One word. Malpractice. I'd like to see a study comparing rates of C-sections to cost of malpractice in the state. Docs are terrified of malpractice, and in some states it has gotten outrageous. For instance, in West Virginia you lose your malpractice when you are named in two lawsuits. That doesn't mean that the person has to win, just that they bring a suit. If you put yourself in a doctor's shoes and think about losing your job if you have a bad outcome, you can understand why they do a section if there is even a hint of fetal distress, etc. Sadly, more lawsuits are filed over NOT doing a section when the baby had an issue than doing one.
So, maybe when states start putting caps on lawsuits and people start suing doctors for doing unecessary sections, the section rate will decline. Just sharing my opinion for whatever it's worth.