One in four babies born in NHS hospitals in England last year were delivered by caesarean section, official figures show.
The gradual increase in the number of caesarean sections over the past decade is due to a growing number of complex pregnancies and births, caused by factors such as rising obesity rates and women waiting until they are older to have children. The proportion of spontaneous deliveries that do not involve medications or other medical interventions has steadily declined over the past decade.
“Over the past decade there has been a gradual increase in the number of caesarean sections nationally,” says Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynecologists (RCOG).
“An important factor in this is the growing number of complex births. We are seeing rising rates of obesity nationally and people choosing to have children later in life, both of which can increase the risk of complications.”
Of the 398,675 deliveries in England last year, where the birth method was known, 101,264, or 25%, were caesarean sections. This is an increase from 23% in the previous twelve months and from 13% ten years ago.
Of the total number of caesarean sections last year, 67,100 were recorded as elective, a planned operation usually performed around the 39th week of pregnancy. This is an increase from the 61,030 elective caesarean sections reported in 2022-2023.
The number of emergency caesarean sections – where a vaginal birth is considered too risky for the mother or the baby – also increased year after year from 29,315 to 32,463.
Reasons for a planned cesarean section include when the mother has a low-lying placenta blocking the baby’s way out, in multiple pregnancies, if the mother has health problems that could make a vaginal delivery difficult or if the baby is in a breech position. position. Emergency C-sections are usually done if labor is not progressing or if fetal monitoring shows signs that the baby is in distress.
Most women seek a cesarean section for medical reasons, but they also have the right to choose a cesarean section based on personal preference according to guidelines published by the National Institute for Health and Care Excellence. These state that if a mother does not want a vaginal birth after discussing the benefits and risks, the doctor should “offer a planned cesarean section to women who request a cesarean section.”
A third of total deliveries in the period 2023-2024 were induced, meaning that labor was started using artificial methods such as a diaphragm sweep, pessary or hormone infusion. This share has remained largely unchanged in recent years. However, the number of spontaneous deliveries has steadily declined year on year, from 62% in 2013-2014 to 42% in 2023-2024.
Attitudes towards caesarean sections have changed over the past decade, with a shift from goals to decision-making focused on the individual patient.
In 2022, hospitals in England were told to abandon targets to limit the number of caesarean sections performed to less than 20%, amid fears for the safety of mothers and babies. The head midwife at the time described the targets as potentially unsafe. This followed after the Royal College of Midwives formally halted its normal birth campaign in 2017, after years of preferring to promote vaginal births.
The World Health Organization has also moved away from its position that an “optimal” caesarean section rate should not exceed 15%, based on observations suggesting that there is also less evidence of benefits in terms of neonatal and maternal mortality. However, there are also other medical reasons for choosing a caesarean section, for example to reduce the risk of pelvic organ prolapse or urinary incontinence, which may require surgical treatment later in life.
Dr. Thakar said: “The RCOG does not promote one form of birth over another. Women should be supported to make an informed decision about how they want to give birth, including a discussion about the risks and benefits of both vaginal and caesarean section. The safety and care of the woman and baby during pregnancy, labor and birth should always be paramount.”