Official NHS maternity statistics show that caesareans accounted for 45% of deliveries in English NHS hospitals in 2024-25. More recent monthly NHS maternity data reported that 27% of deliveries under NHS maternity services in January 2026 were emergency caesareans.

But a recent BBC analysis noted that this increase has not been accompanied by similarly clear reductions in stillbirth or neonatal mortality rates. If outcomes are not improving at the same pace as interventions, what is driving the growth in caesarean births?

Common explanations include workforce shortages, litigation concerns, maternity safety scandals and changing perceptions of risk. However, focusing solely on clinical factors risks overlooking how ideas about safety, responsibility, trust and uncertainty all shape childbirth decisions.

Fear, anxiety and uncertainty

In Bangladesh, where I recently completed doctoral research on childbirth and rising caesarean section rates, caesareans accounted for around 45% of births in 2022. Approximately 69% of institutional births were delivered surgically.

Unlike England’s NHS-based system, childbirth in Bangladesh increasingly takes place within a commercial healthcare market. This includes private clinics, out-of-pocket payments and maternity packages. In practice, this can make paid access to scans, senior doctors, private facilities, and fixed packages feel like routes to safety. Caesarean birth may then be understood less as an exceptional intervention and more as the managed, predictable option.

For many families in Bangladesh, safety was a medical, emotional and financial concern. It was sought through spending, testing and access to trusted doctors. As one husband put it: “If I could afford 20,000 BDT [around £120], why not pay 25,000 BDT for better care?” Yet improvements in maternal mortality have been far less pronounced, raising questions similar to those emerging in England.

My research explored how childbirth decisions are made. Women and families frequently described caesarean section as “nirapod” (safe). Yet many also experienced it as a lifelong “khoto” (wound), associated with pain, emotional distress and financial burdens. As Monisha, one of the mothers I interviewed, reflected: “Caesarean leaves scars (khoto) that last a lifetime.”

This contradiction reveals an important feature of childbirth decision-making. Caesarean birth is both a medical procedure and a social and moral experience shaped by fear, anxiety, uncertainty and the promise of safety. As Nadia, who underwent two caesareans, recalled: “I felt I had no space to express my choice, and I ended up convincing myself that they were doing it for my good.”

Decisions were shaped by medical advice, family expectations, trust in doctors and economic pressures. Among surveyed mothers, 44% underwent elective caesareans and 56% emergency procedures. Yet 60% reported that the decision had been made at least a month before delivery, suggesting that many birth pathways were established well before labour. Trust in medical expertise was central: most women surveyed, 71%, underwent caesareans recommended by doctors, while only 6% reported making the decision themselves.

Caesarean birth is both a medical procedure and a social and moral experience shaped by fear, anxiety, uncertainty and the promise of safety.

Trust in medical authority often became a way of managing uncertainty. As one woman said, “I trusted her more than anyone else.” Decisions were rarely framed as personal preference. They were presented as responsible actions taken for the baby’s well-being. One participant recalled: “The doctor left the decision to me, so I decided. That was my weakness, but also my right.” Although responsibility was shared across families and healthcare providers, it often fell most heavily on women.

Related tensions around responsibility, risk and professional accountability can also be seen in England, although they take different forms.

Scrutiny and litigation

In England, clinicians work within systems shaped by scrutiny, inquiries and legal claims following adverse outcomes.

In Bangladesh, the pressures described by doctors in my research were often more immediate and personal. As one obstetrician observed: “If something goes wrong, I always worry about the risk of violence. I have to prioritise my safety first.” The contexts differ sharply, but in both England and Bangladesh, caesarean section can become a way of managing uncertainty, avoiding blame and producing a form of safety that is as institutional and social as it is clinical.

In Bangladesh, these pressures operate within a healthcare system facing severe workforce shortages. The country has approximately seven physicians and six nurses or midwives per 10,000 people. By comparison, the UK has around 33 physicians and 95 nurses or midwives per 10,000 people.

Opportunities for continuous labour support and counselling are therefore limited. Midwives in my research often described having little influence over birth decisions. In both clinical and family narratives, caesarean section frequently emerged as the most predictable and controllable option, while vaginal birth remained associated with uncertainty.

This article was first published under the title “Why more births now end in caesarean section” in The Conversation, on June 18, 2026.

Halima Akhter is a researcher on Caesarean Births in Bangladesh at the Department of Anthropology, Durham University.

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