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........

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