be guided by convenience or profit. It should honor the health, dignity, and informed choice of every woman and give every child the best start in life. It’s time to put care, not commerce, back at the center of childbirth.
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