Your C-Section Odds, State by State

New research suggests that where you live may determine how you give birth.

C-Section Odds State by State Getty Images/Jamie Grill

Whether you have a cesarean delivery may have less to do with your health and preferences and more to do with your zip code. The likelihood of an American woman having a C-section in 2009 and 2010 varied tenfold depending on her state, according to a new study published in the journal PLOS Medicine.

Researchers analyzed data from 1,373 hospitals across 46 US states. While the overall rate of cesarean deliveries across the country was 32.9 percent, the variation of rates between hospitals ranged between 19 and 48 percent.

The average C-section rate for women who had never had the procedure before was 22 percent, varying between 11 and 36 percent depending on where she delivered. Rates for lower risk women fluctuated between 8 and 32 percent, while the rate for women at high risk of complications ranged from 56 to 92 percent.

The need for cesareans differs depending on maternal age, race/ethnicity, insurance status and medical diagnoses, but the wide fluctuation across the US did not decrease after adjusting for these factors, according to the study.

"The variability in hospital cesarean rates was not driven by differences in maternal diagnoses or pregnancy complexity," lead author Katy Kozhimannil, Ph.D., of the University of Minnesota said in a release. "This means there was significantly higher variation in hospital rates than would be expected based on women's health conditions."

Cesarean delivery is the most common inpatient surgery in the US—and its popularity is growing. The number of C-sections nationwide increased from around 1 in 5 deliveries in 1996 to nearly 1 in 3 deliveries in 2011. A 2013 study attributes this rise in the surgery to corresponding rise in conditions that need it—like maternal obesity, gestational diabetes and hypertension—as well as doctors' concerns over liability and malpractice.

Kozhimannil and her team say individual hospital policies, practices and culture could be what is influencing varying cesarean rates and are calling for more consistency across the country. "Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth," Kozhimannil said.

Before you plan a move across the country in hopes of having (or avoiding!) a C-section, find out how your state stacks up. While the study report did not include a state-by-state breakdown, the following rates are from the Centers for Disease Control and Prevention (via NerdWallet) for 2010, the most recent years for which data is available.

State-by-state C-section rates

  • Louisiana 39.6%
  • New Jersey 38.4%
  • Florida 37.8%
  • Mississippi 37.0%
  • West Virginia 36.0%
  • Kentucky 35.4%
  • Alabama 35.3%
  • Connecticut 35.1%
  • Texas 35.1%
  • South Carolina 35.0%
  • Arkansas 34.8%
  • Nevada 34.8%
  • Oklahoma 34.7%
  • New York 34.5%
  • Maryland 34.5%
  • Virginia 34.3%
  • Tennessee 34.2%
  • Delaware 33.9%
  • Georgia 33.8%
  • Rhode Island 33.0%
  • California 33.0%
  • District of Columbia 33.0%
  • Massachusetts 33.0%
  • USA AVERAGE 32.7%
  • Michigan 32.6%
  • Missouri 31.9%
  • Pennsylvania 31.3%
  • Illinois 31.1%
  • Nebraska 31.1%
  • North Carolina 30.8%
  • Ohio 30.7%
  • Kansas 30.5%
  • New Hampshire 30.4%
  • Iowa 30.3%
  • Indiana 30.3%
  • Montana 30.3%
  • Maine 29.8%
  • Washington 29.5%
  • Oregon 29.4%
  • Wyoming 27.9%
  • North Dakota 27.7%
  • Vermont 27.5%
  • Hawaii 27.2%
  • Minnesota 27.1%
  • Arizona 27.0%
  • South Dakota 26.6%
  • Wisconsin 26.0%
  • Colorado 25.9%
  • Idaho 24.8%
  • Utah 23.1%
  • New Mexico 22.8%
  • Alaska 21.5%

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