More babies are born each year in California hospitals than in any other state. And, just as in the rest of the U.S., about a third are delivered by C-section.
A cesarean delivery is sometimes necessary to protect the health of the mother or the baby. But often it is not: Researchers estimate that almost half of the C-sections performed in the U.S. could have been avoided, with the baby being safely delivered vaginally instead.
Performing a C-section when it isn't necessary poses avoidable risks to the mother and her baby and also raises costs, according to the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, the nation's two leading medical organizations that focus on childbirth.
Consumer Reports looked at the C-section rates of more than 250 California hospitals, and found that the hospital you choose can make a big difference in how you deliver, particularly when it comes to C-sections. "Your chances of having a C-section can vary dramatically from hospital to hospital, often even in the same community," says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center.
Our analysis focuses on first-time mothers who should be at low risk for a cesarean: those preparing to deliver a single, full-term baby positioned to come 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. But many experts say that the ideal C-section rate for those births should be even lower than that. "Getting under 24 percent for low-risk births is something all hospitals should be able to do," says Elliott Main, M.D., medical director of the California Maternal Quality Care Collaborative, a nonprofit group that focuses on improving maternity care in the state. "But for those deliveries hospitals should be aiming even lower," he says.
Yet 60 percent of 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.
We asked California hospitals with the highest C-section rates in the state why they perform so many more cesareans than other hospitals. We also asked those with low C-section rates what they are doing to keep their rates down.
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How the Hospitals Responded
We contacted the five hospitals in the state (with at least 200 births) that had the highest C-section rates for low-risk deliveries, and heard back from only two of them: Memorial Hospital of Gardena and El Centro Regional Medical Center.
Kathy Wojno, chief executive officer of Memorial Hospital of Gardena, said that the hospital is disappointed by its high C-section rates and is actively taking steps to lower them. "We are working proactively with our obstetric physicians, nurses, and support staff to reduce them," she said. "The health and well-being of the communities we serve is paramount, and it worries me that patients will see our scores and mistakenly determine that we are not providing high quality maternity care," Wojno said. The hospital also plans to start working with the California Maternal Quality of Care Collaborative to better track how its C-section rates compare to that of other hospitals.
Cathy Kennerson, chief strategic development officer at El Centro Regional Medical Center, said her hospital is also concerned by its high rates, and is working to correct them. "With the support of our Board of Trustees, Executive Team, staff and physicians, we began implementing new initiatives that were focused on best-practices with the goal of bringing our C-section in alignment with the national average," she said.
She points out that the hospital, which is located along the border with Mexico, sees many patients with obesity, diabetes, and hypertension. "These risk factors combined with the lack of prenatal care for some moms contribute to a higher percentage of high-risk patients delivering at our hospital," she said. The hospital is trying to lower C-section rates by making sure all obstetricians on staff know how their C-section rates compare with others in the hospital, by hiring a nurse midwife, and by teaming up with experts at the University of California San Diego Health.
To read the hospitals' full responses, click on the links below. We will add responses from other hospitals when we receive them.
California Hospitals With High C-Section Rates
See our Ratings of California hospitals on C-section rates and other measures of maternity care.
What Hospitals With Low C-Section Rates Do
We also contacted the five hospitals in the state with the lowest C-section rates and asked what they attribute their success to.
In a statement to Consumer Reports, a representative for Sutter Health—which owns two hospitals on our list of hospitals with low C-section rates—said, "We know that a happy life starts with a healthy beginning, so we continuously look for new ways to promote safer birth experiences for mothers and their babies."
The hospital said, "Registered nurses, certified nurse midwives and physicians-on-staff partner on labor management of patients." For instance, the care team avoids elective induction of labor before 41½-42 weeks without a medical indication, provides expectant parents with significant prenatal education and preparation, encourages the use of doulas and offers an active volunteer doula services, and uses epidurals sparingly.
To read the hospital's full response, as well as from other hospitals in the state with low C-section rates, click on the links below.
Large California Hospitals With Low C-Section Rates
What's Happening in the State's Biggest Hospitals
Finally, we also contacted the 10 California hospitals with the greatest number of low-risk deliveries. None earned a top score in our Ratings, 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 C-section rates lower than the national target of 23.9 percent. Click on the links below to see how these large hospitals explain their C-section rates.
C-Section Rates for Low-Risk Deliveries at 10 Big California Hospitals
More on Pregnancy and Childbirth
• Your Biggest C-Section Risk May Be Your Hospital
• 11 Hospitals to Avoid If You Don't Want a C-Section Birth
• Childbirth: What to Reject When You're Expecting
• Preparing for Pregnancy: What to Do Right Now
• Nearing Your Due Date: Plan for Your Baby's Arrival
• Giving Birth: What to Do Right Away
• How to Avoid a C-Section Procedure
• What to Do If You Need a Cesarean Section
• Having a Baby in California
• The Safest Strollers, Car Seats, Cribs, High Chairs, and Other Baby Products
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.
