OBJECTIVES: The recent large increase in caesarean sections (CSs) in Europe seems not to be completely justified: CS is practiced independently of epidemiological evidence.  This work analyses the costs and benefits effectively involved in alternative methods of delivery- vaginal delivery (VD), with and without epidural analgesia, and planned caesarean. METHODS: The empirical analysis has been conducted in an Italian University hospital, through direct collection of data, questionnaires and interviews to patients and staff.  A logistic regression has been used to model the probability of the event “delivery with planned caesarean section” occurring as a function of a set of clinical and socio-economic characteristics of the women.  A micro-costing analysis has been used to assess the direct health costs, following an activity-based costing approach. From a societal perspective we consider also the indirect and the intangible costs of each method. Patients’ wellbeing is measured through appropriate anonymous instruments - the State-Trait Anxiety Inventory, the Italian Questionnaire of Pain and the Childbirth Perception Questionnaire- to measure the changes in clinical and psychological dimensions due to the delivery experience. RESULTS: The results confirm the hypothesis that CS is widely performed for non-medical reasons (Osborn, 1995). The analysis shows that CS is, on average, more expensive than VD, but the difference is marginal if we take into account the opportunity-cost of labour time. CONCLUSIONS: Since CS is generally reimbursed more than VD to cover the supposed higher costs of surgery, differences between the real costs and the DRG tariffs may induce opportunistic behaviour in terms of clinical practice.  We show that, in general, VD with analgesia provides better results both in terms of costs and, but the final effect of its introduction is not clear: it may reduce the frequency of inappropriate caesarean sections, but it may also increase the costs due to complications