Across the United States, approximately one in every ten pregnant women undergoes a cesarean section that medical professionals and public health experts believe might not have been medically necessary. This means that a substantial minority of women are exposed to a major surgical procedure that could, under optimal medical and systemic conditions, potentially be avoided. Strikingly, one of the greatest indicators of whether a mother is likely to experience such an avoidable C-section has little to do with her own age, health status, or pregnancy complications. Instead, data reveal that a major determining factor lies in the institutional practices of the hospital in which she gives birth—specifically, that hospital’s overall C-section rate.
Specialists emphasize that one of the simplest and most powerful ways for expectant mothers to reduce their likelihood of undergoing an unnecessary cesarean is to select a hospital that has a demonstrably lower rate of such surgeries. Yet obtaining that information often proves surprisingly difficult. Despite the profound implications that a hospital’s C-section rate has on maternal and newborn health, only eleven states make this information easily accessible on publicly available websites. In the majority of states, the statistics remain either hidden behind layers of bureaucracy or are deemed confidential, only being released after formal data or public-records requests that can take months to process. Although a handful of hospitals voluntarily share their C-section rates through annual consumer health surveys, many others choose to remain silent, leaving expectant patients without crucial comparative data.
As a result, there exists a fragmented and inconsistent pattern of disclosure across the nation—a patchwork that effectively conceals dramatic differences in cesarean rates even between hospitals located within the same community. When Business Insider collected C-section data from all fifty states and the District of Columbia, early analysis from the first twenty-one states revealed striking contrasts. Some hospitals performed C-sections on fewer than five percent of women with low-risk pregnancies—those who are healthy, full-term, carrying a single baby positioned head down, and giving birth for the first time. At the other extreme, a number of hospitals reported performing cesareans on about half of such women. This enormous variation exposes the profound impact of institutional culture, hospital protocols, and staffing practices on surgical rates, independent of medical necessity.
Healthcare scholars, maternal health advocates, and public transparency watchdogs argue that by choosing not to publish hospital-specific cesarean data, state health departments are inadvertently—if not intentionally—protecting hospitals’ competitive interests at the expense of women’s rights to make informed medical choices. According to Eugene Declercq, a professor of community health sciences at Boston University who has spent decades studying maternal policy, the lack of priority given to this issue stems partly from hospital embarrassment and a general resistance to transparency. In his view, some hospitals simply perform far more C-sections than necessary, and the public deserves to know that.
The consequences of this opacity are deeply personal. Consider the experience of Rachel Bruns, a communications specialist from Iowa. At age thirty-one, healthy, and carrying her first full-term baby in an ideal head-down position, she seemed an excellent candidate for a vaginal birth. A week beyond her due date, her physician began inducing labor with Pitocin, a common drug that stimulates uterine contractions. Despite the nursing team increasing the dosage to its maximum, Bruns’s cervix never dilated beyond four centimeters and she never began pushing. Ultimately, her doctor concluded the labor had stalled, recorded a “failure to progress” diagnosis, and recommended a cesarean section. Exhausted and frightened, Bruns agreed.
The surgery went smoothly by medical standards, yet in the hours following her procedure, as she lay unable to hold her newborn daughter without pain, she could not shake a gnawing doubt about whether the operation had truly been necessary. Her medical records indicated that her amniotic sac was still intact, suggesting she might have been safely eligible for a second induction. The American College of Obstetricians and Gynecologists, the nation’s leading professional body in this field, recognizes that induced labor—particularly when membranes remain unruptured—can often take much longer to reach active labor. It recommends patience and cautions that a C-section should be avoided in many such scenarios unless medical danger is evident. Bruns and her baby had remained healthy and stable throughout her 16.5-hour labor, well within safe parameters. Reflecting on this later, she felt increasingly unsettled.
Driven by her doubts, Bruns eventually sought to uncover whether her hospital had an unusually high cesarean rate. The Iowa Department of Public Health initially denied her request, citing confidentiality, but she persisted. After prolonged correspondence and negotiation, the department relented and released the figures. The data were revealing: the hospital where she delivered had a C-section rate fifteen percent higher than the state average in the year of her daughter’s birth, and that trend persisted over the following four years. Even more strikingly, doctors there performed cesarean sections on women with no prior surgical births nearly twice as often as physicians at another hospital located just two miles away. For Bruns, this discovery was painful confirmation. Had she had access to that information beforehand, she said, she would have chosen a different facility altogether.
While cesarean sections unquestionably save lives when medically warranted—a large population study found that up to nineteen percent of births should justifiably be performed this way—the overall U.S. rate remains far above that threshold, exceeding thirty-two percent. This disparity suggests that roughly one in three American cesareans could potentially be avoided, preventing nearly half a million major surgeries each year. Each unnecessary cesarean exposes women to higher risks of hemorrhage, infection, and blood clots, and also increases the odds of serious complications in future pregnancies.
The variation across hospitals is extreme. According to data spanning forty-four states, C-section rates can be as low as seven percent in some facilities and as high as seventy percent in others. While a woman’s medical background—including age, obesity, prior C-section, or chronic conditions such as diabetes—naturally influences her risk, numerous studies consistently demonstrate that institutional factors overshadow individual ones. After controlling for medical and demographic variables, the hospital a woman selects remains one of the strongest predictors of whether she will undergo an unnecessary surgical delivery.
Yet hospital transparency remains rare. In California, the state’s Department of Public Health maintains a publicly searchable database showing C-section rates for each hospital and even advises women to pick facilities with lower rates if they wish to minimize their risk. However, most states fail to follow California’s lead. Seven—Arizona, Arkansas, Colorado, Hawaii, Idaho, Nebraska, and South Dakota—explicitly classify their hospital C-section data as confidential, either by policy or by law. Louisiana stands out for a different reason: its Department of Health has said it does not even collect such statistics. Other states initially refuse to release the data but sometimes relent after pressure or detailed inquiries, as Alaska did following questions about its confidentiality policies.
Even when states agree to provide the information, they sometimes impose steep fees that act as barriers to access. Utah, for instance, initially quoted a cost of eighteen hundred dollars for the relevant data before later reducing it to nine hundred while promising eventual free publication online. The result is that, across much of the country, pregnant women must navigate opaque bureaucratic systems, lengthy response times, and sometimes prohibitive costs simply to learn which hospitals in their state have higher or lower surgical delivery rates.
Experts argue that such secrecy places institutional priorities above patient welfare. Hospitals often depend financially on high delivery volumes and adequate insurance reimbursements to maintain profitability in their maternity wards. Thus, each prospective patient—every woman giving birth—represents both a medical responsibility and a financial asset. Industry critics note that this economic incentive may, in some cases, subtly influence both institutional culture and provider behavior.
Certain legal cases underscore the competitive pressures hospitals face. In 2016, Tenet Healthcare Corporation, one of the nation’s largest health systems, paid over half a billion dollars to settle federal and state charges that its subsidiaries had engaged in an unlawful kickback scheme intended to inflate their maternity business. That same year, a jury awarded sixteen million dollars in damages against Brookwood Medical Center in Alabama, then majority-owned by Tenet, after it was found to have misrepresented its maternity services in advertising campaigns designed to draw expectant mothers. Together, such cases illustrate the financial motivations that can shape how hospitals market and manage childbirth services.
Because obstetric reputation operates in a highly competitive environment, hospitals with lower C-section rates sometimes highlight them in promotional material, while those with higher ones may seek to keep the numbers quiet. Large systems like Kaiser Permanente and Sutter Health, for example, use relatively low C-section rates as marketing proof of their commitment to safe, evidence-based maternity care. Conversely, administrators at hospitals with elevated rates often argue that public disclosure could unfairly damage their reputations, claiming that such raw numbers fail to account for patient complexity. Experts like Dr. Emily White VanGompel from the University of Illinois Chicago refute this rationale, noting that many institutions treating large numbers of high-risk pregnancies still manage to maintain low rates among low-risk patients—a more meaningful comparative standard.
Indeed, obstetric researchers recommend focusing specifically on cesarean rates among low-risk pregnancies to evaluate potential overuse. These are cases where surgery is least likely to be medically indicated. Publishing such data not only empowers women to make informed choices but also pressures hospitals to examine their internal policies, staffing models, and care protocols. Evidence from California demonstrates this effect: after state initiatives encouraged hospitals to publish and reduce low-risk cesarean rates, the statewide average dropped by twelve percent over five years, from 26 percent to 22.8 percent.
Many hospitals now disclose their rates through The Leapfrog Group, a nonprofit organization that surveys facilities about the quality of their maternity care. In 2024, about seventy percent of hospitals surveyed—nearly 1,700 institutions—voluntarily provided data on C-section rates and related metrics. Nevertheless, notable blind spots persist. Some hospitals with high or inconsistent rates decline participation entirely, such as Springhill Medical Center in Mobile, Alabama. Between 2018 and 2024, doctors there performed surgeries on roughly 37.5 percent of low-risk pregnancies, among the highest in the state. Within a six-mile radius, two other hospitals—one with similar patient volumes and another specializing in high-risk pregnancies—recorded much lower averages. Despite these glaring discrepancies, Springhill’s refusal to participate meant that expectant mothers had no simple way to compare its outcomes before choosing where to deliver.
This pattern repeats across states from Alaska to Massachusetts. In Arkansas, for instance—where hospital C-section data remains legally confidential—over a quarter of women with low-risk pregnancies deliver via cesarean, and nearly forty percent of hospitals simply decline to respond to transparency surveys. The cumulative effect of these omissions is a pervasive lack of clarity that ultimately limits patient autonomy. Without reliable, public data, many women remain unaware of potential risks inherent in their chosen hospitals.
Advocates maintain that meaningful progress in maternal health demands transparency. When hospitals publish detailed metrics, they invite accountability and promote trust. When they obscure such data, they reinforce an opaque system that prioritizes institutional image over patient empowerment. Ultimately, the ability to make an informed birthing choice—one that balances safety, comfort, and evidence-based care—should not depend on a state’s policy of disclosure or a hospital’s willingness to volunteer information. It should be a fundamental right, accessible to every expectant mother seeking to bring new life into the world in the safest possible way.
Sourse: https://www.businessinsider.com/hospital-c-section-rates-state-data-map-2025-10
