PURPOSE:
To examine the contributing factors behind the rising rates of elective caesarean sections in South India—particularly the influence of culture and technology—and explore how midwifery can serve as a critical intervention in reclaiming and promoting normal birth.

DISCUSSION:
Deeply rooted cultural norms—such as auspicious birth timings, fear of labor pain, and the association of c-sections with modernity—continue to influence women’s expectations. These are now intensified by a growing culture of instant gratification where planned and painless births are preferred over the unpredictability of labor. This shift carries serious implications: increased maternal and neonatal risks, higher healthcare costs, and diminishing trust in natural birth. Midwifery offers a vital, evidence-based alternative—focused on informed choice, respectful care, and support for physiological birth. However, South India, like much of the Global South, faces a critical shortage of trained and empowered midwives, especially in the private sector.This issue extends beyond India. Many developing countries face similar challenges, including urbanization, digital influence, weakening traditional birth supports, and gaps in midwifery services. Therefore, insights from South India hold wider relevance for global maternal health systems. This presentation stresses the urgent need to expand midwifery education, regulation, and integration globally.

EVIDENCE WHERE RELEVANT:
According to recent data, the Cesarean section rate in some Indian states in the private sector is nearing 70%, the rate of pregnancy complications is much less, around 40%, indicating that the rise in c section rates is most likely due to non-clinical factors. Through a systematic review, data collection, and patient interviews - a repetitive theme of maternal desire to avoid labor pain was noted as the reason for surgical delivery.

KEY MESSAGE:
The increasing preference for elective caesarean sections in India reflects a global trend reshaping childbirth practices. To ensure safe, informed, and woman-centered care, substantial investment in midwifery is essential as a cornerstone of maternal health worldwide. Climate change 1