Cesarean sections (C-sections) are the most common surgical procedure in the United States. In California, however, a focused statewide initiative helped reduce the rate of first-time C-sections among low-risk pregnancies from 26% in 2014 to just 22.8% by 2019, below the CDC’s public health goal of 23.9%.
Why C-Section Rates Are a Concern in the U.S.
That said, access to lower-intervention birth experiences is inconsistent across the state. C-section rates vary dramatically—from just 13% at some hospitals to over 83% at others—depending mainly on location, hospital policies, and care models. Regional differences are apparent: the Los Angeles area averages 33.6%, while the North Bay region averages just 19.6%.
How Midwives Are Making a Difference in California
Hospitals in the North Bay region of California have embraced midwifery services with impressive results. By hiring nurse-midwives and integrating them into labor and delivery teams, facilities are seeing measurable improvements in vaginal birth outcomes and C-section reduction.
One standout example is Ukiah Valley Medical Center, which now reports a C-section rate of just 16%—one of the lowest in the state.
Marin General Hospital: A Case Study
Marin General Hospital in Greenbrae adopted midwifery care after assuming control of the county birth center. Initially, it served publicly insured patients. Administrators expanded midwifery services to include privately insured patients as well. The results were swift and positive.
The hospital’s C-section rate dropped from 32% to approximately 18–22% across 1,400 births annually—a reduction of nearly 10% over three years.
| Hospital | Before the Midwifery Program | Current Rate |
|---|---|---|
| Ukiah Valley Medical Center | – | 16% |
| Marin General Hospital | 32% | 18–22% |
UCSF Research Validates the Midwife Model
A study by the University of California, San Francisco, examined outcomes at Marin General and found that mothers who had previously delivered via C-section were 9% more likely to have a successful vaginal birth (VBAC) when attended by a midwife.
“I think that doctors have embraced the outcome of the study and see us as a positive influence on lowering the C-section rate,” said Sheri Matteo, director of midwifery at Prima Medical Group in Novato. “Obstetrics is a team sport, and midwives are now considered essential team members.”
What This Means for the Future of Maternity Care
California hospitals are showing that midwives complement physicians and help drive better outcomes. As more facilities evaluate their C-section rates and maternal health indicators, the evidence favoring midwifery integration grows.
Check out our California CNM licensing guide to learn how to become a certified nurse midwife and join this movement.
Policy Outlook: Expanding Midwifery Access
Despite these success stories, only a small percentage of hospitals added midwives during California’s statewide quality improvement campaign. Experts believe that expanding midwifery integration, especially in high-rate regions, is one of the most impactful opportunities to reduce unnecessary C-sections further.
Ongoing policy changes around reimbursement, credentialing, and education access will be critical to scaling these outcomes statewide and beyond.
Frequently Asked Questions
How much have C-section rates dropped in California?
California reduced its first-time, low-risk C-section rate from 26% in 2014 to 22.8% by 2019, outperforming the CDC’s public health target of 23.9%.
What role do midwives play in reducing C-section rates?
Midwives support physiologic birth and use fewer interventions, leading to significantly lower cesarean rates compared to physician-only models of care.
Which hospitals in California have low C-section rates?
Hospitals like Ukiah Valley Medical Center (16%) and Marin General (18–22%) have achieved low rates through midwifery integration and supportive care models.
Is midwife-attended birth safe for first-time moms?
Yes. Studies show that midwifery-led care can reduce surgical births without increasing risks, primarily when midwives work within hospital-based teams.
Can I have a VBAC with a midwife?
Many midwives are trained to support vaginal births after cesarean (VBAC), and research from UCSF shows increased success rates when midwives are involved.
Disclaimer
This article is for informational purposes only and does not constitute medical advice. Readers should consult healthcare professionals for clinical decisions.
Source: CMQCC via Stanford Medicine