Healthy Beginnings / Reducing Low-Risk Cesarean Births

Reducing Low-Risk Cesarean Births2025-05-14T17:33:33-07:00

Safe Births. Healthy Parents and Babies.

Although most pregnant individuals can have vaginal births, surgical delivery (cesarean section, or C-section) is an appropriate method when vaginal delivery carries risk for the fetus and/or the pregnant individual. Cesarean delivery is a major abdominal surgery with short- and long-term risks and consequences, such as surgical complications, admission of the infant to neonatal intensive care, longer recovery period, increased health risk for future pregnancies and births, and high medical costs. There is strong clinical evidence that many pregnant Californians undergo procedures such as C-sections, repeat C-sections, and labor inductions that may not be medically necessary.1

Deliveries that result in first-time, full-term (37 or more weeks gestation), one fetus (singleton), headfirst (vertex) live births are considered low-risk. Among these, cesarean deliveries may pose avoidable risks of significant short- and long-term maternal health complications or death that can compound with subsequent cesarean deliveries.2

This indicator tracks the low-risk cesarean birth rate, in an effort to reduce the rates of medically unnecessary cesarean deliveries.

Low-Risk Cesarean Births

In 2022 (baseline year), the low-risk cesarean birth rate was 25.2%. The most recent rate available is 25.2% (2022). We hope to reach a target of 23.6% or lower by 2034.

More Data about Low-Risk Cesarean Births

Baseline

25.2%

Current Rate

25.2%

Target

23.6%

Indicator Highlights

Data Snapshot

Low-Risk Cesarean Rate, Over Time

 

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Low-Risk Cesarean Rate, by Demographic Category

 

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Low-Risk Cesarean Rate, by County

 

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Indicator: Low-risk Cesarean Birth Rate – Nulliparous Term Singleton Vertex (NTSV) cesarean births among low-risk deliveries, California

Description: The C-section rate among low-risk deliveries, i.e., the cesarean delivery rate among births that are first-time (nulliparous), full-term (37 or more completed weeks of gestation based on the obstetric estimate), singleton (one fetus), and headfirst (vertex or cephalic) births (also known as NTSV).

Data Limitations: Vital Statistics data is derived from the registration process and includes confidential and non-confidential identifiers, demographic information, and medical/health data from the certificate. The information on the certificates are provided by informants and clinicians; accuracy and completeness is dependent on the reporting parties.

Indicator Source: California Department of Public Health, Birth Statistical Master File, 2007–2017: Compiled from information on birth certificates, including demographic information related to the infant and parents, as well as medical data related to the birth.

California Department of Public Health, California Comprehensive Master Birth File, 2018+: Compiled from information on birth certificates, including demographic information related to the infant and parents, as well as medical data related to the birth. Beginning in 2018, the California Comprehensive Master Birth File replaced the Birth Statistical Master File.

Indicator Calculation Methodology: The low-risk cesarean delivery rates are the numbers of term (37 or more completed weeks of gestation), singleton, and vertex births with cesarean delivery method per 100 birthing individuals giving birth for the first time with term, singleton, vertex births. Denominators include all live births to California resident birthing individuals. The state dashboard uses single year data; the county dashboard uses three-year aggregated data. Records with missing or unknown delivery method were excluded.
https://www.cdph.ca.gov/Programs/CFH/DMCAH/surveillance/CDPH%20Document%20Library/Data-Dashboards/About-the-Data-Delivery-Methods.pdf

Data Collection Methodology: The California Department of Public Health receives and compiles birth certificates. The birth files include all state registered births, and births to California residents that occurred out-of-state.

Program URL Link: California Department of Public Health: Maternal, Child & Adolescent Health Division: https://www.cdph.ca.gov/Programs/CFH/DMCAH/surveillance/Pages/Delivery-Methods.aspx

Reporting Cycle: Annual (Fall)

1. Lally, S., & Lewis, V. (2014). Maternity Care Patient Engagement Strategies. Integrated Healthcare Association, 1-12. www.iha.org/wp-content/uploads/2020/10/Issue-Brief-Maternity-Care-Patient-Engagement-Strategies-1.pdf

2. Rosenstein MG, Chang S, Sakowski C, et al. (2021). Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California. JAMA, 325(16):1631–1639. doi:10.1001/jama.2021.3816

3. California Health Care Foundation. Reducing Unnecessary C-Sections in California. A CHCF-Supported Effort from 2015 to 2020. https://www.chcf.org/project/reducing-unnecessary-c-sections/#related-links-and-downloads

4. California Department of Public Health: Maternal, Child & Adolescent Health Division. (2022). Data Dashboards: Delivery Methods. January 2025. https://www.cdph.ca.gov/Programs/CFH/DMCAH/surveillance/Pages/default.aspx#backtoTop

5. Cal Hospital Compare. (2022). California Maternity Honor Roll Fact Sheet. June 2022. https://calhospitalcompare.org/wp-content/uploads/2022/08/Fact-Sheet-w-List-of-Honor-Roll-Hospitals_Maternity-Honor-Roll_CHC_2022-3.pdf

Stories & Solutions

Smart Care California Award

Smart Care California recognized 104 California hospitals with an award for achieving the national Healthy People 2020 goal for low-risk, first-birth Cesarian sections (C-sections).

Healthy Babies are Worth the Wait Community Program

Healthy Babies are Worth the Wait is a community program that focuses on decreasing “preventable” preterm birth through educating pregnant patients, perinatal providers, and the community on risk factors and strategies for reducing risks of preterm birth.

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