Delivery disparities: Hospitals do more C-sections among patients in minority groups

Hospitals are more likely to perform C-sections for patients in minority groups compared to white patients, according to a report from The Leapfrog Group.

The patient safety organization found consistent disparities in the report, “The State of Maternity Care in U.S. Hospitals,” which was released this week. The gaps varied, but hospitals consistently showed higher C-section rates for patients who belonged to minority groups.

The largest disparities occurred among Black patients. The analysis found nearly 21% of U.S. hospitals showed disparities in the rate of C-sections between Black patients and white patients.

“This is an alarming statistic, underscoring the urgent need for systemic change in U.S. maternity care,” the report stated.

After years of reducing the rate of C-sections, progress has stalled, according to the report.

While C-sections are necessary for some patients, the procedures carry some risks, and they bring additional risks for future pregnancies, including problems with the placenta and ruptures of the uterus, according to the American College of Obstetricians and Gynecologists. Patients with C-sections typically have longer hospital stays. The ACOG recommends C-sections only when benefits outweigh the risks.

The Leapfrog Group has released previous reports on maternity care, but the group said this is its first analysis to include data about hospital-reported disparities in C-section rates by race and ethnicity.

The report found disparities in the rate of C-sections between Black patients and white patients in 164 of 784 hospitals, or one in five hospitals (20.9%).

Disparities in the C-section rates of Asian patients were found in 14.7% of hospitals, and gaps were found in the C-section rate of Hispanic patients in 5% of hospitals, according to the report.

After years of declines, the rates of C-sections among first-time mothers have risen since 2020, the report shows. That’s noteworthy because patients having babies for the first time are at typically low risk of the need for a C-section.

The average rate of C-sections for first-time mothers reached 25.3% in 2024, compared to 25.2% in 2023 and 24.5% in 2020. The rate remains lower than a decade ago (26.4% in 2015), but the report indicates that hospitals aren’t reducing the rate of C-sections.

Hospitals are faring better when it comes to performing fewer episiotomies. Nationwide, episiotomy rates have dropped by 73% since 2012, according to the report. The national rate of episiotomies has fallen to 3.4% in 2024.

Leah Binder, president and CEO of The Leapfrog Group, praised hospitals for reporting data on disparities in C-section rates, but she said there’s work to be done.

“Transparency takes courage, and it is the critical first step on the path to real change,” Binder said in a statement accompanying the report. “We congratulate hospitals on reducing episiotomy rates, which has made a difference for thousands of women and babies. However, we urge renewed efforts to lower C-section rates and continue improving maternity care for all patients.”

Healthcare leaders have expressed growing concern over the nation’s disturbing maternal mortality rate, and the tens of thousands of women who suffer serious complications tied to childbirth. As many as 60,000 women annually suffer serious pregnancy complications, the Commonwealth Fund estimates.

More hospitals have been closing labor and delivery units in recent years, and that has led to more “maternity deserts.” More than one in three counties are without obstetricians or birthing facilities, according to the March of Dimes.

As rural hospitals continue to face serious financial difficulties, more are dropping labor and delivery services. Since 2011, 267 rural hospitals have stopped providing obstetric services, according to the Chartis Center for Rural Health.