A quarter of all babies born in England are now delivered by emergency caesarean section, marking a significant rise over the last five years, according to BBC analysis. The increase in unplanned caesarean operations has grown by eight percentage points, while elective caesarean rates have also risen. At the same time, the proportion of vaginal births without instruments has decreased from over half to 43% of all deliveries.
Why this matters
The rise in emergency caesarean sections represents a major change in childbirth practices in England. This shift has not been seen in other European countries, raising questions about the underlying causes. Emergency caesareans are often performed when there is an immediate risk to the mother or baby, making the increase a significant concern for maternity care services, healthcare professionals, and families.
Key developments
- Emergency caesarean rates in England have increased from 18% to 26% over five years.
- Planned caesareans now account for 20% of births.
- Vaginal births without instruments have fallen from 53% to 43%.
- Emergency caesarean rates vary across the UK, with Scotland at 22%, Wales at 20%, and Northern Ireland at 16%.
- England’s ranking for caesarean birth rates among 42 countries rose from 14th in 2020 to 9th in 2025.
Background
A caesarean section involves making a surgical cut through the mother’s abdomen and womb to deliver the baby. Emergency caesareans are classified by urgency, from immediate threats to life to cases where labour is not progressing well. The NHS does not publish detailed data on the reasons for emergency caesareans, making it difficult to pinpoint exact causes for the rise.
Experts suggest multiple factors may be involved, including increased maternal age, obesity, pre-existing medical conditions, and a culture of fear among maternity staff and pregnant women. High-profile maternity safety scandals in England have also influenced attitudes towards caesarean delivery, with previous targets to keep caesarean rates low being dropped in 2022.
Expert perspectives
Prof Marian Knight, director of the National Perinatal Epidemiology Unit, describes the rise as a “total change in how women give birth” in England. She notes that other European countries have not experienced such sharp increases. Prof Shakila Thangaratinam, a consultant obstetrician, emphasizes the need for better data to understand the reasons behind the rise and highlights disparities in emergency caesarean rates among different ethnic groups, with rates about one in three for Black and Asian mothers compared to one in four nationally.
Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, expresses concern about the capacity of maternity services to cope with the increased demand for emergency caesareans, warning that insufficient operating theatre availability could become a problem.
Impact on mothers and healthcare system
Emergency caesarean sections involve major surgery and require physical recovery, which can be challenging for new mothers. Khushi, an 18-year-old mother who had an emergency caesarean due to her baby’s heart rate slowing during labour, described the experience as frightening and mentally traumatic despite a successful outcome.
From a healthcare perspective, emergency caesareans are more costly than vaginal deliveries or planned caesareans, with estimated costs of nearly £9,000 per emergency procedure compared to about £4,800 for vaginal births and £6,000 for planned caesareans. The rise in emergency caesareans also contributes to increased pressure on NHS staff and resources.
NHS response
NHS England states that decisions about birth methods are made based on individual circumstances and clinical advice to ensure the safest approach for mothers and babies. The NHS acknowledges that many factors influence caesarean rates and emphasizes its commitment to maternity safety and wellbeing.
The Department of Health and Social Care highlights ongoing efforts to improve maternity and neonatal safety, with the national maternity taskforce chaired by the Health Secretary playing a key role.
Recommended reading
For more context, see related Peack News coverage and explainers linked below.
