During the years 1951-1980 the cesarean section rate in Sweden increased from 1.7% to 11%. In connection with this procedure 103 maternal deaths were reported, of which 49% were related to age as risk factor. The overall fatality rate declined from 5.1 to 0.4 per 1,000 operations; cesarean section mortality decreased from 8.6 to 4.4 per 100,000 births. The altered age distribution amongst the parturients contributed to a decrease of 17% in mortality. Half of the deaths were attributed to the surgical procedure. During the 1970s these complications constituted a six-fold risk increase of abdominal over vaginal delivery, and complications attributed to the surgical procedure of abdominal delivery comprised 19% of the maternal mortality during the same period.