Caesarean sections have for the first time become the most common form of birth in England, surpassing 'natural' vaginal deliveries. In the fiscal year 2024/25, 45.1 percent of women gave birth via caesarean, a significant increase from just 9 percent in 1980. Concurrently, the rate of unassisted vaginal births has sharply declined from 76.5 percent to 43.8 percent over the same period. The remaining 11 percent of births were assisted vaginal deliveries, involving instruments like forceps or suction.

Several complex factors are thought to be driving this trend. A key contributor is the surging obesity rate in the UK, where over one in four women aged 18 and over are now obese. Studies indicate that obese women are up to twice as likely to require a C-section due to increased risks to both mother and baby, including slower labor and larger babies. While a high Body Mass Index (BMI) increases the likelihood, a C-section is not solely based on BMI, as emphasized by the pregnancy charity Tommy's.

Another significant factor is the growing number of women choosing to give birth later in life. NHS England figures reveal that nearly one in four births (23.9 percent) are to mothers over 35 years old, up from 19.9 percent a decade ago. Older women face higher risks of complications and prolonged labor, as their uterine muscles may be less effective, leading to weaker contractions. This often results in doctors advising either an elective or emergency C-section. The C-section rate rises with maternal age, from 35.6 percent for women aged 20-24 to 57.9 percent for those 40-44, and 71.5 percent for those 45-49.

Beyond medical necessity, some women opt for elective C-sections for the convenience of scheduling, allowing them to plan their lives around a known birth date. Additionally, women who have had one C-section are more prone to having subsequent caesarean deliveries. In 2024/25, planned caesareans accounted for 20 percent of all births, and emergency C-sections for 25.1 percent, with both types reaching their highest recorded levels.

While acknowledging the increased risks for older mothers, an information sheet from Barts Health NHS Trust for women over 40 also highlights potential benefits. These include a greater likelihood of healthy eating and exercise, less smoking, enhanced confidence from life experience, and increased emotional and financial stability. The advice encourages older mothers not to worry excessively about age, but to focus on a healthy pregnancy and bonding with their baby.

The rising C-section rate has significant implications for the National Health Service (NHS). Dr. Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, notes that the increase is multifaceted, partly due to improved abilities to detect when a baby's wellbeing is deteriorating during labor. She stresses the critical need for services to be adequately prepared with the right staffing levels, training, and facilities to manage increasingly complex births and interventions, ensuring safe, high-quality, personalized, and compassionate care.

Financially, a C-section is more costly to the NHS than a natural birth. The average cost of a birth in 2022/23 was £5,417. A planned C-section costs approximately £4,000, about £800 more than a natural birth, while an emergency C-section is the most expensive, costing up to £6,000 per birth, according to NHS tariffs.

Alongside these trends, a recent report from the Care Quality Commission (CQC) highlighted persistent concerns within NHS maternity services. One in five women reported not feeling taken seriously when raising concerns during labor, and many felt they couldn't get the help they needed or weren't given the right advice. Key issues, such as one in ten women being left alone during worrying times in late labor or birth, remain unchanged. While women seeing the same midwife throughout pregnancy reported more positive experiences, those from deprived neighborhoods were less likely to feel treated with dignity and respect.

Fiona Gibb, director of midwifery at the Royal College of Midwives, attributes the steady rise in caesarean births to a combination of changing maternal population needs, parental choices, and systemic pressures. She underscores the importance of supporting every woman to make informed choices about their birth plan, emphasizing that no birth is without risk, including caesareans, and access to accurate information is paramount.

Overall, the total number of babies born in England also fell to its lowest in 23 years during the last financial year, with 542,235 births, 3,000 fewer than the previous year and 100,000 fewer than a decade ago.