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 births over the past decade is due to a growing number of complex pregnancies and births, caused by factors including rising obesity rates and women waiting until they are older to have children. The proportion of spontaneous deliveries that do not involve drugs or other medical interventions has steadily declined in the last 10 years.
“Over the past decade, there has been a gradual national increase in the number of caesareans,” said Dr Ranee Thakar, the president of the Royal College of Obstetricians and Gynaecologists (RCOG).
“A major factor of this is the growing number of complex births. We are seeing national rising rates of obesity and people choosing to have children at a later stage in their life, both of which can increase the chance of complications.”
Of the 398,675 deliveries in England last year where the method of onset of birth was known, 101,264, or 25%, were C-sections. This is up from 23% in the previous 12 months and 13% a decade ago.
Of the total caesareans last year, 67,100 were recorded as elective, a planned surgery that is usually carried out around the 39th week of pregnancy. This is an increase on the 61,030 elective caesareans reported in 2022-23.
The proportion of emergency caesarean sections – when a vaginal birth may be deemed too risky for either the mother or baby – also increased year on year from 29,315 to 32,463.
Reasons for a planned C-section include when the mother has a low-lying placenta, which blocks the baby’s way out, for multiple pregnancies, if the mother has health issues that could make a vaginal birth difficult or if the baby is in a breech position. Emergency C-sections typically happen if labour is not progressing or if foetal monitoring shows signs that the baby is in distress.
Most women seek a C-section for medical reasons, but also have the right to opt for one 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 medic should “offer a planned caesarean birth for women requesting a caesarean birth”.
A third of the total deliveries for 2023-24 were induced, meaning labour was started using artificial methods such as a membrane sweep, pessary or hormone drip. This proportion has been broadly unchanged in the last few years. However, spontaneous delivery has steadily declined year on year from 62% in 2013-14 to 42% in 2023-24.
Attitudes towards C-sections have shifted during the last decade, with a move away from targets towards decision-making focused on the individual patient.
In 2022, hospitals in England were told to abandon targets aimed at limiting the number caesarean sections carried out to below 20%, over fears for the safety of mothers and babies. At the time, the chief midwife described the targets as potentially unsafe. This followed the Royal College of Midwives formally abandoned its normal birth campaign in 2017, after years of promoting vaginal births as preferable.
The World Health Organization has also moved on from its stance that an “optimal” C-section rate should be no more than 15%, based on observations that suggested that beyond this there is less evidence for benefits in terms of newborn and maternal mortality. However, there are other medical reasons for opting for a C-section, such as 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 on the risks and benefits of both vaginal and caesarean births. The safety and care of the woman and baby during pregnancy, labour and birth should always be the main focus.”
