“It’s payment-based. ”

Incorrect.

The C-section pattern looks entirely different. There is a huge spike first thing in the morning, another bump just before noon and a plateau in the early evening before the drop at night. There are very few C-section births at night. Roughly 10 times as many babies are born per minute during the early morning peak than the middle of the night. Whereas some C-sections are performed due to an emergency during birth, most are scheduled for varied reasons. Therefore, when a C-section takes place is heavily influenced by hospital schedules and the workweek, as is true for any other planned medical procedure.

A naturally-born baby is an emerging health crisis. The negative outcomes stretch all the way to neonatal and maternal death. The timeframe can be a dozen minutes to dozens of hours. Treatment is an unknown and emergent process involving many different specialists whose schedules are effectively locked down for the duration of labor.

A c-section baby is a surgical procedure that you can plug directly into Outlook. It is entirely managed by the medical team with zero input or influence from the patient. It is routine, it is repeatable, it is entirely divorced from the natural complications of birthing an infant naturally and consistently too large for a mother's hips.

A C-section rate of 10% to 15% is “natural”, she said. “Above 15%, you don’t have additional benefits, and you have the risks, and you have the unnecessary health costs.”

This is a really common number that nobody likes to talk about the source of. We like to say that 80% of women are perfectly capable of having an unassisted childbirth without any external help whatsoever - because prior to the advent of modern medicine, the infant mortality rate was around 20%. So - control for "modern medicine" and around one in five women is going to need some sort of medical intervention. That it's gone from around 15% to around 30% has a lot more to do with liability and scheduling than it does with "money."

Fun fact: 90% of private hospitals and 40% of public hospitals deliver by c-section in Brazil.