Seven in 10 Korean births now by C-section amid older mothers, doctor shortage

Seven in 10 deliveries in Korea last year were by cesarean section (C-section), up from about four in 10 in 2016, as high-risk pregnancies, changing preferences among mothers and a shortage of delivery staff push more women toward surgery, analysts say.

Of the 242,103 births last year covered by the analysis, 169,891, or 70.2 percent, were cesarean deliveries, according to National Health Insurance Service (NHIS) data obtained by Rep. Kim Yoon of the Democratic Party, a member of the National Assembly’s Health and Welfare Committee, and released Wednesday. The analysis linked data on government support for pregnancy and childbirth medical costs with health insurance and medical aid claims.

The rate has risen every year since 2016, when it stood at 42.5 percent. It passed 50 percent in 2019 and topped 70 percent for the first time last year.

A 33-year-old woman surnamed Kim, who lives in Yongsan District, central Seoul, decided early in her first pregnancy last year to have a C-section, although doctors had not told her a natural delivery would be difficult. She was afraid of a long labor and an episiotomy, and she was unsettled by stories from people around her who had gone through labor only to end up having emergency surgery.

“Surgery hurts too, but waiting through labor without knowing when it would end was scarier,” she said.

Mothers have also grown older. Women aged 35 or older accounted for 41.2 percent of all births last year, up from 30.6 percent in 2016. C-sections accompanied by a pre-eclampsia-related diagnosis rose from 2,585 to 3,754 over the same period. Pre-eclampsia is a serious pregnancy complication marked by high blood pressure and signs of damage to organs such as the kidneys or liver.

“As marriage and childbirth are delayed, pregnancies at an older age are increasing,” said Kim Eui-hyeok, a professor of obstetrics and gynecology at CHA Ilsan Medical Center. “Pregnancy at an older age can raise the risk of pregnancy complications such as gestational diabetes and hypertensive disorders, and these factors also affect the decision on how to deliver.”

Some cases require surgery because of the condition of the fetus or the position of the placenta. In others, an attempted natural birth is switched to an emergency cesarean when labor fails to progress or the fetus shows signs of trouble. “A cesarean section is not necessarily required just because a pregnancy is at an advanced maternal age,” Kim stressed.

The rise has also been seen among younger mothers. The cesarean rate among mothers aged 34 or younger rose from 39.2 percent in 2016 to 67.7 percent last year. For first-time mothers, it rose from 45.6 percent to 74.8 percent.

Doctors say changing preferences among mothers also play a role.

“Mothers these days tend to wonder why they should have to endure labor at all,” said the director of a private obstetrics clinic who requested anonymity. “More and more of them say, ‘I’m going to have a C-section,’ from early in their pregnancy, even when there is nothing particularly wrong.”

Conditions in the medical system are also a factor. Korea’s teaching hospitals have faced staff shortages since the conflict between doctors and the government over medical school admissions began in 2024.

“Since the conflict between doctors and the government, shortages of trainee doctors and other staff have made it harder to handle emergency deliveries, and a shortage of anesthesiologists has sometimes made it difficult to give epidurals,” said an obstetrician at a university hospital who requested anonymity. If mothers have to endure labor without an epidural, it is hard for them to choose a natural delivery, the obstetrician added.

Fear of malpractice liability also plays a part.

“In the past, we recommended natural delivery if there was no particular problem, but these days we don’t make a point of recommending it,” the obstetrician said. “There is growing fear that even if we do our best, we could be held liable for hefty damages if the outcome is bad.”

The gap between regions has also widened. Based on mothers’ place of residence, Gangwon had the highest cesarean rate last year at 76.8 percent, followed by North Chungcheong at 76.7 percent and Busan at 75.9 percent. The rate was lowest in Gwangju, at 55.2 percent; it was 61.6 percent in Jeju. The gap between the highest and lowest regions grew from 12.9 percentage points in 2016 to 21.6 percentage points last year. Differences in delivery staffing and the ability to handle nighttime and emergency deliveries could be contributing to the gap.

The number of obstetrics clinics that can deliver babies is falling, and those that remain struggle to be ready for deliveries around the clock because of low national health insurance reimbursement rates and staff shortages, according to doctors in the field. As a result, even mothers who want a natural birth end up scheduling a C-section in advance rather than waiting for labor to start at an unpredictable time.

“There are many factors behind the rise in cesarean sections, including an increase in high-risk pregnancies, changing preferences among mothers and a shortage of delivery staff,” Rep. Kim said. “The most important thing is that mothers should be able to receive a full explanation and choose the delivery method that suits them.”

“The government must strengthen the obstetric medical work force and the safety net for medical accidents to guarantee both mothers’ right to choose and the safety of mothers and newborns,” he added.

BY RHEE ESTHER [[email protected]]