In many cases, a C-section birth is absolutely necessary. But often it is not: Researchers estimate that in almost half of the cesareans performed in the U.S, the babies could have been safely delivered vaginally instead.
Performing a C-section when it isn't necessary poses avoidable risks to the mother and her child and needlessly 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.
To highlight the problem, Consumer Reports recently investigated C-section birth rates in more than 1,200 hospitals across the country. We focused on first-time mothers who should be at low risk of needing a cesarean: pregnant women expecting just one child whose babies are delivering at full-term in the proper position, which means coming out head first.
The target C-section rate for those births, set by the Department of Health and Human Services, is 23.9 percent or less. And while a new government analysis shows the national average for those births declined slightly in recent years, it's still above that target.
What Did the Hospitals Have to Say?
Particularly notable are the 11 hospitals listed below, all of which have C-section rates for low-risk deliveries of 36 percent or higher—more than 10 percent above the national average.
We've asked those hospitals what they are doing to improve, and why their C-sections birth rates were so much higher than the national average.
South Miami Hospital has the highest C-section birth rate for low-risk deliveries among that group, at 53 percent. Jack Ziffer, M.D., chief physician executive for Baptist Health South Florida—which owns South Miami Hospital as well as Baptist Hospital of Miami, another hospital on our list—told us "we can attribute C-section rates to various factors, including certain risk factors or medical conditions that could put the health of the mother and child at risk such as advanced age of the mother, high blood pressure, or gestational diabetes, as well as maternal request."
But experts say C-section birth rates that high are rarely justified, even among hospitals that may serve many high-risk women.
"Getting under 24 percent for low-risk births is something all hospitals should be able to do," says Elliott Main, M.D., the medical director of the California Maternal Quality Care Collaborative, a nonprofit organization that works to improve outcomes for mothers and babies in that state. In fact, Main says, "for those deliveries, hospitals should be aiming even lower."
To read South Miami's full response, as well as those from other hospitals, click on the links in the chart below.
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Large U.S. Hospitals With High C-Section Rates
How Hospitals Keep C-Section Rates Low
We also contacted five large hospitals with the lowest C-section rates to see how they achieved those levels. We've heard back from two of them, including Crouse Hospital in Syracuse, N.Y., which had the lowest C-section rate for low-risk pregnancies among hospitals with at least 3,500 births in our Ratings, at just 11 percent. Robert Silverman, M.D., chief of the hospital's Department of Obstetrics and Gynecology, attributes the hospital's success to several factors, including mandatory review of all primary C-sections, having certified nurse midwives on staff, and sharing the C-section rates with all obstetricians and midwives on staff, so they can see how they compare to the others. "This has been a team effort that has involved nursing and physician leadership as well as all practitioners," Silverman says.
To see the list of large hospitals with low C-section rates, plus their full responses, see the chart below.
Large U.S. Hospitals With Low C-Section Rates
How to Avoid a C-Section
While Crouse Hospital and other medical centers around the country have been able to reduce their C-section rates, those efforts can take time. So it could be up to you to reduce your risk of having a C-section. Use our hospital Ratings to compare the C-section rates of hospitals in your area. And read our advice on how to avoid unnecessary cesareans.
In addition, see our other reports on pregnancy and childbirth:
• Your Biggest C-Section Risk May Be Your Hospital
• 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 on C-Sections: 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. The data come from the Leapfrog Group as well as from the California Maternal Quality Care Collaborative, as provided by the California Healthcare Assessment and Reporting Task Force. We rate hospitals with at least 30 low-risk deliveries in either 2014 or the 12-month period ending June 2015. Hospitals submit data to Leapfrog voluntarily. Hospitals that score low on this measure may score well on other measures, such as preventing infections or readmission. Read more about how we rate hospitals.
