C-section rates vary widely by hospital, but women often can’t see the data

Getty Images; Alyssa Powell/BI

Roughly one in 10 pregnant women in the US undergoes a cesarean section that experts say could have been avoided. One of the strongest predictors of her risk of a medically unnecessary C-section isn’t her age, health, or pregnancy complications — it’s the C-section rate at the hospital where she delivers.

One of the best ways to avert an unnecessary C-section is to choose a hospital with low rates for the procedure, experts say. Yet pregnant women looking for this data may come up short.

Only 11 states make hospital C-section rates easily accessible on public websites, Business Insider found. Most states either say hospital C-section rates are confidential or release data only in response to formal public records or data requests. Some hospitals voluntarily disclose their C-section rates in response to annual consumer surveys; many do not.

What results is a patchwork of disclosures that can hide significant C-section rate swings across nearby hospitals. Business Insider requested C-section data from all 50 states and Washington, D.C. An analysis of the first 21 to produce data reveals some hospitals performed surgeries on fewer than 5% of women with low-risk pregnancies — those who are least likely to require surgery to safely deliver their babies since they are pregnant for the first time, are at full term, are not delivering twins, and whose babies are head-down rather than breech. On the high end, 10 hospitals operated on around 50%.

Maternal healthcare providers, academics who study C-section rates and maternal health outcomes, and consumer advocates say that states’ decision not to publicly publish hospital C-section rates benefits some hospitals competing for patients — but deprives pregnant women of critical information about their healthcare.

“It’s not a priority for them, and frankly, some hospitals are embarrassed by it,” said Eugene Declercq, a professor of community health sciences at Boston University who studies the impact of federal and state policy on maternal health.

“Some hospitals just cut more,” Declercq said. “People should know that.”

A far higher rate

Rachel Bruns, a communications specialist in Iowa, didn’t know the C-section rate at the hospital she picked.

Bruns, then 31 years old, was healthy and pregnant for the first time with a full-term baby positioned face-down — an ideal candidate for a vaginal delivery, her medical records show. About a week past her due date, Bruns’ doctor induced her labor with Pitocin, a medication that causes the uterus to contract.

Nurses maxed out Bruns’ Pitocin dosage, but she never dilated beyond 4 centimeters and never began to push. Bruns remembers her doctor saying she was unlikely to deliver vaginally. Bruns’ labor had “failed to progress,” according to her medical records, and her doctor recommended a C-section. Bruns, who says she was exhausted and scared, consented.

After her operation, lying in the recovery room unable to hold her newborn daughter without pain, Bruns felt a lingering, corrosive doubt: Was her surgery actually necessary?

Bruns’ amniotic sac had not ruptured, so she remembered her doctor said she could have attempted a second induction. Her labor had been long — 16.5 hours, according to her medical paperwork — but the American College of Obstetricians and Gynecologists says that women who are induced, like Bruns, often have significantly longer labors; even when their amniotic sac is ruptured, which speeds up labor, it could safely take up to 18 hours to reach the active pushing stage. She and her baby were healthy and had tolerated labor well, the kind of patients for whom, even in a prolonged early labor, ACOG recommends a C-section “should be avoided.”

Bruns couldn’t shake it. She later asked Iowa’s Department of Public Health and Human Services for hospital C-section rates. The department initially said those were confidential, but eventually released them after a lengthy negotiation.

The data was stark. In the year Bruns delivered her daughter and in the four successive years, the hospital where she delivered had a C-section rate 15% higher than the state average, a finding Business Insider’s own analysis of Iowa hospital delivery data confirmed. Over those same five years, doctors at her hospital performed surgeries on women with no prior C-sections, like Bruns, at nearly double the rate on average as the doctors at a hospital located 2 miles away.

“It’s hard to make peace with,” Bruns said. “If I had known, I would have chosen a different hospital.”

The Iowa Department of Health and Human Services did not respond to Business Insider’s request for comment.

When medically necessary, a C-section is a lifesaving surgery. A recent large study found that up to 19% of all deliveries should be C-sections to protect the health and lives of women and their babies.

The US C-section rate is far higher — over 32%. That suggests that around one in three C-sections could be avoided, eliminating nearly half a million surgeries each year that leave women at a higher risk of hemorrhages, blood clots, and infections, and more likely to develop dangerous complications in future pregnancies.

Individual hospital C-section rates vary widely, ranging from extremes as low as 7% and as high as 70%, a recent study of data from 44 states shows. A woman’s age, health, whether she’s obese, and pre-existing conditions, such as diabetes or a previous C-section, may increase the chance that her baby is most safely delivered by C-section.

Multiple studies document that the hospital a woman chooses remains one of her biggest risk factors for undergoing a medically unnecessary C-section, after controlling for age, health, race, hospital delivery volume, and a host of other variables.

The delivery business

“Some hospitals do more unnecessary Cesarean deliveries than other hospitals,” reads a website run in partnership with California’s Department of Public Health that links to annual C-section rate data for each hospital in the state. To lower your risk of surgery, the site recommends, “choose a hospital with lower Cesarean delivery rates.”

Such transparency is rare.

Seven other states with a combined 23 million residents — Arizona, Arkansas, Colorado, Hawaii, Idaho, Nebraska, and South Dakota — told Business Insider that hospital cesarean delivery rate data is confidential, either by department policy or state law. The Louisiana Department of Health said the state does not track C-section rates by hospital — the only state in the country that claimed not to track this information.

Alaska initially cited confidentiality, but released the data after Business Insider requested more information about the department’s policies.

An Idaho Department of Health and Welfare spokesperson suggested that Business Insider ask the state’s hospital association, a private trade group. The Idaho Hospital Association and the Idaho Medical Association did not respond to Business Insider’s requests for comment. The hospital associations for the seven other states did not respond to Business Insider’s request, declined to produce hospital C-section rate data, or said their organization does not track C-section rates.

A spokesperson from the Hawaii State Department of Health told Business Insider the department has a “long-standing policy” against publicly disclosing hospital C-section rates, saying comparisons would be unfair to hospitals.

“C-section rates may vary significantly due to differences in patient populations,” the Hawaii spokesperson wrote, “as well as differences in hospital practices, capacity, or available services.”

Dozens of other states and Washington, D.C., do not readily publicly publish hospital C-section rates. Instead, they only release that information in response to public records or data requests, sometimes for a hefty fee. The Utah Department of Health and Human Services, for example, initially priced the data at $1,800 when reached in mid-September.

When reached for comment in October, Josie Thacker, a spokesperson for the Utah Department of Health and Human Services, said that hospital C-section rates in Utah would eventually be available for free on a public website, which is undergoing an update.

“Until the update is complete, the fee for the data you requested is $900,” Thacker wrote to Business Insider in an email.

By keeping C-section rates out of the public eye — either by withholding data or not making it readily accessible — health departments put the interests of hospitals over pregnant women’s rights to make informed choices about their medical care, experts told Business Insider.

Hospitals traditionally operate labor and delivery departments at a financial loss unless patient volume and insurance reimbursements are kept high, according to former hospital administrators and recent industry analysis. Each patient — every woman in labor and baby delivered — is valuable to hospitals looking to turn a profit.

Some hospitals go to extremes. Two lawsuits in particular, while neither involves allegations of medically unnecessary C-sections, illustrate the lengths some hospitals allegedly go to capture a larger share of the delivery market.

In 2016, Tenet Healthcare Corporation, which at the time operated 79 hospitals, paid over $513 million to settle federal and state charges accusing the hospital giant and its subsidiary hospitals in Georgia of engaging in an illegal kickback scheme to swell their delivery business. Tenet admitted responsibility and agreed to a court-appointed monitor, and two of its subsidiaries pleaded guilty to conspiracy to defraud the United States and violate the federal Anti-Kickback Statute.

That same year, a 2016 jury awarded $16 million in damages in a civil suit against Brookwood Medical Center in Birmingham, Alabama, a hospital that at the time was majority-owned by Tenet, in part for launching an aggressive marketing blitz on television, billboards, and social media advertising labor care philosophies and amenities that were, in reality, unavailable or directly conflicted with the hospital’s own care policies, according to court filings.

The jury found Brookwood was responsible for reckless fraud and medical negligence. Brookwood’s current spokesperson referred Business Insider to Tenet for comment. Tenet did not respond to Business Insider’s queries.

A patchwork of hospital disclosures

With each pregnant woman’s choice of where to deliver so hard fought, a hospital’s low C-section rate may become an advertising advantage; a high rate, a weak spot. Relatively low C-section rates are used in promotional materials at large hospital systems like Kaiser Permanente or Sutter Health.

Some hospitals argue that C-section rate disclosure would bias consumers against facilities with higher C-section rates, said Dr. Emily White VanGompel, a family medicine doctor and professor at the University of Illinois Chicago who studies how organizations impact C-section rates.

Their argument is simple: If potential patients can look up a hospital’s delivery rate data, “they’re going to just all go to see the hospital with the lowest C-section rates,” White VanGompel said, which could be unfair to hospitals that treat more women with complicated or high-risk pregnancies. That logic falls apart on closer scrutiny, she told Business Insider, since many hospitals that serve high-risk pregnant women still manage to keep their low-risk C-section rates low.

To better compare C-section rates at hospitals that treat different types of patients, maternal health experts recommend looking at the rate doctors operate on low-risk pregnancies. Women with low-risk pregnancies are the least likely to require surgery to safely deliver their babies, so this metric is one of the best to evaluate a hospital’s possible cesarean overuse.

Experts say a hospital’s administration and delivery policies have an outsize influence on the number of C-sections it performs. Publicly disclosing hospitals’ low-risk C-section rates not only benefits women as consumers but could also encourage hospitals to safely support more vaginal deliveries, said White VanGompel, Declercq, and four other public health and maternal health researchers at the schools of medicine at Stanford University, Johns Hopkins University, the University of Michigan, and Harvard.

In California, hospitals participating in a state-led initiative to lower low-risk C-section rates publicly published their C-section rates, among other maternal healthcare improvement strategies. Over five years, the state’s low-risk C-section rate declined from 26% to 22.8% — a 12% drop.

Some hospitals already voluntarily disclose their low-risk C-section rate through a maternal health survey conducted annually by The Leapfrog Group, a healthcare transparency and consumer advocacy organization that publishes the results in a searchable database. In 2024, over 1,700 hospitals — around 70% of those surveyed — disclosed maternity care quality data, including C-section rates, according to the group’s 2025 maternal healthcare report.

Significant blind spots remain. Springhill Medical Center, the only for-profit hospital in Mobile, Alabama, for example, declined to respond to Leapfrog’s 2025 survey. Doctors at that hospital performed surgeries on 37.5% of women with low-risk pregnancies on average between 2018 and 2024 — among the highest average rates in the state over those same years, according to Alabama Department of Public Health data obtained by Business Insider after filing a data request.

It’s not known if any of those C-sections could have been avoided, but the lack of publicly available data meant expectant mothers could not compare Springhill’s rate to those of surrounding hospitals.

Springhill’s average low-risk C-section rate from 2018 to 2024 was 33% higher than at a nearby hospital with roughly the same number of low-risk deliveries, and nearly 47% higher than a university teaching hospital that specializes in women with higher-risk pregnancies. The three hospitals are located within 6 miles of one another.

“Springhill Medical Center remains committed to safe, evidence-based care for all patients,” Deanna Kyrimis, the president and CEO of Springhill, wrote in a statement to Business Insider. “We rigorously monitor our clinical outcomes and engage in a comprehensive quality review process — including case-by-case evaluations of cesarean deliveries — to ensure they align with medical necessity and best practices, supporting the highest standard of care for mothers and babies.”

Business Insider identified similar patterns of hospitals declining to disclose to Leapfrog comparatively high C-section rates for low-risk pregnancies in Alaska, Maine, Maryland, Massachusetts, Mississippi, Nevada, Rhode Island, Vermont, Washington, and Wisconsin.

In Arkansas, where hospital C-section rates are confidential, more than a quarter of women with low-risk pregnancies deliver their babies by C-section — the 10th highest rate in the US, according to federal data.

Of the Arkansas hospitals surveyed, 40% declined to respond to Leapfrog’s maternal health survey. None of those Arkansas hospitals contacted by Business Insider disclosed their low-risk C-section rate.

Read the original article on Business Insider

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