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Iowa Value:
Percentage of singleton, head-first, term (37 or more completed weeks) first births that were cesarean deliveries
Iowa Rank:
Percentage of singleton, head-first, term (37 or more completed weeks) first births that were cesarean deliveries
19.1% - 23.4%
23.5% - 24.9%
25.0% - 26.5%
26.6% - 28.3%
28.4% - 30.3%
US Value: 26.6 %
Top State(s): South Dakota: 19.1 %
Bottom State(s): Maryland: 30.3 %
Definition: Percentage of singleton, head-first, term (37 or more completed weeks) first births that were cesarean deliveries
Data Source and Years(s): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Natality Public Use Files via CDC WONDER Online Database, 2023
Suggested Citation: America's Health Rankings analysis of U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Natality Public Use Files via CDC WONDER Online Database, United Health Foundation, AmericasHealthRankings.org, accessed 2026.
Nearly one-third of births in the United States were delivered by cesarean (C-section) in 2023. This surgical procedure removes the baby through an incision in the birthing parent’s abdomen. Many cesarean deliveries are unnecessary and have no health benefits for parents with low risk for complications based on their medical profile (e.g., singleton baby, head-first position, full-term baby at 37 or more weeks of gestation, first time giving birth). Variations in the style of practice among obstetricians and casual attitudes about surgery contribute to the overuse of this procedure.
While cesarean deliveries are necessary in some situations, such as slow labor progression, fetal distress or health concerns for the woman, they can cause unnecessary short- and long-term side effects for parents and infants if performed without medical need. C-sections are associated with increased maternal mortality and morbidity compared with vaginal births and are associated with health risks for mother and infant, including:
Surgical procedures are associated with prolonged admissions, making cesarean deliveries more costly than vaginal deliveries. A recent study found that the average spending per C-section among those with employer-sponsored health insurance was $26,280, compared with $14,768 for a vaginal delivery.
The prevalence of low-risk cesarean delivery is higher among:
After a woman has had a C-section, there is an 86% chance that any subsequent pregnancy will also be delivered by C-section. However, rates of women attempting vaginal birth after a cesarean (VBAC) are increasing nationwide. As of 2023, the annual VBAC rate was 15.1%.
The American College of Obstetricians and Gynecologists recommends that health care providers encourage women without an indication for a C-section to plan on having a vaginal delivery and that providers do not perform elective C-sections before 39 weeks of gestation. Efforts to support vaginal delivery after a cesarean can reduce birth-related morbidity.
Some actions that could lead to a decrease in C-section rates include:
Studies show that having the continuous support of a doula throughout pregnancy and labor can reduce the incidence of low-risk C-sections. States can finance and support community-based doula practice through Medicaid policies. Recommendations include providing Medicaid reimbursement for doula services, setting reimbursement rates that adequately cover the costs, and creating fiscal incentives for quality care and performance in maternity care.
Women can take proactive steps to reduce their risk of a C-section, such as staying physically active and talking with their health care provider about labor and birth preferences.
Healthy People 2030 has an objective to reduce cesarean births among low-risk women with no prior births.
American College of Nurse-Midwives. “Lowering Your Chance of Cesarean Birth.” Journal of Midwifery & Women’s Health 65, no. 5 (September 2020): 723–24. https://doi.org/10.1111/jmwh.13174.
American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. “ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request.” Obstetrics & Gynecology 133, no. 1 (January 2019). https://doi.org/10.1097/AOG.0000000000003006.
Collier, Ai-ris Y., and Rose L. Molina. “Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions.” NeoReviews 20, no. 10 (October 1, 2019): e561–74. https://doi.org/10.1542/neo.20-10-e561.
Habak, Patricia J., and Martha Kole. “Vaginal Birth After Cesarean Delivery.” In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2024. http://www.ncbi.nlm.nih.gov/books/NBK507844/.
Kozhimannil, Katy Backes, Michael R. Law, and Beth A. Virnig. “Cesarean Delivery Rates Vary Tenfold among US Hospitals; Reducing Variation May Address Quality and Cost Issues.” Health Affairs 32, no. 3 (March 2013): 527–35. https://doi.org/10.1377/hlthaff.2012.1030.
Osterman, Michelle, Brady Hamilton, Martin Joyce, Anne Driscoll, and Claudia Valenzuela. Births: Final Data for 2023. National Center for Health Statistics (U.S.), March 21, 2024. https://doi.org/10.15620/cdc/175204.
Osterman, Michelle J. K. Changes in Primary and Repeat Cesarean Delivery: United States 2016-2021. Vital Statistics Rapid Release No. 21. Hyattsville, MD: National Center for Health Statistics, July 6, 2022. https://doi.org/10.15620/cdc:117432.
Ouyang, Lijing, Shanna Cox, Cynthia Ferre, Likang Xu, William M. Sappenfield, and Wanda Barfield. “Variations in Low-Risk Cesarean Delivery Rates in the United States Using the Society for Maternal-Fetal Medicine Definition.” Obstetrics & Gynecology 139, no. 2 (February 2022): 235–43. https://doi.org/10.1097/AOG.0000000000004645.
Sandall, Jane, Rachel M. Tribe, Lisa Avery, Glen Mola, Gerard H. A. Visser, Caroline S. E. Homer, Deena Gibbons, et al. “Short-Term and Long-Term Effects of Caesarean Section on the Health of Women and Children.” The Lancet 392, no. 10155 (October 2018): 1349–57.https://doi.org/10.1016/S0140-6736(18)31930-5.
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