For the first time in England’s history, more babies are now born via caesarean section than through natural vaginal births, according to newly released NHS data for the 2024-25 period. It’s a moment that marks a seismic shift in the way families welcome new life—and it’s not just a blip or a statistical quirk. The numbers are clear: 45% of births in England this past year were delivered by caesarean section, compared to 44% born through spontaneous, unassisted vaginal delivery. Another 11% required assistance such as forceps or ventouse, highlighting the increasingly medicalized landscape of childbirth in the country (BBC, The Guardian, Daily Mail).
This change didn’t happen overnight. Over the last decade, the number of caesarean births in England has doubled, echoing a similar surge seen across the globe. Back in 1980, only 9% of English births were via caesarean, while unassisted vaginal deliveries accounted for a whopping 76.5%. Fast-forward to today, and those numbers have nearly flipped: unassisted vaginal births have dropped to 43.8%, while caesareans have soared to 45.1% (Daily Mail).
What’s fueling this dramatic rise? Experts say the story is complicated, with no single culprit at fault. NHS England points to a mix of factors: more women are choosing caesareans, the average maternal age is rising, and pre-existing health conditions like diabetes and obesity are becoming more common. As Dr. Donna Ockenden, who is leading the largest maternity inquiry in NHS history, told BBC Radio 4, "We know there is an increasing maternal age, we know there is rising ill health. I also think previous experience will play a part. Birth trauma and having a caesarean section first time, may influence their decision to have a C-section the second time round."
Indeed, the data shows that age is a significant factor. One in four births (23.9%) in 2024-25 were to mothers over 35, up from 19.9% a decade ago. For women under 30, natural vaginal birth remains the most common way to deliver. But for those aged 30 and over, caesareans have become the norm. The numbers are even more pronounced for older mothers: 59% of births among women aged 40 and over were by caesarean, and among those aged 45 to 49, an astonishing 71.5% delivered by this method (Daily Mail, The Guardian).
Why do older mothers tend to have more caesareans? As Barts Health NHS Trust notes in information provided to expectant mothers over 40, "It has been known for many years that older women are more likely to experience problems in pregnancy and childbirth." As women age, their uterine muscles may not contract as effectively, leading to prolonged labor and a higher likelihood of complications. Doctors may therefore advise elective or emergency caesareans more frequently for this group. Still, there are upsides to being an older mum: better health habits, more life experience, and often greater emotional and financial stability, according to Barts Health NHS Trust.
Obesity is another major factor. More than a quarter of women aged 18 and over in the UK are now classified as obese. Pregnancy charity Tommy’s warns, "If you had a high Body Mass Index (BMI) before or at the start of pregnancy you are more likely to need a C-section, but you won’t be given one based on BMI alone." Obesity can slow labor and increase the risk of having a larger baby, which can complicate vaginal delivery. Studies suggest that obese women are up to twice as likely to need a caesarean (Daily Mail).
But it’s not just age and health driving the trend. Many women now prefer the predictability and control of a scheduled caesarean, especially if they’ve had one before. As Dr. Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, explained, "There are varied and complex factors contributing to this, including improvements in our ability to detect when a baby's wellbeing is deteriorating during labour, and therefore respond appropriately." She added, "The observed increase in caesarean rates means we must ensure that services are appropriately prepared, with the right staffing levels, training and facilities to manage increasingly complex births and increasing interventions."
The NHS data reveals that 20% of births in 2024-25 were planned caesareans and 25.1% were emergency caesareans—both at record highs (The Guardian). Nearly half of all caesareans were planned in advance, reflecting a shift in both medical practice and patient preference.
Yet, the rising caesarean rate brings challenges. The average cost of a birth to the NHS in 2022-23 was £5,417, but planned caesareans cost about £4,000—around £800 more than a natural birth—while emergency caesareans can run up to £6,000 each (Daily Mail). These added costs come at a time when the total number of babies born in England has dropped to its lowest in 23 years: 542,235 births in 2024-25, 3,000 fewer than the previous year and 100,000 fewer than a decade ago (Daily Mail, The Guardian).
For many women, the decision to have a caesarean is deeply personal—and sometimes, it’s a matter of feeling that it’s the "least worst option." Professor Soo Downe of the University of Lancashire told the BBC, "In some cases women are going for caesarean sections as a kind of least-worst option because they don’t really believe they’re going to have the kind of support they need to have a safe, straightforward, positive labour and birth in hospital." She pointed to systemic pressures: birth centers closing, midwife shortages, and women feeling unsupported or unable to access the birth experience they hoped for.
The state of maternity care remains a hot-button issue. Reviews into maternity care are ongoing at 14 NHS trusts, and a recent Care Quality Commission report found that one in five women do not feel taken seriously if they raise a concern during labor. Issues like being left alone at worrying moments or not seeing the same midwife throughout pregnancy persist, with women from deprived neighborhoods less likely to feel treated with dignity and respect (Daily Mail).
Fiona Gibb, director of midwifery at the Royal College of Midwives, summed up the challenge: "Every woman should be supported to make informed choices about the type of birth they want and what is best for them. No birth is entirely without risk, including caesarean, so ensuring women have the right information to make the right choice for them is imperative."
As the NHS adapts to these shifting patterns, the priority remains clear. An NHS spokesperson told BBC, "All women should receive safe, personalised maternity care in line with best practice guidance and clinical evidence. The priority should always be the safety and wellbeing of both mothers and babies, and decisions about how a baby is born are made through informed discussions that consider individual circumstances, clinical advice and a woman’s preferences, ensuring the safest and most appropriate approach for each birth."
With medical intervention now part of half of all births in Britain, the evolving story of childbirth in England is as complex as it is personal. For families and clinicians alike, the focus is on making every birth as safe and positive as possible—no matter how the journey begins.
