Hospital C-Section Rates Vary Widely. Women Often Can’t See the Data.

Roughly one in 10 pregnant ladies within the US undergoes a cesarean part that consultants say might have been averted. One of many strongest predictors of her threat of a medically pointless C-section is not her age, well being, or being pregnant problems — it is the C-section fee on the hospital the place she delivers.

The most effective methods to avert an pointless C-section is to decide on a hospital with low charges for the process, consultants say. But pregnant ladies on the lookout for this information might come up quick.

Solely 11 states make hospital C-section charges simply accessible on public web sites, Enterprise Insider discovered. Most states both say hospital C-section charges are confidential or launch information solely in response to formal public information or information requests. Some hospitals voluntarily disclose their C-section charges in response to annual client surveys; many don’t.

What outcomes is a patchwork of disclosures that may conceal important C-section fee swings throughout close by hospitals. Enterprise Insider requested C-section information from all 50 states and Washington, D.C. An evaluation of the primary 21 to supply information reveals some hospitals carried out surgical procedures on fewer than 5% of girls with low-risk pregnancies — those that are least more likely to require surgical procedure to securely ship their infants since they’re pregnant for the primary time, are at full time period, usually are not delivering twins, and whose infants are head-down fairly than breech. On the excessive finish, 10 hospitals operated on round 50%.

Maternal healthcare suppliers, lecturers who research C-section charges and maternal well being outcomes, and client advocates say that states’ determination to not publicly publish hospital C-section charges advantages some hospitals competing for sufferers — however deprives pregnant ladies of vital details about their healthcare.

“It is not a precedence for them, and admittedly, some hospitals are embarrassed by it,” mentioned Eugene Declercq, a professor of neighborhood well being sciences at Boston College who research the influence of federal and state coverage on maternal well being.

“Some hospitals simply minimize extra,” Declercq mentioned. “Individuals ought to know that.”

A far increased fee

Rachel Bruns, a communications specialist in Iowa, did not know the C-section fee on the hospital she picked.

Bruns, then 31 years previous, was wholesome and pregnant for the primary time with a full-term child positioned face-down — a super candidate for a vaginal supply, her medical information present. A couple of week previous her due date, Bruns’ physician induced her labor with Pitocin, a drugs that causes the uterus to contract.

Nurses maxed out Bruns’ Pitocin dosage, however she by no means dilated past 4 centimeters and by no means started to push. Bruns remembers her physician saying she was unlikely to ship vaginally. Bruns’ labor had “didn’t progress,” in line with her medical information, and her physician really helpful a C-section. Bruns, who says she was exhausted and scared, consented.

After her operation, mendacity within the restoration room unable to carry her new child daughter with out ache, Bruns felt a lingering, corrosive doubt: Was her surgical procedure really obligatory?

Bruns’ amniotic sac had not ruptured, so she remembered her physician mentioned she might have tried a second induction. Her labor had been lengthy — 16.5 hours, in line with her medical paperwork — however the American School of Obstetricians and Gynecologists says that ladies who’re induced, like Bruns, typically have considerably longer labors; even when their amniotic sac is ruptured, which accelerates labor, it might safely take as much as 18 hours to succeed in the energetic pushing stage. She and her child had been wholesome and had tolerated labor effectively, the sort of sufferers for whom, even in a chronic early labor, ACOG recommends a C-section “must be averted.”

Bruns could not shake it. She later requested Iowa’s Division of Public Well being and Human Providers for hospital C-section charges. The division initially mentioned these had been confidential, however finally launched them after a prolonged negotiation.

The info was stark. Within the yr Bruns delivered her daughter and within the 4 successive years, the hospital the place she delivered had a C-section fee 15% increased than the state common, a discovering Enterprise Insider’s personal evaluation of Iowa hospital supply information confirmed. Over those self same 5 years, docs at her hospital carried out surgical procedures on ladies with no prior C-sections, like Bruns, at practically double the speed on common because the docs at a hospital situated 2 miles away.

“It is arduous to make peace with,” Bruns mentioned. “If I had recognized, I might have chosen a distinct hospital.”

The Iowa Division of Well being and Human Providers didn’t reply to Enterprise Insider’s request for remark.

When medically obligatory, a C-section is a lifesaving surgical procedure. A recent large study discovered that as much as 19% of all deliveries must be C-sections to guard the well being and lives of girls and their infants.

The US C-section fee is way increased — over 32%. That means that round one in three C-sections may very well be averted, eliminating practically half 1,000,000 surgical procedures annually that depart ladies at a better threat of hemorrhages, blood clots, and infections, and extra more likely to develop harmful problems in future pregnancies.

Particular person hospital C-section charges differ broadly, starting from extremes as little as 7% and as excessive as 70%, a latest research of information from 44 states reveals. A girl’s age, well being, whether or not she’s overweight, and pre-existing circumstances, resembling diabetes or a earlier C-section, might enhance the prospect that her child is most safely delivered by C-section.

A number of research doc that the hospital a girl chooses stays considered one of her greatest threat components for present process a medically pointless C-section, after controlling for age, well being, race, hospital supply quantity, and a number of different variables.

The supply enterprise

“Some hospitals do extra pointless Cesarean deliveries than different hospitals,” reads an internet site run in partnership with California’s Division of Public Well being that hyperlinks to annual C-section fee information for every hospital within the state. To decrease your threat of surgical procedure, the positioning recommends, “select a hospital with decrease Cesarean supply charges.”

Such transparency is uncommon.

Seven different states with a mixed 23 million residents — Arizona, Arkansas, Colorado, Hawaii, Idaho, Nebraska, and South Dakota — advised Enterprise Insider that hospital cesarean supply fee information is confidential, both by division coverage or state legislation. The Louisiana Division of Well being mentioned the state doesn’t monitor C-section charges by hospital — the one state within the nation that claimed to not monitor this data.

Alaska initially cited confidentiality, however launched the info after Enterprise Insider requested extra details about the division’s insurance policies.

An Idaho Division of Well being and Welfare spokesperson advised that Enterprise Insider ask the state’s hospital affiliation, a non-public commerce group. The Idaho Hospital Affiliation and the Idaho Medical Affiliation didn’t reply to Enterprise Insider’s requests for remark. The hospital associations for the seven different states didn’t reply to Enterprise Insider’s request, declined to supply hospital C-section fee information, or mentioned their group doesn’t monitor C-section charges.

A spokesperson from the Hawaii State Division of Well being advised Enterprise Insider the division has a “long-standing coverage” in opposition to publicly disclosing hospital C-section charges, saying comparisons can be unfair to hospitals.

“C-section charges might differ considerably attributable to variations in affected person populations,” the Hawaii spokesperson wrote, “in addition to variations in hospital practices, capability, or out there companies.”

Dozens of different states and Washington, D.C., don’t readily publicly publish hospital C-section charges. As an alternative, they solely launch that data in response to public information or information requests, typically for a hefty payment. The Utah Division of Well being and Human Providers, for instance, initially priced the info at $1,800 when reached in mid-September.

When reached for remark in October, Josie Thacker, a spokesperson for the Utah Division of Well being and Human Providers, mentioned that hospital C-section charges in Utah would finally be out there without spending a dime on a public web site, which is present process an replace.

“Till the replace is full, the payment for the info you requested is $900,” Thacker wrote to Enterprise Insider in an e-mail.

By maintaining C-section charges out of the general public eye — both by withholding information or not making it readily accessible — well being departments put the pursuits of hospitals over pregnant ladies’s rights to make knowledgeable decisions about their medical care, consultants advised Enterprise Insider.

Hospitals historically function labor and supply departments at a monetary loss except affected person quantity and insurance coverage reimbursements are saved excessive, in line with former hospital directors and up to date business evaluation. Every affected person — each girl in labor and child delivered — is efficacious to hospitals seeking to flip a revenue.

Some hospitals go to extremes. Two lawsuits particularly, whereas neither includes allegations of medically pointless C-sections, illustrate the lengths some hospitals allegedly go to seize a bigger share of the supply market.

In 2016, Tenet Healthcare Company, which on the time operated 79 hospitals, paid over $513 million to settle federal and state costs accusing the hospital big and its subsidiary hospitals in Georgia of participating in an unlawful kickback scheme to swell their supply enterprise. Tenet admitted accountability and agreed to a court-appointed monitor, and two of its subsidiaries pleaded responsible to conspiracy to defraud the US and violate the federal Anti-Kickback Statute.

That very same yr, a 2016 jury awarded $16 million in damages in a civil swimsuit in opposition to Brookwood Medical Middle in Birmingham, Alabama, a hospital that on the time was majority-owned by Tenet, partly for launching an aggressive advertising blitz on tv, billboards, and social media promoting labor care philosophies and facilities that had been, in actuality, unavailable or immediately conflicted with the hospital’s personal care insurance policies, in line with courtroom filings.

The jury discovered Brookwood was liable for reckless fraud and medical negligence. Brookwood’s present spokesperson referred Enterprise Insider to Tenet for remark. Tenet didn’t reply to Enterprise Insider’s queries.

A patchwork of hospital disclosures

With every pregnant girl’s selection of the place to ship so arduous fought, a hospital’s low C-section fee might grow to be an promoting benefit; a excessive fee, a weak spot. Comparatively low C-section charges are utilized in promotional supplies at massive hospital methods like Kaiser Permanente or Sutter Well being.

Some hospitals argue that C-section fee disclosure would bias customers in opposition to amenities with increased C-section charges, mentioned Dr. Emily White VanGompel, a household medication physician and professor on the College of Illinois Chicago who research how organizations influence C-section charges.

Their argument is easy: If potential sufferers can search for a hospital’s supply fee information, “they’ll simply all go to see the hospital with the bottom C-section charges,” White VanGompel mentioned, which may very well be unfair to hospitals that deal with extra ladies with difficult or high-risk pregnancies. That logic falls aside on nearer scrutiny, she advised Enterprise Insider, since many hospitals that serve high-risk pregnant ladies nonetheless handle to maintain their low-risk C-section charges low.

To higher evaluate C-section charges at hospitals that deal with various kinds of sufferers, maternal well being consultants advocate trying on the fee docs function on low-risk pregnancies. Girls with low-risk pregnancies are the least more likely to require surgical procedure to securely ship their infants, so this metric is without doubt one of the greatest to guage a hospital’s potential cesarean overuse.

Specialists say a hospital’s administration and supply insurance policies have an outsize affect on the variety of C-sections it performs. Publicly disclosing hospitals’ low-risk C-section charges not solely advantages ladies as customers however might additionally encourage hospitals to securely help extra vaginal deliveries, mentioned White VanGompel, Declercq, and 4 different public well being and maternal well being researchers on the colleges of medication at Stanford College, Johns Hopkins College, the College of Michigan, and Harvard.

In California, hospitals collaborating in a state-led initiative to decrease low-risk C-section charges publicly printed their C-section charges, amongst different maternal healthcare enchancment methods. Over 5 years, the state’s low-risk C-section fee declined from 26% to 22.8% — a 12% drop.

Some hospitals already voluntarily disclose their low-risk C-section fee by way of a maternal well being survey performed yearly by The Leapfrog Group, a healthcare transparency and client advocacy group that publishes the ends in a searchable database. In 2024, over 1,700 hospitals — round 70% of these surveyed — disclosed maternity care high quality information, together with C-section charges, in line with the group’s 2025 maternal healthcare report.

Vital blind spots stay. Springhill Medical Middle, the one for-profit hospital in Cellular, Alabama, for instance, declined to answer Leapfrog’s 2025 survey. Medical doctors at that hospital carried out surgical procedures on 37.5% of girls with low-risk pregnancies on common between 2018 and 2024 — among the many highest common charges within the state over those self same years, in line with Alabama Division of Public Well being information obtained by Enterprise Insider after submitting a knowledge request.

It is not recognized if any of these C-sections might have been averted, however the lack of publicly out there information meant expectant moms couldn’t evaluate Springhill’s fee to these of surrounding hospitals.

Springhill’s common low-risk C-section fee from 2018 to 2024 was 33% increased than at a close-by hospital with roughly the identical variety of low-risk deliveries, and practically 47% increased than a college instructing hospital that focuses on ladies with higher-risk pregnancies. The three hospitals are situated inside 6 miles of each other.

“Springhill Medical Middle stays dedicated to protected, evidence-based take care of all sufferers,” Deanna Kyrimis, the president and CEO of Springhill, wrote in an announcement to Enterprise Insider. “We rigorously monitor our scientific outcomes and have interaction in a complete high quality evaluate course of — together with case-by-case evaluations of cesarean deliveries — to make sure they align with medical necessity and greatest practices, supporting the best commonplace of take care of moms and infants.”

Enterprise Insider recognized comparable patterns of hospitals declining to open up to Leapfrog comparatively excessive C-section charges for low-risk pregnancies in Alaska, Maine, Maryland, Massachusetts, Mississippi, Nevada, Rhode Island, Vermont, Washington, and Wisconsin.

In Arkansas, the place hospital C-section charges are confidential, greater than 1 / 4 of girls with low-risk pregnancies ship their infants by C-section — the tenth highest fee within the US, in line with federal information.

Of the Arkansas hospitals surveyed, 40% declined to answer Leapfrog’s maternal well being survey. None of these Arkansas hospitals contacted by Enterprise Insider disclosed their low-risk C-section fee.