Blue Cross Blue Shield Association Report Shows Where Mothers Reside Has Big Impact on C-Section Rates

New study indicates national decline in cesarean deliveries after twenty years of rising rates

CHICAGO – The rate of babies delivered by cesarean section varies widely by geographic location, indicating that where a mother lives has a significant impact on how she will give birth, according to a new study by the Blue Cross Blue Shield Association (BCBSA). In fact, the rate of cesarean deliveries is more than twice as high in some parts of the country than in others, after adjusting for factors such as age.

While geographic disparities exist, the data found a consistent decline in the national rate of cesarean births reversing a 20-year trend of increasing rates. During a five-year period between July 2010 and June 2015, the cesarean rate decreased slightly each year within the Blue Cross and Blue Shield (BCBS) member population, to 33.7 percent from 35.2 percent. The 1.5 percentage point decrease in cesarean deliveries represents approximately 36,000 more vaginal births than expected during the five-year study period. Given the increased medical complications and extended recovery time associated with C-sections, this reversal is promising, despite the worrisome geographic differences in rates.

The study, “Cesarean Birth Trends: Where You Live Significantly Impacts How You Give Birth,” represents a comprehensive analysis of medical claims from 3 million commercially-insured BCBS members.*

The study shows:

  • In markets that had at least 5,000 births, Miami, Florida, recorded the highest adjusted** (49.6 percent) cesarean rates, and Albuquerque, New Mexico, registered the lowest adjusted cesarean rates of 22.7 percent.

  • The West South Central divisions of the U.S. had the highest cesarean rate of 39.4 percent, while the lowest rate of 29.3 percent was found in the Mountain division.

  • Rates vary significantly by local market area, with the variation remaining after adjusting for age, multiple births and breech births.

“Because C-sections increase complications for babies and mothers, the procedure should be reserved for situations where surgeries are medically necessary,” said Dr. Trent Haywood, senior vice president and chief medical officer for BCBSA. “These findings underscore the need for medical professionals to address variations in clinical practices by educating patients on the importance of vaginal births.”

The wide difference in rates among U.S. cities varying from approximately 25 to 50 percent by market also indicates a need to examine geographically-driven factors, such as local practice patterns and the legal malpractice environment. Additionally, each geographic division has a different distribution of ages of delivering mothers and different rates of clinical conditions associated with cesarean deliveries, such as breech delivery or multiple births.

This year, BCBSA announced a new national designation to help prospective parents find hospitals that deliver quality, affordable maternity care. The Blue Distinction® Centers for Maternity Care program evaluates hospitals on several quality measures, including the percentage of newborns that fall into the category of early elective delivery, an ongoing concern in the medical community. Compared with babies born at 39 weeks or later, early term infants face higher risks of infant death and respiratory ailments such as respiratory distress syndrome, pneumonia, and respiratory failure, among other conditions.

In addition, hospitals that receive a Blue Distinction Center for Maternity Care designation agreed to meet requirements that align with principles that support evidence-based practices of care, as well as having initiated programs to promote successful breastfeeding, as described in the Baby-Friendly Hospital Initiative by Baby-Friendly USA or the Mother-Friendly Hospital program by the Coalition for Improving Maternity Services (CIMS) through its “Ten Steps of Mother-Friendly Care.” The program also evaluates hospitals on overall patient satisfaction, including a willingness to recommend the hospital to others.

This is the eighth study of the Blue Cross Blue Shield: The Health of America Report series, a collaboration between BCBSA and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into healthcare affordability and access to care.

For more information, visit

*This report examines the medical claims of more than 3 million deliveries for Blue Cross and Blue Shield commercially-insured members from July 2010 through June 2015 to assess the trend in overall cesarean rates nationally and differences in the rate across regions and markets. It also looks at the interaction of age and key conditions of birth on the rate and makes adjustments to the geographic variation to account for these factors.

** Rates are adjusted to match the national average age distribution and prevalence of breech and multiple births.

About BHI
Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Health Intelligence Company, LLC operates under the trade name Blue Health Intelligence (BHI) and is an Independent Licensee of BCBSA. For more information, visit

About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.