Compared to Brazilians, who clock in at a Caesarean section rate of 52%, the American C-section rate of 32.7% might not seem so high. However, the U.S. percentage is currently double the World Health Organization’s (WHO) target rate of 10-15%, and there is no evidence that health care quality improves once a country’s rate goes above 15%. Certain maternal health conditions and complications during labor necessitate a C-section, including breech birth or a baby showing signs of distress in utero during the labor process. C-sections, however, are indeed a surgical procedure that can have complications such as post-operative bleeding and pain, and a higher likelihood of a C-section in subsequent pregnancies. The American College of Obstetricians and Gynecologists has pushed in recent years for longer labor and pushing stages to reduce C-section rates.

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Some women request elective C-sections for psychological reasons (such as past sexual trauma) or for lifestyle reasons including work or a particular doctor’s schedule. There is disagreement about why the United State’s rate is high and whether it should be held to the WHO standard, but C-section rates vary throughout the country and some hospitals and birthing centers are already at the target rate. Some recent evidence suggests that perhaps the type of medical practitioner present during labor and delivery may impact these rates. A 2015 study found that women laboring with a traditional private practice doctor (ie: one who is paid according to each delivery type) had a C-section rate of 31.6%, while women laboring with midwives or laborists (ie: salaried doctors paid per shift who do not receive extra pay for Caesarean sections) had a C-section rate of 17.3%.

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