Why Belly Births Happen (with Stats)

After my unplanned Cesarean, I heard someone describe my birth as an “emergency C-section.” I knew this wasn’t true. While my belly birth was unplanned and urgent, it was not a true emergency. This nuance is important because emergency C-sections are very rare and often much scarier than what I experienced. I had looked up my hospital’s C-section rate before delivering, and I was reassured to see that it was below the state and national averages. I had an easy pregnancy, carried to 42 weeks, and did all the prep I could for a vaginal delivery. When my midwife held my hand as they administered anesthesia in the operating room, she looked calm. While she was very surprised that my birth had abruptly pivoted, she had seen this before. Birth is unpredictable, after all. Plenty of women with low-risk, singleton pregnancies and no plans to deliver via Cesarean end up in the operating room, like I did. Many of those women don’t fully understand why. You can request your medical records to see the reasons listed for your Cesarean. Reviewing your birth medical records can be very healing as you come to terms with how it all played out. 

Each belly birth has its own unique story, and these statistics help us understand the scope of shared experiences for Cesarean birth moms. 

It seems like every time I’ve heard “don’t become a statistic” in my life, it was associated with something awful, like drunk driving. The stigma around the growing Cesarean rate in the United States is no different. But the fact of the matter is higher Cesarean delivery rates have contributed to reduced perinatal and maternal mortality in high-risk cases. The U.S. also has other factors to consider. As more families turn to reproductive technology like IVF, belly births can offer a safer delivery option for multiples or older parents. Some parents choose a scheduled Cesarean for emotional, psychological, or physical reasons. A trauma-informed approach to birth means holding space for planned Cesareans as a valid birth option, and the rise in Cesareans partly reflects more autonomy for women in birth planning. 

While experts agree that not all Cesarean deliveries are medically necessary, the goal isn’t zero either. The World Health Organization says optimal rates are around 10–15% for saving lives—though other bodies suggest up to 19% may be appropriate in certain health care systems. The U.S. rate (~32%) is on the high end, but part of that may reflect advances in patient choice, care access, and provider caution.

Here's what we know from current research and U.S. hospital data:

• About 32% of all births in the U.S. happen via cesarean (CDC, 2023)

• Of those, about 60–65% are unplanned, including emergency cesareans

• Only about 35–40% are scheduled (planned) cesareans

Let’s break that down by common reasons for a Cesarean:

🚨 1. Fetal Distress (~23%)

This is one of the leading reasons for an unplanned C-section. It happens when the baby's heart rate drops or shows signs of distress during labor. In these cases, time is often critical, and the cesarean may be urgent or emergent depending on the situation.

Risk with continuing vaginal delivery:

If the baby's heart rate drops or shows signs of not getting enough oxygen (like late decelerations), staying in labor could lead to brain injury, oxygen deprivation (hypoxia), or even stillbirth. A Cesarean becomes the safer choice to prevent long-term damage.

🌀 2. Failure to Progress (~34%)

Also called “labor dystocia,” this includes stalled labor, failure to dilate, or baby not descending. It’s one of the most common reasons for cesareans in first-time moms, and often starts as an attempted vaginal birth that ends in an unplanned C-section.

Risk with continuing vaginal delivery:
When labor stalls for hours (either dilation or descent), it increases the risk of infection (especially if waters have broken), exhaustion for the birthing person, fetal distress from prolonged contractions, and trauma to the baby or parent from difficult forceps/vacuum deliveries.

🩻 3. Abnormal Baby Position or Size (~16%)

If baby is breech (feet or butt first), transverse (sideways), or their head is too big to fit through the pelvis, a C-section may be the safest route. These may be planned ahead of time, especially with known breech positioning late in pregnancy.

Risk with continuing vaginal delivery:

• Breech or transverse positions can lead to the baby’s head getting stuck (especially dangerous in breech).

• Macrosomia (very large baby) increases the chance of shoulder dystocia, where the baby’s shoulder gets stuck after the head is out—a true emergency.

• Vaginal delivery in these cases can result in nerve injuries, fractures, or oxygen deprivation.

🗓️ 4. Repeat Cesarean / Maternal Medical Reasons (~20–25%)

Planned belly births often include:

• Repeat Cesareans after a prior belly birth

• Placenta previa or accreta

• Preeclampsia or gestational diabetes

• Health conditions like heart or kidney issues

Some of these are elective repeat C-sections, and others are medically recommended ahead of time.

⚡ 5. Emergency Situations (~6–7%)

Emergency cesareans are rare but serious. These happen when immediate action is needed to save the life of the baby or mother. Examples include:

• Uterine rupture

• Cord prolapse

• Severe placental abruption

These surgeries typically happen within minutes of the decision.

Risk with continuing vaginal delivery:

All of these are immediate life-threatening situations. Time is critical—vaginal delivery would take too long and could result in severe injury or death for the baby and/or birthing person.

🫂 6. Mental Health, Trauma, or Birth Preference (Statistically Unreported)

Some parents choose cesarean birth due to anxiety, previous birth trauma, or for emotional well-being. These births are often planned, but they’re not always reflected in the standard medical stats—yet they are entirely valid and deserve space in the conversation.

Risk with vaginal birth in these cases:
Sometimes, vaginal birth is not the safest emotional or psychological option—especially for survivors of trauma, anxiety disorders, or previous traumatic births. In these cases, a planned cesarean can reduce the risk of:

• Feeling unsafe, out of control, or physically violated

• Birth-related PTSD

• Panic attacks during labor

  Protecting a mother’s emotional well-being is a legitimate medical reason.

Cesareans Generally Fall Into 3 Categories

Planned Cesarean:
Scheduled ahead of time, often for medical reasons or personal preference. You go into the hospital not in labor.

Unplanned Cesarean:
Starts as a vaginal birth, but due to complications or labor stall, shifts to C-section. May still feel calm or semi-urgent.

Emergency Cesarean:
Fast, urgent, and often frightening. Decision-to-incision time is usually under 30 minutes. Emotionally intense for many families.

No matter the reason for it, a Cesarean is a powerful act of love rooted both in a mother’s courage to endure surgical delivery and in the natural human instinct to help bring new life safely into the world.