Caesarean section (CS) is an essential obstetric intervention when medically indicated, but its increasing use has become an important maternal-health and health-system issue internationally. South Korea represents a particularly important setting because its national CS rate has risen substantially while the number of births has declined. National Health Insurance claims analyses reported an increase in the CS rate from approximately 36.3% in 2006 to 40.6% in 2015, while a later national review reported an increase from 36.9% in 2012 to 58.7% in 2021 [Kim et al., 2020; Kim et al., 2023]. A nationwide population-based study using National Health Insurance data reported that the crude CS rate reached 67.4% in 2024 [Lee et al., 2026]. These trends occur in a context of advanced maternal age, changing parity patterns, declining fertility, assisted reproductive technology, multiple pregnancy, placenta previa, pre-eclampsia, changing obstetric practice, and health-system and medico-legal considerations [Kim et al., 2020; Kim et al., 2023; Lee et al., 2026]. This review synthesizes evidence concerning the epidemiology, indications, maternal and neonatal consequences, determinants, and policy responses relevant to caesarean delivery in South Korea. It emphasizes that a national CS percentage should not be interpreted as an appropriate target for individual hospitals or patients. The World Health Organization recommends case-by-case decision-making and the use of the Robson 10-group classification to understand the clinical composition of CS use rather than pursuing a predetermined population rate [WHO, 2017; WHO, 2021]. The paper proposes a South Korea-focused framework based on Robson classification, shared decision-making, evidence-based labour management, appropriate use of vaginal birth after caesarean (VBAC/TOLAC), audit and feedback, maternity-service quality improvement, and support for clinicians and women. The objective is not to promote vaginal delivery at the expense of safety, but to optimize the appropriateness, safety, and quality of mode-of-delivery decisions.
Keywords:Republic of Korea; caesarean section; cesarean delivery; maternal health; obstetric care; Robson classification; VBAC; TOLAC