A comprehensive investigation released last week reveals that Black women are significantly more likely to undergo cesarean sections during childbirth than white women at the same hospitals, highlighting persistent racial inequities in America’s healthcare system. This troubling pattern, documented in the Leapfrog Group’s 2025 Maternity Care Report, provides unprecedented hospital-by-hospital data showing systemic differences in surgical intervention rates.
The report, which draws from over 2,400 participating hospitals representing 80% of U.S. hospital beds, found that in approximately one-fifth of facilities, Black patients underwent C-sections at markedly higher rates than white patients receiving care in identical settings. These disparities persist despite medical consensus that many cesarean deliveries are medically unnecessary and potentially carry greater risks than vaginal births.
The scope of the problem
The national C-section rate for first-time mothers with full-term, head-down, single pregnancies, known as Nulliparous, Term, Singleton, Vertex (NTSV) births, stands at 25.3%, significantly higher than rates considered optimal by maternal health experts. This figure varies substantially by state, with the highest rates found in:
- Mississippi at 28.9%
- New York at 28.3%
- Massachusetts at 27.8%
In contrast, states with the lowest surgical intervention rates include:
- Nebraska at 18.8%
- Utah at 19.7%
- Idaho at 20%
These geographical variations suggest that factors beyond medical necessity, including hospital practices, physician preferences, and potentially biased decision-making, may contribute to the elevated rates among Black women.
Signs of progress
Despite concerning C-section rates, the report identified positive trends in other aspects of maternal care. Episiotomy rates, surgical incisions made to enlarge the vaginal opening during delivery, have plummeted by 73% since Leapfrog began tracking this measure in 2012, currently averaging just 3.4% nationwide.
Additionally, most surveyed hospitals now offer evidence-based maternity care services that give women more options and support during the birthing process. The report found that 96.1% of facilities provide lactation consultants, while 89.7% allow doulas during labor and delivery. These patient-centered approaches help women navigate the birthing process with greater autonomy and support.
Expanding options for maternal care
The data shows growing availability of alternative birth options that may help reduce unnecessary interventions. Among reporting hospitals:
84.1% permit vaginal birth after a previous C-section, allowing women to avoid repeat surgical deliveries when medically appropriate. This option has been historically limited at many facilities despite evidence supporting its safety for many women.
Certified midwives are available in labor and delivery at 61% of hospitals, providing an alternative model of care that typically emphasizes fewer medical interventions and greater patient agency.
Postpartum tubal ligation services, which allow women to access permanent contraception immediately after birth, are offered at 81.6% of surveyed facilities, though the report does not address whether these services are equally accessible across racial groups.
The human impact
The disparities highlighted in the report have real consequences for Black mothers and families. C-sections, while sometimes medically necessary, carry increased risks including infection, blood loss, longer recovery times, and complications in future pregnancies. When performed without clear medical indication, these procedures may expose women to unnecessary risks without corresponding benefits.
For Black women already facing higher rates of maternal mortality and morbidity, the elevated C-section rates represent another layer of inequity in a healthcare system that has historically underserved communities of color. These surgical disparities may contribute to the broader maternal health crisis affecting Black mothers, who die from pregnancy-related causes at three times the rate of white women according to Centers for Disease Control and Prevention data.
Driving systemic change
The Leapfrog report marks a significant advancement in addressing maternal health disparities by providing facility-specific data that allows for targeted interventions. Previous research has documented racial differences in C-section rates at the national level, but the hospital-by-hospital analysis offers a more granular understanding of where disparities are most pronounced.
Healthcare quality experts suggest several approaches to addressing the identified gaps. These include implementing standardized protocols for determining when C-sections are medically indicated, reducing provider-to-provider variations in surgical intervention rates, and addressing implicit bias through comprehensive training programs.
Some hospitals have successfully reduced both overall C-section rates and racial disparities by adopting these strategies. These facilities demonstrate that improvement is possible when institutions commit to evidence-based practices and equity-focused care models.
The path forward
While the reduction in episiotomy rates demonstrates that meaningful progress is possible, the persistent C-section disparities underscore the need for renewed commitment to equitable maternal care. Advocates emphasize that addressing these issues requires both individual provider education and broader systemic reforms.
For expectant mothers, particularly Black women, the report offers valuable information for making informed healthcare decisions. Women can now identify facilities with lower C-section rates and more equitable practices, potentially improving their birth outcomes through careful provider selection.
As the national conversation around maternal health equity continues to evolve, transparency tools like the Leapfrog report provide crucial accountability mechanisms. By shining light on disparities that might otherwise remain hidden, such data-driven approaches pave the way for a more just and effective maternal healthcare system, one where a woman’s race no longer predicts her likelihood of surgical intervention during childbirth.
