I think the first part is correct. There is probably an optimal rate of c-section which is materially higher than "strictly necessary" and optimizes for mom+baby health. What I am concerned about is the scheduled c-sections. For most births, there is not really a medically credible way to determine in advance that vaginal birth will be dangerous (as a relevant corrolary, consider that there is no way to meaningfully determine the weight of a baby prior to birth).

C-sections are scheduled in advance (sometimes over a month in advance) because the American medical system has optimized for cost reduction (which includes extreme risk aversion) rather than patient outcomes.

A c-section performed after several hours of active labor leads to a much higher chance of hemorrhage and danger to the baby than a scheduled c-section.

Additionally, there are many factors that can be used to determine the risk of natural birth.

It's many years since I had children but we were curious about home birth, and what I understood from looking into it was that there is, apparently, no significant difference in overall safety between home births and hospital births.

However, there was a significant difference in the reasons things went wrong. Because in a hospital you're more likely to receive unnecessary treatment due to the "cascade of intervention"; and interventions such as C-sections have inherent risk. While at home, you're more likely to have an actual emergency.

How well do they control for planned home births having lower risk profiles at the outset? For example, even had I been determined to try labor, I would have done so in a hospital, because I was 40 and have a hiatal hernia that will always be at risk of tearing further. I’d be an idiot to have tried at home.

I don’t recall. It’s a long time ago. I do remember that there were some other factors like proximity of home to hospital.

Mostly the advice we got was, if you have a medical condition that increases risk, then go to a hospital or a birthing centre. But if not, and you live reasonably close to a hospital, home birth is quite safe.

Unfortunately there are still very limited services for birth outside of hospitals in the US. Providers have a hard time getting regulatory approval and insurance, so they are selective in who they will take as homebirth or out-of-hospital birthing center clients. Basically, only people with very low risk profiles can make it through all the qualifiers for an attended out-of-hospital birth.

I am speaking from personal experience with births in one of the biggest US cities in the last five years. Anecdotally, I think that some less-dense areas have better CNMW practices and more access to midwives due to traditionally less access to hospitals, but it seems very variable.

Let's do it like with abortions- let people suffer, let's risk their health until it is clear they will die with intervention. Absolutely necessary is cruel standard.