II. Interventions & C-Sections
NIH State-of-the-Science Conference: Cesarean Delivery on Maternal Request (2006)
Fewer than 1 in 10 C-sections are actually requested by the mother
Truly elective (patient-requested) C-sections account for under 10% of all scheduled cesareans. The vast majority are physician-initiated. NIH consensus panel concluded that any decision must be carefully individualized.
The NIH and ACOG have separately examined how often scheduled cesareans are actually being requested by mothers, as opposed to being recommended or arranged by the physician. The patient-requested share of all scheduled cesareans turns out to be under 10 percent.
The other 90 percent are physician-initiated, either for prior-cesarean repeat, breech presentation, or some other indication the provider identified. This matters because the public narrative often frames the high US cesarean rate as a consumer preference issue, with the implication that mothers are choosing the surgery. The data does not support that framing.
Mothers who walk into hospitals planning a vaginal birth are the ones absorbing most of the increase. The surgery is being added by the people delivering the care, not requested by the people receiving it.
<10%
Patient-requested share
90%+
Physician-initiated
1 in 10
C-sections actually chosen by mom
Why it matters
The "mothers are choosing this" framing is not what the data shows. Most cesareans happen because the provider decides, not because the mother asks.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.