The cesarean rate has reached an all-time high at 29.1% of all births in the United States. In this column, the risks inherent in cesareans are discussed within the context of the current climate of "intervention-intensive" labor and birth, forced cesareans, the precipitate decrease in vaginal births after cesarean, and the alarming increase in primary cesarean, including "patient-choice" cesareans. Strategies to increase women's confidence and to promote, protect, and support normal birth are discussed as ways to decrease the cesarean rate.