Focus Area: C-Sections


Each year, about 4 million births take place in the United States, with California accounting for about 1 in 8 of all U.S. births, or 500,000 births, each year. Childbirth is the No. 1 reason for hospitalization nationally and in California, and Medi-Cal pays for about half of all California births. Between 1997 and 2014, California’s total C-section rate increased dramatically from about 1 in 5 births to more than 1 in 3 births.

While life-saving in certain cases, C-sections can pose serious risks to both babies and mothers, and once a woman has a cesarean, about 9 in 10 end up having a C-section for subsequent births, increasing their risk of major complications. Efforts to improve maternity care are starting to yield positive results in California as low-risk, first-birth C-section rates have begun to decline from 27.3 percent in 2013 to 25.6 percent in 2015, according to California Maternal Quality Care Collaborative data. However, significant overuse of this surgical procedure and unwarranted variation persists. Although 40% of California hospitals that provide maternity care services have achieved or surpassed the national Healthy People 2020 goal of 23.9%, the other 60% have not; the range for low-risk, first-birth C-section rates in California hospitals spans from below 15% to over 60%. Hospital C-section rates, along with other maternity care measures, may be found at Through the Smart Care California initiative, the state’s largest public and private health care purchasers are working with hospitals and clinicians to reduce low-risk, first-birth C-sections across the state at every hospital to 23.9%, thereby improving maternity care.

What's New

2018 Hospital C-Section Honor Roll Media Coverage

News Release: Smart Care California Announces Third Annual C-Section Honor Roll (October 23, 2018)

2018 Hospital C-Section Honor Roll List

Fact Sheet: Reducing Low-Risk C-Section Births in California, updated October 2018

My Birth Matters: C-Section Consumer Education Campaign



Patients, Families, and Caregivers


Payers and Purchasers


California C-section Consumer Education: Audience Research Findings and Prototypes (Eric Antebi, California Heath Care Foundation, Smart Care California Meeting, October 2017)

C-Section Payment as a Priority: Overview of Value-based Payment for Birth in California and Nationally (Elliott Main, M.D., California Maternal Quality Care Collaborative, Smart Care California Meeting, June 2017)

Reducing C-Section Deliveries in California: Background & Opportunities for Collaboration (Lance Lang, M.D., Covered California, and Stephanie Teleki, Ph.D., California Heath Care Foundation, Smart Care California Meeting, October 2015)

Hospital C-section Honor Roll Archives

2017 Hospital C-Section Honor Roll Media Coverage

News Release: Smart Care California Recognizes 111 Hospitals for Reducing C-Sections

2017 Hospital C-Section Honor Roll List

2016 Hospital C-Section Honor Roll: News Coverage

News Release: California Hospital C-Section Honor Roll Announced, Oct. 26, 2016

2016 Hospital C-Section Honor Roll List