It is important to recognise that the World Health Organisation recommendations take into account all kinds of pregnancies, high and low risk. Although high risk pregnancies are often funneled into hospitals that are equipped with higher care facilities these larger hospitals also frequently have a higher overall number of childbirth admissions. A higher rate of C/S, say toward the 15% rather than the 5% would be expected in these hospitals but it is very difficult to understand a C/S rate of 30% - 50%+. A a clear description of the circumstances surrounding the statistics would be important in assessing how reasonable the intervention rates in a particular hospital are. I think, as Baby4 pointed out, it is important to describe the whole picture - why the C/S was performed, the health status of the women on presentation, the demographics of the population accessing the particular hospital/obstetrician, the idea of what constitutes high risk in the minds of the particular obstetricians evaluating the health status of these women. As with many childbirth questions it can be difficult to process the details of these situations so we may need sometimes to look back at the big picture which tends to reflect the general philosophies that probably abound in the institutions in question.