Graphic: Igor Vujcic/BIRN.
November 10, 2026
Balkan Insight
By Eleni Stamatoukou
Key Takeaways:
Nearly 63% of births in Greece in 2025 were by caesarean section, one of the highest rates in the EU, driven by time pressures, staff shortages, limited midwife-led care and insufficient training in vaginal birth.
Many women reported feeling pressured into unnecessary C-sections, with poor informed consent and lasting trauma, while experts note rates above 10% do not reduce mortality and raise risks.
Proposed remedies include midwife-led care, natural-birth centres, Robson classification audits and hospital incentives, but implementation remains stalled amid resistance and no national oversight.
Five weeks before her due date, Mirela’s doctor told her the baby was in the breech position, lying bottom or feet down.
The doctor proposed a caesarean section, but Mirela, a 32-year-old electrical engineer from the island of Crete, was reluctant and asked why. Responding to a BIRN online questionnaire, Mirela recalled her doctor growing annoyed and telling her to “do what you want, at your own risk”.
Mirela asked about a non-invasive procedure in which the foetal position is manipulated, but, she said, the doctor insulted her and dismissed the procedure as dangerous. Eventually, the baby turned on its own, head down. Nevertheless, the doctor insisted on inducing labour, claiming that “the baby was big”.
Mirela tried unsuccessfully to find another doctor and eventually agreed to an induction. Thirteen hours passed without a contraction, during which time Mirela couldn’t eat and her water intake was rationed. Weak and worried, she underwent a C-section. This was January 2025.
Mirela said she suffered “nightmares for months” afterwards and had to seek psychological help.
According to the Hellenic Statistical Authority, ELSTAT, almost two-thirds [62.7 per cent] of births in Greece in 2025 were by C-section, up from 58.4 per cent in 2020.
In 2023, EU data placed Greece fifth in the bloc in terms of rates of C-sections, behind Turkey, Cyprus, Romania and Bulgaria.
Experts blame the rate on a desire among doctors as well as parents “to save time”, as well as shortages of midwives and anaesthesiologists, a lack of doctor training in natural childbirth, and not enough information for young couples.
Experts blame the rate on a desire among doctors as well as parents “to save time”, as well as shortages of midwives and anaesthesiologists, a lack of doctor training in natural childbirth, and not enough information for young couples.
C-sections “are not treated as a surgical procedure,” but rather as an “expected outcome of pregnancy,” said Kleanthi Gourounti, a professor in the Department of Midwifery at the University of West Attica and Vice President of the Midwives’ Association of Athens.
Obstetrician Ioannis Mouzalas, a vocal advocate of natural childbirth, told BIRN: “It is a solution for the obstetrician that used to save money, but now it saves time, unless you consider that time is money.” At his clinic, the C-section rate is between 18 and 22 per cent.
“I’ve come to believe that natural childbirth will remain the minority, not only because of doctors but also because of the mindset of just wanting to ‘get the birth over with’,” Mouzalas said. “Nevertheless, I think it’s worth trying to increase natural childbirth. Not for ideological reasons, but for scientific reasons.”
‘We could have waited’
Maria, a 37-year-old lawyer, gave birth to her first child in August at a public hospital in Athens via a C-section. The procedure was deemed medically necessary “due to the baby’s breech presentation and the umbilical cord being wrapped twice around its neck and shoulder”, she said.
Maria had preferred a vaginal birth, and her doctor, whom she had chosen because she trusted him, encouraged her to wait and try certain exercises to help the baby change position, but to no avail.
“I felt a bit disappointed,” Maria said, but “I accepted the decision, prioritising my child’s safety”.
Gourounti said it “goes without saying that a C-section can be lifesaving for both the woman and the foetus”.
“The issue, however, is that there must be documentation justifying the necessity of every C-section.”
The Hellenic Obstetrical and Gynaecological Society has set guidelines for performing C-sections.
But what happens in cases where a C-section is not necessary?
Another respondent to the questionnaire, Eftichia, quoted her doctor as saying: “When women reach their 39th week, I induce labour. I don’t let them go any longer.”
Eftichia, a 34-year-old police officer, had attended seminars led by independent midwives in Athens during her first trimester. While she preferred a vaginal birth, the seminars had prepared her for every eventuality.
During one of her check-ups, her doctor mentioned that there was low amniotic fluid and suggested that her waters might have broken without her realising; the very next day, he “announced that he was going to break my waters”.
The induction began at 9:00 a.m., but by 6:00 p.m., there was still no cervical dilation. She was told that the baby’s position was preventing pressure on the cervix, which is necessary for dilation to begin, so a C-section was performed.
“That is why I believe that if we had waited just one more week, I might have been able to give birth naturally, even with an induction,” Eftichia said. “The baby would have descended and moved into the proper position, something that didn’t happen because, for some reason, we were in such a rush.”
The cause of Greece’s high rate of C-sections is “multifactorial”, said Dimitra Kentrifylli, an independent midwife and lecturer in the obstetrics department at the Metropolitan College in Thessaloniki.
They begin with “the wrong prenatal care monitoring plan”.
“Normally, there should be midwife-led care for low-risk pregnancies,” said Kentrifylli, in “close collaboration with obstetricians”.
Research shows that midwife-led births are less likely to involve medical intervention as midwives are more likely to treat childbirth as a natural process and focus on psychological support and the position of the mother.
“When a woman in labour has a midwife continuously by her side, the likelihood of needing a Caesarean section decreases, and overall birth outcomes improve,” said Apostolos Athanasiadis, president of the Hellenic Society of Obstetrics and Gynaecology.
“This is because the care provided is truly personalised – essentially one-on-one – allowing a strong relationship of trust to develop between the midwife and the woman,” he added.
Other factors include a shortage of anaesthesiologists and midwives, a lack of public awareness, and a failure to conduct regular evaluations of the service provided by healthcare bodies.
According to the World Health Organisation, WHO, C-section rates above 10 per cent do not reduce mortality but instead increase health risks for both mother and baby.
Kentrifylli said that fear of childbirth drives many women to request C-sections, yet this fear remains “unrecognised”.
Of 14 women who told BIRN it was their wish to have a C-section, nine said they were afraid of a natural birth.
Likewise, Mouzalas said, some young obstetricians also turn to C-sections “out of fear or panic” because they don’t have enough experience of natural births.
According to Gourounti, when you have a high rate of C-sections, new resident doctors and midwives do not get to practice vaginal deliveries, and thus “the skill is lost”.
Are women given enough information?
Niki* was eight months gone when her doctor told her the baby was “too big”, that she had a “very narrow pelvis”, and that the baby would “tear her apart”.
Despite her partner’s objections, Niki agreed to a C-section.
“A doctor is someone to whom you entrust your body,” she said. “It is extremely difficult to shatter that trust; it’s like choosing to turn a blind eye – as if you don’t want to hear the truth.”
She describes the birth of her child as “an unforgettable, negative experience”.
“I didn’t see that, through this, I had gained a child. All I saw was that I had ended up with an incision on my abdomen.”
Almost half of respondents said they felt steered or pressured into undergoing a C-section.
Gourounti said the question is “to what extent the choice, the consent to all of this, is truly informed”.
More than two thirds of respondents said they did not receive any prenatal information about birth options from their midwife or doctor.
Angeliki, a 38-year-old teacher, said she underwent a C-section she now believes was not medically necessary.
In her response to the BIRN questionnaire, she cited “the importance of women being well-informed promptly, choosing appropriate healthcare professionals, and receiving support during childbirth and breastfeeding”.
Gourounti said women must also actively seek information: “We are currently living in an era where information is available online. We can access it. Furthermore, we should certainly press the professional we are consulting to discuss this with us. In other words, women themselves need to assert their rights”.
Ioanna Vasilaki, an independent midwife and president of the Association of Independent Midwives of Greece, EAMME, said doctors will sometimes suggest inducing labour so the baby can be delivered during his or her shift. Often this ends in a C-section.
A third of respondents said their labour was induced; a quarter of these women said they were not told why.
Half who underwent C-sections said it was conducted as an emergency procedure.
Gourounti said it was “quite strange that when you go to give birth, one in two women ends up having some kind of difficulty or medical issue that arises during labour, necessitating an emergency C-section”.
According to Giorgos Daskalakis, professor of obstetrics and gynaecology at the National and Kapodistrian University of Athens and director of the first obstetrics and gynaecology clinic at the public Alexandra Hospital, some doctors in public hospitals outside Greece’s main urban centres work too many shifts, “so it is extremely difficult for them to spend too much time performing normal deliveries on women”.
Midwives say that often epidurals are not provided to women giving birth vaginally because there aren’t enough anaesthesiologists in Greece.
According to a report in the Greek newspaper Kathimerini in 2024, there are roughly 1,000 anaesthesiologists in Greece. The Hellenic Society of Anaesthesiology puts the figure at 750, in a country of some 10.5 million people. That’s far fewer than global healthcare bodies recommend.
“If you pay,” said Kentrifylli, “if you find a hospital doctor and they see you privately in their office and take you to the emergency room without it being time for you to give birth and put you in a labour induction position, then you will have the option of an epidural.”
Daskalakis said that issues with the legal framework in the event of alleged malpractice are also driving doctors to err on the side of caution by recommending C-sections.
“Consequently, every time a complication arises, the simple question asked is: ‘If a C-section had been performed, would things have turned out differently? Would it have been better?’ And the inevitable answer is that a caesarean section would obviously have led to a better obstetric outcome. Terrified of legal repercussions, doctors are highly susceptible to performing a C-section just to get through the process easily.”
In mid-2024, a law was passed allowing for the creation of Natural Birth Centres within public hospitals and independent institutions, where midwives would oversee deliveries. Amid what midwives say is resistance from obstetricians, no such centre has been opened in the public health system. One private centre was opened, but it closed in January this year, citing financial constraints.
Daskalakis is not enthusiastic about such birth centres. Instead, to encourage natural childbirth, he says staffing should be approved, uniform protocols introduced, and public awareness raised.
Financial incentives?
Daskalakis also argues for bonuses for hospitals that cut their own rate of C-sections.
“The money won’t go into someone’s pocket,” he said. “It will go to the hospital, which will automatically have an incentive to monitor the process because it will receive a bonus.”
Mouzalas, however, said the way a birth is handled should have nothing to do with “economic or ideological” considerations. “It should be related exclusively to scientific reasons”.
In 2017, the WHO proposed the use of the Robson classification as the global standard for assessing and comparing C-section rates across healthcare facilities.
The Robson classification was applied for the first time in 2019 by scientists in Greece to identify trends in caesarean births by examining 8,572 women in a private health facility. Just under 61 per cent of births were caesareans, 34.6 per cent were induced, and 30.7 per cent were births after a previous C-section.
However, in Greece, there is a complete absence of any oversight mechanism for C-sections.
“There is no system in place to require every hospital and every physician to provide a substantiated explanation as to why they deemed a C-section necessary,” said Gourounti, who expressed doubts regarding the widespread application of the Robson classification system in Greece.
“Each hospital and each doctor must provide a substantiated explanation as to why they deemed the choice of a caesarean section necessary,” she said.
Professor Athanasiadis told BIRN that the Robson classification is used in all Obstetrics and Gynaecology departments of the Aristotle University of Thessaloniki, as well as at the Aretaieion and Alexandra public hospitals in Athens, though he stressed he cannot speak for all Ob-Gyn departments across Greece.
According to him, the Robson classification serves as an “internal audit” tool that helps refine clinical practice and reduce unnecessary C-sections. He also underlined that the Robson system can be implemented in public hospitals, but not in private ones, which do not have a departmental structure but instead rely on collaborating private physicians.
The role of the midwife
Gianna, a 33-year-old literature teacher in Athens, faced a number of complications during her pregnancy and, fearing something might go wrong, agreed to be induced.
When the induction didn’t work, a C-section was performed.
“For me, it was a traumatic experience that left me feeling like a failure and filled with guilt,” said Gianna*.
She was left with numbness in her abdomen, and difficulties with breastfeeding took an even greater toll on her emotional well-being.
Almost 40 per cent of respondents described their experience of childbirth as negative, saying it had left them traumatised.
“It is deeply concerning to see such high rates of C-sections, alongside a large proportion of women who return home after giving birth feeling that the entire experience was traumatic, all this in a country facing a severe demographic crisis,” said Gourounti.
For Mouzalas, the increasing number of C-sections is also due to the “distortion of the midwifery profession” in Greece, which is too often marginalised.
In Greece, prenatal care and pregnancy monitoring are usually carried out by obstetricians.
“About one per cent of pregnant women will turn to a midwife as their first healthcare professional,” said Kentrifylli, who, as an independent midwife, supports low-risk, at-home deliveries as well as in private hospitals.
Midwives’ associations have long demanded official job recognition that ensures their professional autonomy and reflects their full scope of competencies.
In February, the health ministry withdrew a draft job description, which midwives criticised as degrading “the scientific and autonomous role of the midwife”.
“The Ministry committed that the responsibility for childbirth would remain with the midwife within the primary healthcare setting,” said Gourounti. “They stated that they would review the text with legal experts and then sign it. Unfortunately, as we speak, this has not yet happened.”
Mouzalas told BIRN: “We need a model where doctors and midwives do not compete, but compete for a common goal.”
The Greek Ministry of Health has not responded to BIRN’s questions.
*Some names have been changed to allow interviewees to remain anonymous.
About Balkan Insight
The Balkan Insight (formerly the Balkin Investigative Reporting Network, BIRN) is a close group of editors and trainers that enables journalists in the region to produce in-depth analytical and investigative journalism on complex political, economic and social themes. BIRN emerged from the Balkan programme of the Institute for War & Peace Reporting, IWPR, in 2005. The original IWPR Balkans team was mandated to localise that programme and make it sustainable, in light of changing realities in the region and the maturity of the IWPR intervention. Since then, its work in publishing, media training and public debate activities has become synonymous with quality, reliability and impartiality. A fully-independent and local network, it is now developing as an efficient and self-sustainable regional institution to enhance the capacity for journalism that pushes for public debate on European-oriented political and economic reform.
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