Caesarean sections have become the most common method of childbirth in England, marking a historic shift in maternity care. Newly released NHS England figures reveal that for the first time, surgical deliveries have overtaken unassisted vaginal births.
A Dramatic Reversal in Birth Trends
The data shows that 45.1 per cent of women who gave birth in the 2024/25 financial year delivered via caesarean. This represents a staggering increase from just 9 per cent in 1980. Over the same period, the proportion of unassisted vaginal births has plummeted from 76.5 per cent to 43.8 per cent. The remaining 11 per cent of births last year were assisted vaginal deliveries, involving instruments like forceps or suction.
This reversal points to profound changes in maternal demographics and clinical practice. Of the total caesareans, 20 per cent were planned procedures, while 25.1 per cent were emergency operations – both figures are the highest ever recorded.
Key Drivers: Age, Obesity, and Choice
Experts cite multiple, interconnected factors fuelling this trend. A significant driver is the rising age of mothers. The statistics confirm that one in four births (23.9 per cent) are now to women aged over 35, up from 19.9 per cent a decade ago. Older maternal age is associated with a higher risk of complications and prolonged labour, often leading to a recommendation for a caesarean.
The caesarean rate escalates sharply with age: 35.6 per cent for women aged 20-24, compared to 57.9 per cent for those aged 40-44, and 71.5 per cent for mothers aged 45-49. NHS guidance for expectant mothers over 40 acknowledges the increased risks but also highlights potential benefits, such as greater emotional and financial stability.
Alongside age, surging obesity rates are a major contributor. More than one in four UK women are now clinically obese. Obesity in pregnancy raises the risk of needing a caesarean, as it can lead to slower labour and larger babies. The charity Tommy's confirms that a high BMI increases complication risks for both mother and baby, though it is not the sole reason for a surgical birth.
Furthermore, some women opt for the convenience of scheduling an elective caesarean, and those who have had one previously are more likely to do so again in later pregnancies.
Implications for the NHS and Maternity Services
The shift has substantial implications for NHS planning and resources. Dr Alison Wright, President of the Royal College of Obstetricians and Gynaecologists, stated that the increase is driven by complex factors, including better detection of foetal distress during labour. She emphasised the need for services to be "appropriately prepared, with the right staffing levels, training and facilities to manage increasingly complex births."
The financial impact is also notable. The average NHS cost for a birth in 2022/23 was £5,417. A planned caesarean costs around £4,000 – approximately £800 more than a natural birth – while an emergency procedure can reach up to £6,000.
These developments occur against a backdrop where overall birth numbers are falling. The total number of babies born in 2024/25 was 542,235, the lowest in 23 years and about 100,000 fewer than a decade ago.
Concerns about maternity care quality persist. A recent Care Quality Commission report found one in five women feel they are not taken seriously when raising concerns during labour. While there have been some improvements, satisfaction levels remain "stubbornly static," with issues like women being left alone at worrying times during birth still prevalent.
The data paints a clear picture of a transformed landscape for childbirth in England, where surgical intervention has moved from the exception to the norm, demanding a responsive and well-resourced maternity system for the future.
