A growing number of hospitals are proving that high C-section rates are not inevitable — a shift with major implications for racial health disparities, since Black women face elevated risks from surgical deliveries. The New York Times reports that Rochester General Hospital cut C-section rates for healthy, first-time mothers from 40 percent to 25 percent after a series of reforms that challenged long-standing assumptions about the procedure.
Dr. Elizabeth Bostock, who leads obstetrics there, said many of the “worst disasters” in her career — including hemorrhage and sepsis — stemmed from C-sections. She began routing low-risk patients to midwives, adopting new checklists that promoted vaginal delivery first, and confronting doctors about their individual surgery rates. These efforts played out at a time when national cesarean rates continued to climb.
Researchers have long warned that financial incentives can push hospitals toward surgery. A C-section typically pays about $17,000, compared with just over $11,000 for a vaginal delivery. Some doctors also hold negative or fearful views of childbirth, which studies show can drive higher surgery rates. In other cases, surgery simply fits more neatly into a doctor’s schedule; researchers found that C-sections nationwide tend to spike in the early evening.
Rochester and other hospitals that reduced their rates — including a facility in Illinois that cut its rate by a third — show that change is possible. For Black mothers, who suffer higher rates of pregnancy complications and maternal death, reducing unnecessary surgeries could help narrow long-standing gaps in safety and outcomes.
See: “These Hospitals Figured Out How to Slash C-Section Rates” (November 24, 2025)
