The C-section 'zipcode lottery'

What you probably already know: For decades, C-section rates in the United States have hovered around one-third of all births — well above the 10%-15% rate suggested by the World Health Organization. While the surgery is lifesaving in emergencies, it carries higher risks of infection, blood clots, longer recovery times and complications in future pregnancies. However, a woman’s likelihood of having a C-section often has less to do with her health and more to do with which hospital door she walks through.

Why it matters: New data highlights a staggering disparity in care. According to a 2025 analysis by Business Insider, C-section rates for low-risk, first-time mothers can vary from as low as 7% at some hospitals to more than 60% at others. This suggests that clinical necessity isn't the only driver. On the whole, The Leapfrog Group’s 2025 State of Maternity Care report found that C-section rates were declining until 2020, and are now worsening since the Covid-19 pandemic.

What it means: Hospitals successfully bucking the trend aren't necessarily using high-tech medical breakthroughs, but relatively “minor” behavioral (and financial) tweaks.

• Aligning incentives: Historically, many doctors and hospitals were paid more for C-sections than for vaginal births. Some health systems and insurers are now moving toward blended payment models where providers receive the same fee regardless of the delivery method, removing a financial nudge toward surgery.

• The power of belief: A doctor’s personal philosophy is one of the strongest predictors of intervention, according to The New York Times. Hospitals with lower rates are fostering cultures where labor is allowed more time, and “active management” of labor is replaced by patience, unless a medical emergency arises.

• The leapfrog effect: Transparency is proving to be a catalyst. When hospitals are forced to publicly report their rates, it often triggers internal reviews of why their numbers are higher than the hospital across town.

What happens now? The trend toward lower rates is expected to accelerate as more employers and insurers use reported data to steer patients toward high-performing hospitals. We are also seeing a rise in midwifery and doulas, who are proven to reduce unnecessary interventions. Currently, only 61% of hospitals offer midwives, with a massive regional gap (more than 75% of Northeastern hospitals, compared to fewer than 45% in the South). As the data receives more scrutiny, experts are urging expectant families to shift their focus: It is no longer enough to just research your OB-GYN — you must also vet the hospital where you plan to give birth.