If you live in California and are deciding where to deliver your baby, you’re in luck. You now have access to more information about maternity care than women anywhere else in the country.

That includes how often hospitals perform C-sections, as well as the percentage of women who develop infections after those operations. You can also see at which hospitals women often get episiotomies (a surgical cut just before delivery to enlarge the opening of the vagina) and even how often new moms in each hospital breastfeed their babies.

Consumer Reports has worked with the California Department of Insurance and the California Maternal Quality Care Collaborative, a nonprofit group that focuses on improving maternity care in the state, to gather all of that information, and make it available for free to help women having a baby in California.

“The more you know about a hospital, the more you can choose those that follow evidence-based care, and make sure that your hospital has a culture that supports the kind of birth you want,” says Elliott Main, M.D., medical director of the California Maternal Quality Care Collaborative.  

And Consumer Reports' work in the state shows that the hospital you choose can make a big difference in how you deliver, particularly when it comes to C-sections. “We found that your chances of having a C-section varies dramatically from hospital to hospital, often even in the same community,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center.


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Too Many C-Sections

Consumer Reports’ analysis focuses on first-time mothers-to-be who should be at low risk of needing a cesarean: pregnant women expecting just one child (not twins, triplets, or other multiples) whose babies are delivering at full-term in the proper position, which means coming out head first.

The target C-section rate for those low-risk births, set by the Department of Health and Human Services, is 23.9 percent or lower. But many experts say that the ideal C-section rate for those births is even lower. “Getting under 24 percent for low-risk births is something all hospitals should be able to do,” Main says. “But for those deliveries hospitals should be aiming even lower,” he says.

Yet six in 10 California hospitals had C-section rates above the target for low-risk births; about one in 10 had C-section rates above 33.3 percent, earning those hospitals our lowest Rating.


Read more about C-section rates around the country, plus more on when the surgeries are appropriate, and when they aren’t.
 

C-Section Rates for Low-Risk Deliveries at 10 Big California Hospitals

Of the nearly 250 hospitals in our Ratings, the 10 listed below had the most low-risk deliveries in the state. None earned a top score, and only three—Pomona Valley Hospital Medical Center in Pomona, California Pacific Medical Center in San Francisco, and Alta Bates Summit Medical Center in Berkeley—had rates lower than the national target of 23.9 percent.

Hospital NameLocationC-Section Rate (First-Time Mothers, Low-Risk Deliveries)
Performed Better Than Target
Pomona Valley Hospital Medical CenterPomona20.4
California Pacific Medical Center (California Pacific Medical Center - California Campus)San Francisco21.7
Alta Bates Summit Medical CenterBerkeley23.5
Performed Worse Than Target

El Camino Hospital1

Mountain View25
Kaiser Permanente Orange County Anaheim Medical Center2Anaheim25.1
Hoag Memorial Hospital Presbyterian (Hoag Hospital Newport Beach)Newport Beach25.9
Kaiser Permanente Fontana Medical Center3Fontana26.7
Miller Children's & Women's Hospital Long BeachLong Beach27.6
Cedars-Sinai Medical CenterLos Angeles28.8

Sharp Mary Birch Hospital for Women and Newborns

San Diego33.8

How Hospitals Can Improve

Making a hospital’s C-section rate public not only helps families choose a hospital, but can also motivate hospitals and doctors to change their practices. “There’s a lot of denial of the problem of high C-section rates and we need to overcome it,” says Main, who notes that simply having the data is an important first step in correcting the problem.

“Nobody wants to be an outlier,” says Colleen McNally, M.D., chief medical officer at Sharp Mary Birch Hospital for Women and Newborns in San Diego. That hospital delivered the most babies in California in 2014—and had a C-section rate of nearly 34 percent among low-risk births, earning it our lowest score.

Sharp is using data from the California Maternal Quality Care Collaborative to make changes. “We were able to look at individual physicians’ rates,” she says, and “we knew we had an issue.”

The hospital is now working with providers who have high rates, helping them to encourage vaginal birth by, for example, allowing women to labor longer before resorting to a C-section. In addition, the hospital plans to use a toolkit developed by CMQCC to help hospitals get their low-risk C-section rates below 23.9 percent within five years.  

“It was important to educate both the nurses and the physicians,” McNally says. “It was really important that we were all on the same page.”

It’s also vital to involve patients. “We provided a lot of education to patients about the stages of labor,” McNally says, explaining that mothers do much better when they stay at home longer—where they can shower, eat, and move around—and only come to the hospital when they enter active labor.

“Are we at the California ideal rate?” McNally says. “Not yet, but we’re getting closer.”

Officials at Memorial Hospital of Gardena say it too is working with CMQCC to track its performance against other hospitals. And the hospital has recruited a perinatologist—a specialist in caring for mothers and babies—to be on call 24/7 to consult with patients and obstetricians “to ensure the safest and best birthing outcomes for mothers and their newborns,” says Kathy Wojno, R.N., CEO at the hospital.

The state of California is also taking steps that it hopes will motivate hospitals to lower their C-section rates. For example, Covered California, the state’s Affordable Care Act health insurance exchange, recently proposed that all plans listed on the exchange must contract with hospitals that meet certain standards, including low C-section rates.



California Hospitals With High C-Section Rates

Of the nearly 250 California hospitals in our Ratings, 26 had C-section rates above 33.3 percent for low-risk deliveries. Hospitals with rates above that level received our lowest score. Twelve of them were hospitals with at least 200 low-risk deliveries in 2014.

Large California Hospitals With Low C-Section Rates

Of the nearly 250 California hospitals in our Ratings, 16 had C-section rates at or below 18.4 percent, earning them our top score. Twelve of them were hospitals with at least 200 low-risk deliveries in 2014.

Hospital NameLocationC-Section Rate (First-Time Mothers, Low-Risk Deliveries)
Sutter Davis HospitalDavis12
Emanuel Medical CenterTurlock13
Bakersfield Memorial HospitalBakersfield15
Kaiser Permanente Redwood City Medical CenterRedwood City16
Sutter Maternity and Surgery Center of Santa CruzSanta Cruz16.2
Kaiser Permanente Roseville Medical CenterRoseville16.9
San Joaquin Community HospitalBakersfield16.9
Mad River Community HospitalArcata17
San Francisco General Hospital and Trauma Center (San Francisco General Hospital)San Francisco17.3
John Muir Medical Center - Walnut CreekWalnut Creek17.4
Woodland Healthcare (Woodland Memorial Hospital)Woodland17.7
Loma Linda University Medical Center - MurrietaMurrieta18.1

Two of those high-ranked hospitals are part of the not-for-profit Kaiser Permanente healthcare system, which has 38 hospitals nationally. Kaiser's average C-section rate for low-risk births was 22 percent, which was below the national target.

Kaiser tends to do well in part because its structure allows it to identify best practices, and then quickly spread them to all of its facilities, says Tracy Flanagan, M.D., a board-certified obstetrician-gynecologist and director of women's health with Kaiser.

Those practices include staffing the labor and delivery floors with certified nurse-midwives, and establishing standards for how to interpret electronic fetal monitoring. That’s important, Flanagan explains, because different doctors sometimes interpret those tracings in different ways, leading to inconsistent care.

Three Key Hospital Indicators: Infections, Breastfeeding, and Episiotomies

While knowing your hospital’s C-section rate is key, it doesn’t tell you the whole story.

“You also want to know it’s a safe place,” says Main, at the California Maternal Quality Care Collaborative. One key indication of that: how many women undergoing a C-section develop an infection at their incision after the operation.

Two other important indicators: how often women undergo episiotomies, and the percentage of mothers who breastfeed their babies while they are in the hospital. “We need to focus on changing the culture to perform fewer interventions like episiotomies and greater support for natural functions like breastfeeding,” Main says.

Episiotomies can be necessary in the case of a delivery that requires help from forceps or a vacuum, or if the baby is descending too quickly for the tissues to stretch. But often, routine episiotomies don’t help and are associated with several problems, including more damage to the area near the rectum and a longer healing period, according to a 2009 Cochrane review of 8 studies involving more than 5,500 women.

And breastfeeding is best for most babies, according to the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention. Breast milk provides the best nutritional mix, is easier to digest, and has been linked to a reduced risk of ear infections, diarrhea, respiratory illnesses, allergies, and sudden infant death syndrome. For mothers, breastfeeding soon after giving birth triggers the release of a hormone that helps the uterus to contract, and may reduce the amount of bleeding you have. It may also help you lose any weight you gained during your pregnancy, and possibly reduce your risk of breast and ovarian cancers.

Explore Hospital Childbirth Ratings for California

Click on the map below to use our interactive tool showing how hospitals compare on C-sections, infections, breastfeeding, and episiotomies.


How We Rate Hospitals
Consumer Reports compares hospitals on C-section rates for first-time mothers who don't deliver prematurely and who are pregnant with a single baby in the proper position for delivery. Lower C-section rates earn higher scores. The data do not include information on some factors that may increase C-section-risk, such as pregnancy-related high blood pressure, diabetes, obesity, or other chronic diseases. We rate hospitals with at least 30 low-risk deliveries in 2014, based on data from the California Maternal Quality Care Collaborative and provided to Consumer Reports by the California Healthcare Assessment and Reporting Task Force. Hospitals that score low on this measure may score well on other measures, such as preventing infections. Read more about how we rate hospitals.

Editor's Note: This report is supported in part by the California HealthCare Foundation, based in Oakland, Calif.