OBJECTIVES: The aim of the study is to compare delivery mode in hospital (vaginal and cesarean) between two European countries, according to patient’s comorbidities as diabetes, age, multiple pregnancies, obesity, and prematurity. METHODS: A retrospective cohort was performed from national PMSI (France) and CMBD (Spain) public databases 2006 to 2014. Multivariate regression was done to model cesarean delivery according to comorbidities. All of childbirth hospitalizations were extracted by selecting DRG. Comorbidities were identified according to each country diagnosis classification’s (ICD 10 for France and ICD-9 for Spain). RESULTS: The number of annual hospitalization for childbirth is stable in France around 800,000 stays (-2% between 2006 and 2014). In the public Spain sector, we observed a decrease of 12% between 2006 and 2014 with almost 330,000 stays in 2014. The cesarean rate in 2014 is 20% in France versus 22% in Spain and increased by 2% between 2006 and 2014 for France and decreased by 12% for Spain. The median age is 30 years in 2014 for France versus 32 years for Spain and has increased by one year between 2006 and 2014 in the two countries. The standardized caesarean rate is 1% higher in Spain and + 1.2% for prematurity, and + 0.3% for multiple births. Multivariate analysis of cesarean deliveries highlights a significance of all risk factors (age, prematurity, diabetes, obesity and multiple births). The multiple pregnancy is the first risk of cesarean delivery with an OR of 5.36 (5.10-5.63) for Spain versus 3.85 (3.72-3.98) in France. The second risk is the prematurity in France with an OR of 2.03(1.98-2.08) and the diabetes in Spain with an OR of 1.90(1.81-2.00). CONCLUSIONS: Multiple pregnancy is the most important risk factor for cesarean delivery for Spain and France. The second risk factor is obesity for Spain and prematurity for France.