Episode 187: Understanding Cesarean Rates

Why do cesarean rates keep rising and what does that actually mean for the families you support?

We have to start by breaking down the cesarean rate conversation the birth world has been getting wrong.

From the origins of the WHO 15% figure what it actually said, what it was designed to measure, and why we’ve been misapplying it for 40 years. We also need to understand to the difference between total cesarean rates, primary cesarean rates, and the NTSV rate that matters most for hospital comparison. Without underdstanding these numbers we can not have accurate and honest coversations with clients about what they mean.

Topics covered in this episode:

• The WHO 15% cesarean rate where it came from and why it doesn’t mean what we think it means
• Total vs. primary vs. NTSV cesarean rates and how to use them
• How NICU level and case mix affect hospital cesarean data
• The five nonclinical drivers behind the rising rates, including litigation fear and financial incentives
• Racial disparities in cesarean rates and the case of Cherise Doyley
• Doula bias around cesarean birth and how it shows up in our work
• Practical tools for helping clients ask better questions and build advocacy skills

Whether your client is working toward an unmedicated birth or scheduling a cesarean by choice, this episode is for you. Bodily autonomy doesn’t require our approval and our clients deserve better than our unexamined assumptions.