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.
Baseline
25.2%
Target
23.6%
Indicator Highlights
Childbirth is the number-one reason for hospitalization in California and in the US. In California, there are 500,000 births each year (one-eighth of all US births), almost half of which are paid for by Medi-Cal.3
Unnecessary cesarean deliveries drive up costs of care. The total average payment for C-sections is nearly 50% higher than for vaginal births, not including associated costs (such as hospital readmissions, home care, and subsequent C-sections).
Vaginal birth after cesarean (VBAC), which is an option for pregnant individuals who have undergone only one prior cesarean and are experiencing healthy pregnancies, has increased from 4.4% in 2008 to 13.1% in 2022.4
For most birthing individuals who deliver their babies vaginally during their first labor, their subsequent deliveries are also vaginal. However, once a birthing individual has had a C-section, they will most likely have the same procedure for subsequent births — leading to higher risks of major complications, such as hysterectomy and uterine rupture. Vaginal births after cesarean are still unavailable in many California hospitals.3
Data Snapshot
There is marked variation in the rates of cesarean delivery (from 12% to 35%) at hospitals across California that suggest hospital policies, labor and delivery unit culture, and individual clinician attitudes rather than patient factors alone drive the rates of cesarean delivery.2,5
In 2022, low-risk cesarean births were highest among Black or African American and Pacific Islander birthing individuals, and lowest among individuals who identified as American Indian and Alaska Native, Latino, or White.
Pacific Islander individuals who had one previous C-section delivery were more likely to subsequently deliver vaginally, while American Indian and Alaska Native as well as Latino individuals were less likely to have a subsequent vaginal delivery.4
Low-Risk Cesarean Rate, Over Time
Low-Risk Cesarean Rate, by Demographic Category
Low-Risk Cesarean Rate, by County
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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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