YONKERS, NY — A number of factors can increase a woman’s chance of having a C-section—such as being older, heavier or having diabetes. But the single biggest variable may be where a woman chooses for delivering her baby. That’s one of the key findings in a new investigation unveiled by Consumer Reports.

The report reveals pronounced variations in C-section rates among U.S. hospitals for low-risk deliveries, even hospitals in the same communities and among similar institutions. The investigation also shows that most hospitals have C-section rates that are above targets set by the Department of Health and Human Services (HHS).

Consumer Reports focused on the C-section rates of first-time moms anticipating a low-risk delivery. That means women delivering full-term, single babies (not twins, triplets or other multiples) that are properly positioned for delivery.  The target C-section rate for those births, set by the U.S. Department of Health and Human Services, is under 23.9 percent.  That’s ten percent less than the rate for such births in 2007, which the government uses as a baseline from which to improve.

CR’s report is available free online at ConsumerReports.org. It includes Ratings of more than 1,200 hospitals based on their C-section rates.

“Our investigation reveals that most U.S. hospitals have failed to come close to reaching what we consider to be attainable benchmarks,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center.

Nearly six in 10 of the hospitals rated by Consumer Reports have C-section rates above the national target of 23.9 percent and about one in six have C-section rates above 33.3 percent, earning Consumer Reports’ lowest score.  By contrast, only about one in eight hospitals have rates of 18.4 percent or lower, the cutoff for a top score in CR’s ratings. 

“The irony is that for a woman who really wants to have a non-surgical birth, her biggest risk of having a C-section might be which hospital she goes to,” added Peter. “We hope our ratings will shine a light on hospitals with high C-section rates and help expectant moms make informed choices.”

Because hospitals are not required to publicly report their C-section rates, Consumer Reports does not have C-section rates for more than half of the estimated 3,000 U.S. hospitals that deliver babies. With no reporting requirement, many hospitals simply choose not to release that information. Particularly notable in their absence are 24 hospitals with more than 5,000 births, including many in and around New York City such as Mount Sinai Hospital, New York-Presbyterian Hospital, and NYU Langone Medical Center.  (The Joint Commission, a hospital accrediting organization, has C-section rates for hospitals with more than 300 births each year, but does not make that information public.) 

“You have to give credit to the hospitals that report their data, even the hospitals that are lower performers,” says Leah Binder, chief executive officer of The Leapfrog Group, the nonprofit organization that collects and reports the data in most of the country. “It’s the hospitals that don’t report that you have to wonder about.” Binder notes that hospitals do not have to pay The Leapfrog Group when they report data.  Consumer Reports uses Leapfrog’s data for its ratings in all states but California; data from California come from the California Maternal Quality Care Collaborative.

Key findings:

• Nearly sixty-percent of the hospitals rated (743 hospitals) have C-section rates above the national target for low-risk births in first-time moms. And 18 percent had C- section rates above 33.3 percent. There are 24 such hospitals with a high volume of deliveries. See page 3 for a list of those hospitals.

• Conversely, only 13 percent of U.S. hospitals (165 hospitals) have rates at or below 18.4 percent, the cut-off for a top score in the ratings. Nineteen of them are hospitals with a high volume of deliveries.  See page 4 for a list of those hospitals.

• The variation among all U.S. hospitals is dramatic. For example, C-section rates for low-risk deliveries in first-time moms in large hospitals range from 11 percent at Crouse Hospital in Syracuse, N.Y., to 53 percent at South Miami Hospital in Miami, Fla. Wide variations are also evident among hospitals in the same community. For example, in Chicago, 30 percent of low-risk deliveries at the University of Chicago Medical Center were by C-section, while 10 miles away at Northwestern Memorial Hospital the rate was just 17 percent. And in Southern California, Kaiser Permanente Riverside Medical Center has a C-section rate of 22 percent compared to 35 percent at Riverside Community Hospital.

• The likelihood of having a C-section varies widely depending on where in the country women live. In general, rates are higher in the northeast and south and lower in the west and midwest.

• Three states, plus the District of Columbia, have average C-section rates that are above 30 percent: Mississippi (31 percent); Kentucky (32 percent), Florida (32 percent) and D.C. (35 percent).

• Four states have average C- Section rates that fall below 18.5 percent: South Dakota (14 percent), Wyoming (17 percent), New Mexico (18 percent), and North Dakota (18 percent.

LARGE HOSPITALS WITH HIGH C-SECTION RATES

Overall, there are 221 hospitals in the U.S. with C-section rates above 33.3 percent for low risk deliveries, the cutoff for receiving Consumer Reports’ bottom score.  Twenty-four of them are hospitals with a high volume of deliveries:

LARGE HOSPITALS WITH LOW C-SECTION RATES

There are 165 hospitals in the U.S. with C-section rates for low-risk deliveries at 18.4 percent or lower, the cutoff for earning CR’s top score.  Nineteen of them are hospitals with a high volume of deliveries:

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.

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About Consumer Reports

Consumer Reports is the world’s largest and most trusted nonprofit, consumer organization working to improve the lives of consumers by driving marketplace change. Founded in 1936, Consumer Reports has achieved substantial gains for consumers on health reform, food and product safety, financial reform, and other issues. The organization has advanced important policies to cut hospital-acquired infections, prohibit predatory lending practices and combat dangerous toxins in food. Consumer Reports tests and rates thousands of products and services in its 50-plus labs, state-of-the-art auto test center and consumer research center. Consumers Union, a division of Consumer Reports, works for pro-consumer laws and regulations in Washington, D.C., the states, and in the marketplace. With more than eight million subscribers to its flagship magazine, website and other publications, Consumer Reports accepts no advertising, payment or other support from the companies whose products it evaluates.