Consumer Reports Analysis: Most U.S. Hospitals’ C-Section Rates Exceeding National Targets

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A Mother’s Risk of Having a C-Section Can Vary As Much As Ninefold Across Hospitals in the US

Research suggests that for childbirth, women pick their doctor first, not their hospital. Our goal is to get women thinking about the hospital too, since the hospital you choose can play a big role in determining your risk of a C-section.

A new Consumer Reports analysis of more than 1,300 hospitals finds that 56 percent of U.S. hospitals have C-section rates above the national target for low-risk births. The report also reveals startling variations in C-section rates from hospital to hospital, even those within the same zip code. The message to mothers? Your biggest risk for an unnecessary C-section may be the hospital you choose.

Roughly one in three babies born in this country, or about 1.3 million children each year, are now delivered by cesarean section, the most common surgery performed in U.S. hospitals.

“Research suggests that for childbirth, women pick their doctor first, not their hospital. Our goal is to get women thinking about the hospital too, since the hospital you choose can play a big role in determining your risk of a C-section,” says Doris Peter, Ph.D., director, Consumer Reports Health Ratings Center.

The C-section hospital ratings – all free – are available online at CR.org/hospitalratings.

In many cases, cesarean sections are absolutely necessary. But often they are not: Almost half are done in situations where babies could be delivered vaginally instead, according to research. “Most hospitals are doing far too many unnecessary C-sections and women, armed with this data, can help Consumer Reports send a message to hospitals that we want them to improve,” said Peter.

Consumer Reports’ goal is two-fold: first, to make C-section rates public to help new moms make smart choices, and second, to use the ratings as a mechanism to bring high rates down and thus drive positive marketplace change.

The risk of having a C-section is higher in the Northeast and South, and lower in the West and Midwest. Four states had C-section rates of 30 percent or higher: West Virginia (31 percent), Florida (31 percent), Louisiana (32 percent), and Nebraska (34 percent, where there is only one hospital reporting data). And four states had rates below 18.5 percent: South Dakota (17 percent), Idaho (17 percent), New Mexico (17 percent), and Minnesota (18 percent). The national benchmark set by the U.S. Department of Health and Human Services is 23.9 percent or less.

The variation among individual hospitals is even more dramatic. For large hospitals, C- section rates range from 7 percent at Crouse Hospital in Syracuse, New York, to 51 percent at South Miami Hospital in Miami, Florida. And just outside of Miami, Hialeah Hospital had the highest C-section rate (65 percent) of all hospitals rated by Consumer Reports.

Even when hospitals are located within close proximity, variations in C-Section rates can be substantial. Consumer Reports found this pattern in multiple locations including the following cities: St. Louis, Missouri; Cincinnati, Ohio; and Fort Worth, Texas. “This variation is a critical point in our analysis because there is a big, important take away for moms. You cannot afford not to know the track record of the hospital where you’re delivering,” says Peter. Furthermore, in a recent study in the journal Birth, more than half of women said they would travel 20 miles farther to have their baby at a hospital with a C-section rate that was 20 percentage points lower.

Some hospitals aren’t making it easy for women to know their C-section rates, Peter said. Consumer Reports does not have data for more than half of the estimated 3,000 hospitals that deliver babies because hospitals aren’t required to report that information to the public. “We applaud those hospitals who do share their C-section data, particularly the ones who do poorly. We see this as a critical step in the direction toward greater transparency and openness,” says Peter.

Most worrisome are the hospitals that perform more than 5,000 births every year and do not publicly report their data, of which there are 28. Consumer Reports contacted the three hospitals with the most births and to date, only one, Memorial Hermann Greater Heights Hospital, responded. New York- Presbyterian Hospital in New York City and Northside Hospital in Atlanta did not respond to requests for comment.

The following states had more than two of these large non-reporting hospitals: Florida, Maryland, New York, Pennsylvania, and Texas. New York has a total of eight non-reporting hospitals, most of which are located in New York City: Long Island Jewish Medical Center, New Hyde Park; Maimonides Medical Center, Brooklyn; Mount Sinai Hospital, NYC; Mount Sinai St. Lukes – Roosevelt, NYC; New York Methodist, Brooklyn; New York- Presbyterian Hospital, NYC; North Shore University Hospital, Manhasset; NYU Langone Medical Center, NYC.

Overall, there were 216 hospitals with C-section rates above 33.3 percent for low-risk deliveries, earning CR’s worst rating. Of these hospitals, the 22 listed below were the ones that delivered the most babies within a year. Conversely, there were 203 hospitals with rates of 18.4 percent or lower, earning CR’s best rating. Twenty- two of them were hospitals that delivered a high volume of babies.

Large Hospitals w/ High C-section Rates

Hospital Name         C- Section Rate

South Miami Hospital, Miami, Fla     51
Richmond University Medical Center, Staten Island, NY     44
Hackensack University Medical Center, Hackensack, NJ     43
Woman’s Hospital of Texas, Houston, TX     41
Midland Memorial Hospital, Midland, TX     40
Inova Fairfax Hospital, Falls Church, VA     39
Las Palmas Medical Center, El Paso, TX     39
Texas Health Presbyterian Hospital, Plano, TX     39
Memorial Regional Hospital, Hollywood, FL     38
Henrico Doctors’ Hospital, Richmond, VA     37
Doctor’s Hospital at Renaissance, Edinburg, TX     37
Baptist Hospital of Miami, Miami, FL     37
Riverside Community Hospital, Riverside, CA     36
Bayshore Medical Center, Pasadena, TX     35
Jackson Health System, Miami, FL     35
Boca Raton Regional Hospital, Boca Raton, FL     34
St. Joseph’s Healthcare System, Paterson, NJ     34
Medical Center at Bowling Green, Bowling Green, KY     34
Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX     34
Wesley Medical Center, Wichita, KS     34
Inova Alexandria Hospital, Alexandria, VA     34
Baptist Medical Center, San Antonio, TX     34

Large Hospitals w/ Low C-section Rates
Hospital Name         C-section Rate
Crouse Hospital, Syracuse, NY     7
SSM St. Mary’s Health Center, St. Louis, MO     12
Memorial Medical Center, Springfield, IL     12
Lovelace Women’s Hospital, Albuquerque, NM     13
Bakersfield Memorial Hospital, Bakersfield, CA     13
Utah Valley Regional Medical Center, Provo, UT     14
WakeMed Raleigh Campus, Raleigh, NC     15
Intermountain Medical Center, Murray, UT     16
Desert Regional Medical Center, Palm Springs, CA     16
NorthShore University Health System, Evanston, IL     17
Kaiser Permanente Panorama City Medical Center, Panorama City, CA     17
Kaleida Health, Buffalo, NY     17
Northwestern Memorial Hospital, Chicago, IL     17
TMC HealthCare, Tucson, AZ     17
University Medical Center, Lubbock, TX     17
Providence Regional Medical Center Everett, Everett, WA     17
San Joaquin Community Hospital, Bakersfield, CA     18
Christiana Care Health System, Newark, DE     18
Bethesda North Hospital, Cincinnati, OH     18
Kaiser Permanente Roseville Medical Center, Roseville, CA     18
JPS Health Network, Fort Worth, TX     18
Southwest Healthcare System, Murrieta, CA     18

About Consumer Reports
Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. For 80 years, CR has provided evidence-based product testing and ratings, rigorous research, hard-hitting investigative journalism, public education, and steadfast policy action on behalf of consumers’ interests. Unconstrained by advertising or other commercial influences, CR has exposed landmark public health and safety issues and strives to be a catalyst for pro-consumer changes in the marketplace. From championing responsible auto safety standards, to winning food and water protections, to enhancing healthcare quality, to fighting back against predatory lenders in the financial markets, Consumer Reports has always been on the front lines, raising the voices of consumers.
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MAY 2017
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Douglas Love