The rate of caesarean section (CSR) in Great Britain (GB) and the U.S.A., 12% in England in 1989 ascertained from a survey performed by the authors, and 24% according to official U.S. figures, is higher than warranted by the known and agreed obstetric indications for this operation, which suggest a rate of 6-8% would be adequate. It is argued that the fall in perinatal mortality which has occurred over the period during which the CS rate has risen is not the main reason for this fall. The training of obstetricians to deal with anxiety, provision of primary maternity care by appropriately trained midwives and general or family practitioners, and changes in management protocols could cut the CSR. The number of women undergoing surgery every year in the U.K. could be reduced by 20,000 and in the U.S.A. by 470,000 if the rate of 6% were achieved. In studies of midwifery care the CSR is even lower and it is possible that labour proceeds more efficiently if the woman knows her caregivers and labours at home, as in The Netherlands. Although CS is much safer than in the past it is still more likely to result in the death of the woman and has significant morbidity for the woman and economic costs for society.