Colorado has a low rate of cesarean sections compared to the rest of the nation, but some of the state’s hospitals perform surgical deliveries at three times the rate as others.
Numbers alone can’t confirm whether hospitals are doing unnecessary C-sections, but some facilities have confirmed they see a need for a culture shift to help keep labor moving.
About 22% of low-risk, first-time mothers in Colorado ended up having a cesarean in 2023, the seventh-lowest rate in the country, according to data from Leapfrog Group, which rates the quality of health care. But individual hospitals’ rates ranged from one in 10 to one in three.
Cesarean deliveries can be lifesaving when labor isn’t going well for the mother or the baby, but they carry risks, including blood clots in the days after and placenta problems in future pregnancies.
Leapfrog defined low-risk mothers as those carrying a single, full-term baby whose head is pointed down. Vaginal deliveries with twins or babies facing head-up are riskier for the fetus than a cesarean delivery, and attempting a vaginal birth after a previous cesarean isn’t always safe. It adopted Healthy People 2030’s goal that no more than 23.6% of first-time mothers with a single, full-term infant facing head-down would have a cesarean.
Colorado as a whole meets that goal, though not all hospitals do. A first-time mother with one baby in a favorable position had about a 10% chance of getting a cesarean at Delta Health on the Western Slope, compared to an almost 33% chance at St. Thomas More Hospital in Cañon City.
St. Thomas More’s cesarean rate for that group dropped to 27.6% in 2024, said Lindsay Radford Foster, spokeswoman for CommonSpirit Health. The hospital is using a program that attempts to move a fetus into a more favorable position for birth as part of its efforts to reduce cesareans, she said.
“CommonSpirit St. Thomas Hospital, which is a critical access hospital, believes in creating an environment of continuous learning and improvement in order to meet the national standards for childbirth,” she said in a statement.
Some patients who appear low-risk still need to deliver by cesarean because the mother or baby isn’t doing well in labor, said Dr. Jeffrey Ecker, a maternal-fetal medicine physician at Massachusetts General Hospital.
Older mothers, those with chronic conditions and those who had obesity before pregnancy are at a higher risk of needing a cesarean. Some patients also request one when they’ve been in labor for a day or longer, and doctors differ in how they respond, he said.
The exact “right” rate will depend on a hospital’s patient mix, Ecker said. But when a state has rates that range from 10% to 33%, it would appear some facilities are performing either too many or too few C-sections, he said.
“It strongly suggests that all these rates can’t be right and best,” he said.
Even in the Denver area, some hospitals have nearly twice the rate of cesareans involving low-risk women that others do.
About 16% of low-risk patients at AdventHealth’s Littleton and Castle Rock hospitals had a cesarean, while 32% at Intermountain Health’s Good Samaritan Hospital in Lafayette did.
One factor in Good Samaritan’s higher rate is that it has a neonatal intensive care unit, meaning that it can accept more-complicated patients, said Dr. Kathleen Rustici, director of women’s health for Intermountain Health’s Front Range hospitals.
But some patients likely have still undergone avoidable cesareans, and Intermountain is working with the obstetrician groups that admit patients there to identify who truly needs one, she said.
“We want our providers to do what seems in the best interest of the patient in that moment,” she said.
The health system has given the providers data on their cesarean rates, which prompted some to seek out guidance after realizing they were outliers, Rustici said. Last year, they also rolled out an algorithm to help doctors decide when a baby’s heart rate pattern demands immediate intervention and when they can safely let labor continue, she said.
Seven other hospitals in Colorado also had cesarean rates above the Healthy People 2030 goal: HCA HealthOne’s Medical Center of Aurora, Sky Ridge Hospital in Lone Tree, Mountain Ridge Hospital in Thornton, Presbyterian-St. Luke’s Medical Center in Denver and Swedish Medical Center in Englewood; as well as Intermountain Health’s Saint Joseph Hospital in Denver and Lutheran Hospital in Wheat Ridge.
HCA HealthOne spokeswoman Stephanie Sullivan said the hospitals improved their cesarean rates in 2024, and Swedish and Medical Center of Aurora now meet the 23.6% goal. Presbyterian-St. Luke’s serves a disproportionate share of high-risk mothers, so its cesarean rate may continue to be higher, she said.
“Our dedicated physicians and specialists help expectant mothers make the best decision for themselves and their babies based on the specific needs of each unique case. The health and welfare of mother and child is always our top priority,” she said in a statement.
The other Intermountain hospitals have also reduced their rates in recent years, with Lutheran coming in at 22% in 2024.
Saint Joseph’s rate is still higher, which is expected since women whose labor doesn’t go as planned at the birth center across the street end up there, Rustici said. But they’ve taken steps to encourage mothers to move during labor, which helps babies get into the right position for delivery, she said.
The cesarean rate is a data point worth looking at for people inclined to use resources like Leapfrog, but not a reason to rule a hospital out, Ecker said.
Patients who have a choice in where to deliver should check if the hospital has taken steps to support vaginal deliveries and talk to their medical providers about how they manage labor when it isn’t proceeding like clockwork, but also isn’t clearly dangerous, he said.
A high rate of C-sections “is a prompt for a dialogue,” he said.
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