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Each year, about 4 million births take place in the United States, with California accounting for about 1 in 8 of all U.S. births, or 500,000 births, each year. Childbirth is the No. 1 reason for hospitalization nationally and in California, and Medi-Cal pays for about half of all California births. Between 1997 and 2014, California’s total C-section rate increased dramatically from about 1 in 5 births to more than 1 in 3 births.

While life-saving in certain cases, C-sections can pose serious risks to both babies and mothers, and once a woman has a cesarean, about 9 in 10 end up having a C-section for subsequent births, increasing their risk of major complications. Efforts to improve maternity care are starting to yield positive results in California as low-risk, first-birth C-section rates have begun to decline from 27.3 percent in 2013 to 25.6 percent in 2015, according to California Maternal Quality Care Collaborative data. However, significant overuse of this surgical procedure and unwarranted variation persists. Although 40% of California hospitals that provide maternity care services have achieved or surpassed the national Healthy People 2020 goal of 23.9%, the other 60% have not; the range for low-risk, first-birth C-section rates in California hospitals spans from below 15% to over 60%. Hospital C-section rates, along with other maternity care measures, may be found at Through the Smart Care California initiative, the state’s largest public and private health care purchasers are working with hospitals and clinicians to reduce low-risk, first-birth C-sections across the state at every hospital to 23.9%, thereby improving maternity care.

Fact Sheet: Reducing Low-Risk C-Section Births in California, updated October 2018



Patients, families, and caregivers

My Birth Matters (Consumer Reports, California Health Care Foundation, California Maternal Quality Care Collaborative)

Delivering your baby: Why scheduling early delivery is not a good idea (Consumer Reports)

In Depth: A Healthy Start for You and Your Baby (Consumer Reports)

10 Things To Reject in the Delivery Room (Consumer Reports)


Toolkit to Support Vaginal Birth and Reduce Primary Cesareans (California Maternal Quality Care Collaborative) 

How One Hospital Brought Its C-Section Rate Down Fast (US News and World Report, May 2015)

Payers and purchasers

Aligning Birth Payment to Reduce Unnecessary C-Section: A Menu of Options (Smart Care California)

Employer Actions to Progress Value-Based Payment in Maternity (Pacific Business Group on Health)

Report: Variation in NTSV C-section Rates Among California Hospitals (Pacific Business Group on Health)

Working Toward Happier Birthdays: An Effort in California to Lower C-Section Rates (Health Affairs Blog, November 2015)


California C-section Consumer Education: Audience Research Findings and Prototypes (Eric Antebi, California Heath Care Foundation, Smart Care California Meeting, October 2017)

C-Section Payment as a Priority: Overview of Value-based Payment for Birth in California and Nationally (Elliott Main, M.D., California Maternal Quality Care Collaborative, Smart Care California Meeting, June 2017)

Reducing C-Section Deliveries in California: Background & Opportunities for Collaboration (Lance Lang, M.D., Covered California, and Stephanie Teleki, Ph.D., California Heath Care Foundation, Smart Care California Meeting, October 2015)

Hospital c-section honor roll archives

2018 Hospital C-Section Honor Roll Media Coverage

News Release: Smart Care California Announces Third Annual C-Section Honor Roll (October 23, 2018)

2018 Hospital C-Section Honor Roll List

2017 Hospital C-Section Honor Roll Media Coverage

2017 Hospital C-Section Honor Roll List

2016 Hospital C-Section Honor Roll: News Coverage

News Release: California Hospital C-Section Honor Roll Announced, Oct. 26, 2016

2016 Hospital C-Section Honor Roll List


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