The report suggests a number of reasons for the increase in cesareans.
To a great extent, the report says, the increase is attributable to women who are higher risk because they are older, are obese or have diabetes, or took fertility-enhancing drugs that make multiple births more likely.
However, Wolfe's report says a predominant reason for the increase is due to physicians who "may find it advantageous to schedule deliveries," and cesareans take "a fraction of the time that the average vaginal birth does."
Also, he says, "Physicians and hospitals may have a financial incentive to perform cesareans. When payment is global and providers receive a fixed fee regardless of type of delivery, they may have an incentive to intervene surgically to avoid a longer procedure.
"Fee schedules favor cesareans: Nationally they average approximately $10,958 while vaginal deliveries average $7,737."
Another reason is technological, because now physicians have more ways to screen for problems and to intervene. And risks of anesthesia have diminished so doctors are less reluctant to use sedation.
Wolfe says that 50 years ago when he was in medical school, the cesarean rate of 5% was acknowledged as way too low because women who should have had them were not given the opportunity. The percentage moved up to 20% over the years, "but then it kept rising, to 25 and 30%."