It is a combination of things. Now, I realize this is going to sound too "out there" for many people, but think about what I have to say before dismissing my explanation.

Women are encouraged to get epidurals to help diminish the pain of birth -- however, what the medical community completely neglects to inform women is that epidurals not only block pain, but slow down contractions, significantly.
Enter Pitocin, or another labor inducing drug, to compensate for the effects of the epidural. Most women are just given labor inducers after the epidural, without the patient even being consulted. Guess what the side effect of Pitocin is? Very painful labor contractions.
Exhausted mothers-to-be are positioned into a seemingly endless cycle of labor slowing drugs and labor inducing drugs, endangering their own health and the health of their unborn child. C-sections become necessary in this environment.

Who is benefiting from this system? The mother, whose labor has been artificially reduced and sped up and reduced and sped up until she is so exhausted and exasperated that more drugs is the only solution? Or, the medical community?

Another interesting question, which directly relates to your C-section query, is why are women in the US so terrified of natural birth?

Obviously, sometimes natural birth is not possible because of complications or risk. I, being the daughter of a former midwife, tend to think that natural birth is better in every situation except those in which there is a recognized problem. But I think that for most women the idea of natural childbirth is terrifying, because every depiction of labor in mainstream media shows it to be an out-of-control, excruciating, horrible experience. I've watched two women give birth naturally (from inches away) and I have to say, it's nothing like the scenes in TV or movies. While both women (one my sister, the other a cousin) certainly experienced pain, exhaustion, and the sort of fear you feel when the only way through is forward, both handled the experience calmly, without any screaming, hysterics, or pleading for drugs.

I also know a lot of women who have ended up having c-sections by choice, and I think the first factor is convenience-you get the doctor you want instead of the one who is there when you go into labor, you can take the time off of work (much more of an issue for women now than in the past) and your family can arrange to be free to be around if you want them. Also, preparing for natural childbirth requires work if you want the experience to be comfortable- women who decide to have natural births often spend weeks or months teaching their bodies and minds the proper breathing, relaxation, position and pushing techniques. As is often said, money can buy a heck of a lot of convenience. I'd say the second big factor is fear- lots of women think birth is an experience they have no control of unless it is scheduled. Some of the women I know who opted for c-sections have lost children or had difficult births before, or are close to people who have, which is certainly a reason to be afraid even in the absence of evidence that there will be a problem.

Finally, I think the generally evolving structure of our healthcare system is a factor. Years ago, you could call your doctor in the middle of the night to come and deliver your baby and he would get out of bed and drive to your house. Doctors were more like wise family friends with expert knowledge than strangers seen only a few times a year. Nowadays, you have to schedule regular doctor's appointments weeks or months ahead, and often when you need urgent care you have to go see a strange doctor. Also, babies are usually delivered by specialists nowadays instead of by general practitioners with whom the patient has a long-standing relationship. Making an appointment to have your baby probably seems more responsible and socially appropriate to most people than just going with the flow and expecting your doctor, hospital, work and family to be ready when your baby is.

A lot of it is liability, although there's definitely a convenience factor.

Women aren't allowed to spend "too long" in labor anymore, which can mean anything from 24 hours after the rupture of the membranes to spending more than 8 hours in the first stage of labor for a primipara. Multiple births these days are more often the result of fertility treatments in older women rather than spontaneous twins (like my siblings are); multiples tend to have more complications and so do older mothers.

Spinal and epidural anesthesias, while making labor more pleasant for women, slow progress. Sometime dramatically, so enter the "too long" factor.

Lots of hospitals (even the big ones) still take an old-school approach to labor and delivery, preventing mothers from changing labor positions as much as they'd like and restricting their freedom to walk; both practices speed up labor. Hell, the Mayo Clinic only just this fall put hot tubs in their birthing suites for pain management--women may only labor, not deliver, in them though. And it's still routine to deny women in labor, even the in early stages, food or water outside of ice chips. I know that the claim is such measures prevent aspiration should emergency anesthesia be necessary, but if your anesthesiologist can't handle car accident victims (who probably have full stomachs), s/he shouldn't be attending births anyway. You wouldn't run a marathon on an empty stomach, would you?

"Assuming the female position," as my old GYN put it, doesn't let gravity help with birth but it sure makes it convenient for the doctors.

There's lots of reasons.

1. You can schedule your child's birth to fit into your busy schedule.

2. No waiting, and differently straightforward (this applies to the doctor too). I knew of one who refused to deliver twins vaginally, period. Twins = automatic C-section. Not to mention the legions of doctors who refuse vaginal birth after a previous C, whether or not it's an easy birth.

And, perhaps most of all:

3. The hospital gets to bill a much more expensive procedure to your insurance company. Sad, but true.

My theory? Having your stomach slit open by a perfect stranger is less of a invasion of privacy than a Doctor staring at your vagina on the worst day of it's life.

Ladies will tell you it's about convenience, but deep down inside? Having your intestines laid aside so doctors can access your uterus is more dignified than "dilated ten centimeters".

I agree, natural is best. However, I do know several moms whose vaginal births wrecked havoc on their plumbing. C-sections take the risk of loss of bladder control out of the equation.

I know it's Cracked, but they dish an interesting argument.

http://www.cracked.com/article_18840_5-common-medical-procedures-that-secretly-arent-worth-it_p2.html

Two words: Torn Perineum

That being said, while I'm concerned about the medicalization of birth and women having full agency in their birthing choices blah blah blah, were I, for some reason, to give birth right now, I (based on what little I know) would pick a C-section

I think the rise in C-sections is only a problem if they have adverse effects for mother or child or if it is not the preferred choice of the woman. Seriously, I don't know why people get hung up on "natural" being the best (especially when it comes to women's bodies)

I imagine this upswing owes a lot just to mentality. It's more socially acceptable, more widely discussed, more easily accessible, so more women feel comfortable opting for it. The desire/demand may not have actually changed *that* much. Who knows how many women 50 or 100 years ago would have opted for C-sections if they were as safe and accessible as they are today.

As time goes on and on and medicine and technology improve, people also seem to just become more blase about surgery in general, from minor to major. Botox injections, laser eye surgery, plastic surgery, cosmetic dental surgery, etc.

I also wonder how much of this might be due to the rising age of mothers (wild speculation alert). Can't really say without some age correlation stats, but maybe more women:

- Are professionals who want to get back in the swing of things sooner (and think C-sections do that for them),
- Are more conscious about aging (rather arguable) or consider themselves less able to bounce back physically than a younger mother would be
- Have the money to afford a C-section
- Are generally worried about having a healthy birth, again because of age
- Etc.

I expect it's some combination of improved recovery times, liability, and profitability. These days, people who have surgery of any kind get discharged from the hospital very quickly so they can complete their recovery at home. In the past, someone who had a C-section might spend a week in the hospital, at great expense obviously, whereas now they typically come home within 48 hours of the surgery.

Rather than proceed with a difficult birth, it is easier from a liability standpoint to just do a C-section. And, especially with the faster recovery times, I suspect the hospital makes a lot more money on surgery without having to add a lot of beds to the maternity ward.

Weight. Bigger moms = bigger babies. This is America, after all.