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For-Profit California Hospitals Perform More Cesareans than Non-Profits

By Jill Arnold

California Watch, a reporting initiative launched in 2009 by the independent, nonpartisan Center for Investigative Reporting, published the results today of the first independent analysis of cesarean rates at the 253 hospitals reporting birth statistics to State of California health authorities.

This analysis is the first to show that for-profit hospitals, such as Los Angeles Community Hospital with a 59 percent cesarean rate, have higher cesarean rates than non-profit hospitals, such as Kaiser Permanente Redwood City Medical Center at which only 14 percent of patients give birth by cesarean.

Higher cesarean rates were not found at hospitals that cater to wealthier patients; rather, higher rates were found at hospitals catering to all races and economic classes. California Watch found no correlation between cesarean rates and a hospital’s percentage of patients receiving Medi-Cal.

According to California Watch, four of the five hospitals in California with the highest cesarean rates were for-profit hospitals in Los Angeles County which treat a higher percentage of African American and Hispanic patients than the state average.

California Watch interviewed Gene Declercq, professor of community health sciences at the Boston University School of Public Health regarding subtle incentives to increase efficiency. Said DeClercq:

“There are factors that are attractive to hospitals in terms of training and staff and facilities,” he said. “It’s a lot easier if you can do all your births between seven and 10 in the morning and know exactly how many operating rooms and beds you need.” Vaginal births are unpredictable, creating inefficiencies that can hurt the bottom line.

The organization released the results of their analysis to the public on Saturday, September 11, 2010, along with a sidebar on their methodology, a React & Act section with information for expectant parents, including a Q & A section with midwife Amy Romano, and region-specific materials (below).


California Cesarean Rates (All hospitals)

Download the data (.csv)

Lee el artículo en español


Downloadable C-section Primers  

Southern California C-section primer


Central California C-section primer 


Northern California C-section primer



Información descargable sobre la cesárea

Información descargable sobre la cesárea (el sur de California)


Información descargable sobre la cesárea (California central) 


Información descargable sobre la cesárea (el norte de California) 


(Twitter hashtag #csectionCW)

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Reader Comments (5)

Of course vaginal deliveries hurt the bottom line, because they can't control them. Thier bottom line is more important than the patients health and that of thier child. It's all about the money. If you haven't already just watch The business of being born. It really is sad, how bad our health care is for the majority of expecting mothers in the USA.

September 11, 2010 | Unregistered CommenterLola

Could you explain a bit more about what "low risk" means? For example, for the two hospitals I have birthed at, Sutter of Santa Rosa does c-sections for every woman with a previous section or a breech baby or twins. The tiny VBAC percentage is, my guess, probably from women who birthed faster than they could prep them for surgery. So when you say only 10% of low-risk women had c-sections, aren't they getting such low numbers because they have a very broad definition of high-risk?

Compare them to Marin General, with a 13 .4% low-risk c-section rate. But they do VBACs and twin/breech vaginal births because they're midwife centered. They also routinely tell their patients that forced cessarians are assault. Are their numbers a bit higher because they are considering those categories as low-risk even though they might require more interventions later in labor? What about other factors? When I was at Marin General, I was classified as "elderly" because I was 40...did that mean high-risk? When I was at Sutter, I was 45 but they never mentioned my age (though I was there for an emergency and a truly necessary surgery).

Is there some standard definition? Is "high-risk" the same as "medically indicated surgical births?" I'm reading the California Watch FAQ for these definitions but it still doesn't make much sense to me. How can a hospital that always performs surgery for a variety of common conditions end up with a lower base rate than a hospital that doesn't?

September 11, 2010 | Unregistered CommenterCyndi

Despite the fact that it would be impossible to go into as much detail as this study did, it would be interesting to go through all the info Jill has posted to see if there's a similar difference in cesarean rates in for-profit and non-profit hospitals in the rest of the country.

September 11, 2010 | Unregistered CommenterVeronica

Ok, I do find it interesting that the study found no difference in rates for private vs. Medi-Cal coverage. My previous research showed differences.

September 11, 2010 | Unregistered CommenterGuggie

How could someone even work in a place where over 50 % of babies were born by c-section? It sounds terrifying and like a horror movie to me.

September 12, 2010 | Unregistered Commentersara
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