During the years 1973–81, the cesarean section (CS) birth rate increased from 5.5% to 12.4% in Sweden. During the same time, perinatal mortality declined from 12 to 7.1 per thousand children. The rates of CS and perinatal mortality, however, cannot be presented as reciprocally dependent variables without taking into consideration many of the other factors that have been at work during the same decade, e.g. improved results of the neonatologists in the lower weight groups, electronic fetal monitoring, use of steroids, introduction of tocolytic agents. The present study revealed that the incidence of CS could vary between 8% and 19% between different obstetric departments in Sweden during 1981. Despite this great difference in CS rate, no difference was noted in the rates of asphyxia or perinatal mortality. It is concluded that in the present study we have seen no indication that a marked increase in the CS rate would improve our present perinatal survival data and furthermore it still remains unproven that CS and perinatal mortality rates necessarily have a reciprocal relationship.