Objectives. A steady increase in the cesarean section rate has been observed in most countries over the past 20 years. This trend has sparked a controversial debate regarding the risks and benefits associated with cesarean section. The objective of this study was to estimate the risk of postpartum maternal death directly attributable to cesarean section. Method. This is a case-control study. Cases were selected from deaths identified in the confidential national survey of maternal deaths for the period 1996–2000. To limit indication bias, deaths due to pre-existing conditions, multiple pregnancies, and women hospitalized during pregnancy were excluded, resulting in a sample of 65 cases. The sample of 10,244 controls was identified from the 1998 National Perinatal Survey. Results. After adjustment, cesarean delivery is associated with a 3.5-fold increased risk of postpartum maternal death compared with vaginal delivery (OR 3.52 [95% CI 2.07–5.98]). This risk is significant for cesarean sections performed before or during labor. Cesarean section is associated with a significantly increased risk of death due to anesthesia complications, infection, and thromboembolism. Conclusion. Even today, delivery by cesarean section is associated with an increased risk of postpartum maternal mortality. This factor must be taken into account when choosing the mode of delivery for each woman. Understanding the causes involved in this increased risk can aid in the implementation of preventive strategies during cesarean sections. (R.A.)