In 2020, the United States Department of Health and Human Services introduced an ambitious public health framework titled *Healthy People 2030*, a comprehensive collection of national objectives intended to elevate the country’s overall well-being by the end of the decade. These goals were designed to create measurable benchmarks for improving outcomes across virtually every major health domain. Now, several years later—precisely at the program’s midpoint—the publication *Business Insider* undertook a detailed examination to assess the nation’s progress and to determine whether policy efforts and medical practices were successfully aligned with the aspirational standards set forth in that plan.
Among the many focal points reviewed, one issue distinctly commanded attention: the rising prevalence of low-risk cesarean deliveries. The data did not merely suggest stagnation—it indicated regression. A warning banner on the official dashboard grimly declared that the United States was, by federal metrics, “getting worse.” The shift was so pronounced that experts began referring to the phenomenon as a “cesarean epidemic.” Dr. Emiliano Chavira, a Los Angeles–based obstetrician and maternal-fetal medicine specialist, articulated profound concern. He emphasized that public discourse often downplays the long-term health risks of excessive surgical birth rates, overlooking the consequences these patterns impose on both individual mothers and the broader arena of public health.
As Business Insider’s reporters delved deeper into this subject, they discovered a striking cognitive dissonance: in the public imagination, cesarean sections are frequently perceived as routine, predictable, and almost synonymous with modern childbirth, while medical researchers consistently described the trend as troubling. To understand this divergence, the team set out to uncover the forces shaping such contradictory narratives—why a potentially life-saving intervention had become both essential and, in certain contexts, alarmingly overused.
The investigation sought to unravel the complex duality of cesarean delivery itself—a procedure that can, without question, save the lives of mothers and babies in critical circumstances, yet is now performed in the United States at approximately twice the rate that the World Health Organization identifies as optimal for maternal and neonatal health. To achieve a holistic understanding, the reporters conducted extensive interviews with more than thirty obstetricians, nurse midwives, and labor and delivery nurses, spanning both active practitioners and retirees whose decades of experience offered historical depth. In addition, over twenty-five academic researchers specializing in maternal health and obstetrical epidemiology were consulted to contextualize the statistical landscape.
Because hospitals seldom share comprehensive cesarean data publicly, the Business Insider team assembled its own dataset from scratch. Formal information requests were submitted to all fifty state health departments and Washington, D.C., seeking details on childbirth outcomes and delivery modes. Ultimately, twenty-nine states and the District of Columbia responded with usable records, enabling the creation of a uniquely comprehensive database covering more than 1,700 hospitals nationwide. This dataset represented an extraordinary cross-section of U.S. maternal care practices.
Through this process, one overarching reality became evident: the physicians responsible for delivering babies often face exceptionally difficult decisions. While the ability to perform an immediate cesarean can serve as a safeguard for maternal and fetal safety, the frequency with which these interventions occur is not dictated solely by medical necessity. Providers across multiple states revealed to Business Insider that additional pressures routinely intrude upon clinical judgment. They described performing C-sections not only out of genuine concern for patient welfare but also due to institutional constraints—shortages of staff or available delivery rooms, limited time to manage complex labors, or an omnipresent fear of malpractice litigation. These systemic factors, combined with the economic structures of hospital reimbursement, subtly but powerfully influence surgical frequency.
Decades of empirical research reinforce these observations. Business Insider found that indirect financial incentives often correlate with higher cesarean rates: surgeries tend to generate greater revenue and are more cost-efficient from a business perspective, offering hospitals predictable scheduling and a perceived buffer against legal risk. Thus, a disturbing paradox emerges—what maximizes institutional profit may simultaneously undermine collective public health. In fact, the data repeatedly underscored the same uncomfortable truth: elevated cesarean rates are linked to poorer maternal outcomes, yet they often bolster a hospital’s financial performance.
To systematically quantify these realities, reporters first gathered C-section rate statistics from hospitals across the country. Historical data showed a dramatic escalation in the prevalence of the procedure since the late 1960s, when it was still considered comparatively rare. Within just ten years, the national rate tripled, and by the early 2000s, it had doubled once again. Initially, researchers investigated whether patient choice—so-called elective cesareans—was the driving factor, but evidence suggested otherwise. Only about 2.5 percent of American births occur by maternal request without medical indication. Instead, demographic and health shifts appear to explain some—but not all—of the rise: women are tending to give birth at older ages, with higher rates of obesity and associated conditions such as diabetes, each of which increases the likelihood that surgery may be deemed the safest course. Even accounting for these variables, however, massive disparities persisted between hospitals.
Controlling for a wide constellation of influences—urban or rural setting, level of obstetric care, case volume, maternal age, race, income, and overall health—studies consistently demonstrated that one of the single greatest predictors of whether a woman would undergo a non-essential cesarean was not her personal profile, but rather the hospital she visited. Transparency, meanwhile, remained elusive. A woman hoping to learn her local hospital’s cesarean rate might easily find that information unavailable; some institutions voluntarily report to consumer surveys, but many decline. Business Insider sought to bridge this informational void by directly obtaining and standardizing state-level data.
As they discovered, disclosure practices vary dramatically. Eleven states refused to release hospital-specific cesarean figures, generally citing confidentiality laws or departmental policy. Louisiana proved to be an outlier in another way—it simply does not track C-sections by hospital. Meanwhile, twenty-eight states required formal public records requests, often accompanied by significant fees reaching as high as $1,500. By publication time, the journalists obtained detailed hospital-level data from eighteen states and the District of Columbia, supplemented by publicly available information from eleven others. Altogether, the team analyzed three main categories of measurement: overall cesarean rate, first-time C-section rate, and the low-risk or NTSV (nulliparous, term, singleton, vertex) cesarean rate.
Experts regard the low-risk rate as the most revealing metric, since it examines women who are experiencing their first pregnancy at full term, with a single baby positioned head-down—precisely the group least likely to require surgical delivery. Even among these patients, substantial variation emerged. To produce balanced comparisons, Business Insider averaged each hospital’s rate across all available years of data to minimize anomalies or unusually high single-year fluctuations. Their results painted a vivid picture: cesarean prevalence ranged from as low as 4 percent overall in one Alaskan hospital to a staggering 62 percent in a Florida facility.
To visualize regional relationships, the team mapped hospital coordinates using data from the Centers for Medicare and Medicaid Services, applying geospatial analysis tools to identify each facility’s nearest neighbor. When compared side by side, neighboring hospitals often exhibited shockingly divergent C-section rates. In hundreds of pairs, one hospital’s rate exceeded the other’s by twenty-five percentage points or more. This pattern underscored the notion that local culture, administrative policy, or financial orientation can shape medical decision-making as much as patient need.
Next, investigators examined whether profit status correlated with higher surgical frequencies. Drawing upon federal datasets and supplemental sources such as SEC filings, court records, and prior journalism, Business Insider verified whether each hospital operated as a nonprofit, for-profit, or public institution. Where ownership structures changed during the sampling years, those transitions were factored into the analysis. The results were stark: in nearly every participating state, for-profit hospitals performed cesareans at meaningfully higher rates. On average, first-time cesarean rates were 20 percent higher, and low-risk cesarean rates 14 percent higher, than in nonprofit or public hospitals.
These findings echo the consensus of numerous prior studies: cesarean delivery, while medically indispensable in certain contexts, has become entangled with hospital economics. Because the procedure is typically more lucrative and predictable than vaginal birth—demanding less labor time, fewer unpredictable variables, and offering easier scheduling—systems that prioritize financial optimization inadvertently encourage elevated rates. The Business Insider investigation illustrates not only the tension between medical necessity and institutional profit but also the urgent need for transparency. By compiling, analyzing, and mapping the data, the team provided an unprecedented public resource that enables both patients and policymakers to see, often for the first time, how dramatically a woman’s childbirth experience may differ based solely on where she delivers her baby.
Sourse: https://www.businessinsider.com/c-section-rate-nationwide-data-methodology-2025-12
