Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19 percent of births in France, seventeen percent of births in Japan, and sixteen percent of births in Finland. How did this happen? Here the author challenges most existing explanations of the unprecedented rise in c-section rates, which locate the cause of this trend in physicians practicing defensive medicine, women choosing c-sections for scheduling reasons, or women's poor health and older ages. The explanation of the c-section epidemic is more complicated, taking into account the power and structure of legal, political, medical, and professional organizations; gendered ideas that devalue women; hospital organizational structures and protocols; and professional standards in the medical and insurance communities.