Rates of caesarean delivery have increased in nearly all OECD countries, although in a few countries this trend has reversed at least slightly in the past few years. Reasons for the increase include the rise in first births among older women and in multiple births resulting from assisted reproduction, malpractice liability concerns, scheduling convenience for both physicians and patients, and the preferences of some women to have a caesarean section. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries, raising questions about the appropriateness of caesarean delivery that may not be medically required.