Hawai`i’s Cesarean Rate

Update December 2015:


Fox News Pregnancy –


10 states with the highest C-section rates

That’s because more C-sections are performed nationwide than are necessary, and rates have been rising. To put a number on that rise, the national C-section rate was 22 percent in 1990 and jumped to 32.7 percent just 20 years later in 2010. More recent data suggests nationwide cesarean section rates have been leveling off in the past few years, but averages are still much higher than decades past. Currently, only one state in the country performs cesareans at a rate below the 1990 average.

Certainly, some women need the procedure, which can save the lives of both mother and baby if there are problems. C-sections are common for mothers of multiples, older women, and high-risk mothers, all of whom are good candidates for the procedure. Still, far more women are receiving cesarean sections than fit into these groups, and there are downsides to the procedure.

For a healthy woman with a healthy pregnancy, an unnecessary C-section can result in unwanted complications, longer recovery times, and much higher hospital bills. So even if everything goes smoothly with your C-section, you’ll probably end up paying more: Natural births cost about $30,000 on average nationwide, while cesarean deliveries cost about $50,000.

READ MORE: How Much it Really Costs to Have a Baby

There are a number of reasons these rates might be rising. Some research suggests doctors might be ordering C-sections for financial incentives. Since it is a surgery, the hospital can charge you more for that procedure than it does for a vaginal birth, and the doctor is paid more as well.

This notion was shrugged off until a 2013 study  showed that doctors are almost 10 percent less likely to have unplanned cesareans themselves than non-physicians. The research, done by the (non-government) National Bureau of Economics Research, also showed physicians have better health outcomes during childbirth, and concluded that financial incentives do play a role, though possibly an unintentional one, in the ordering of an unplanned C-section.

Rates of C-sections vary widely, and can even be vastly different between hospitals within the same city and state, but there are also national trends. In fact, the state that performs the most cesarean births does so at a rate twice as high as the state that performs the least.

The Ten States with the Most Cesareans

1. Louisiana     39.7 percent
2. New Jersey     38.4 percent
3. Florida     37.8 percent
4. Mississippi     37.0 percent
5. West Virginia     36.0 percent
6. Kentucky     35.4 percent
7. Alabama     35.3 percent
8. Connecticut     35.1 percent
9. Texas     35.1 percent
10. South Carolina     35.0 percent

These 10 states also happen to be the only states with cesarean rates at 35 percent or higher, and are all located in the southern and eastern parts of the United States. There are higher rates of obesity and diabetes in the south, both of which tend to make for complicated pregnancies, but there are no studies that have linked the two directly. The rates are based on Centers for Disease Control and Prevention (CDC) statistics for the year 2010, the most recent year complete statistics are available.

The Ten States with the Fewest Cesareans

1. Alaska     21.5 percent
2. New Mexico     22.8 percent
3. Utah     23.1 percent
4. Idaho     24.8 percent
5. Colorado     25.9 percent
6. Wisconsin     26.0 percent
7. South Dakota     26.6 percent
8. Arizona     27.0 percent
9. Minnesota     27.1 percent
10. Hawaii     27.2 percent

These 10 states with the lowest C-section rates are mostly western and midwestern states with sparse populations. These states are also among the fittest in the nation, which could translate into healthier mothers needing fewer cesareans. You may notice that Minnesota and Hawaii have similar rates. Vermont, North Dakota and Wyoming were all within one percentage point of Hawaii’s rate, so rank among the states with the lowest rates as well.

Finding a Quality Provider

If you’re newly pregnant or planning to be, you can potentially save yourself a lot of money and possible problems down the road by doing a little homework before choosing an obstetrician and hospital for maternity care. Always select a doctor and hospital in your insurance network, and call the office to ask what their C-section rates are.

You may also want to know how the doctor manages emergencies and, if you turn out to have a high-risk pregnancy, what the plan would be. Lastly, check into whether the hospital your doc has privileges at offers a comprehensive maternity package for uncomplicated pregnancies. This can save you money by offering a base price for the total delivery, instead of charging for each specific service.

Lacie Glover writes for NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and insurance.

Cesarean Rate Information:


Hawai`i News Now article:


HONOLULU (HawaiiNewsNow) –

The state Department of Health recently released some dramatic statistics about childbirth. The rate of Cesarean sections in Hawaii has jumped exponentially in the last decade. We discovered a variety of reasons for the increase.

Anoilani Aga has two small, healthy children. 10 month old, Nanea, was born traditionally. Her older sister – via Cesarean.

“When I found out I had to have a C-section, I was kind of devastated. I really wanted to have a vaginal first birth,” explains the 32 year old Aga.

Doctors said Aga’s unborn baby was at risk of infection. “From the very beginning, you always know that, if something doesn’t go as planned, you have to be flexible. So, I just had to figure out how to cope with it.”

Whether for medical reasons or by choice, Cesarean sections, both here and nationally, have skyrocketed. We dug deeper and found that, from 2000 to 2010, the state DOH says C-sections in Hawaii jumped from 15% to 28%.

“Absolutely. I think that it’s very surprising,” says Dr. Angela Pratt about the data. She’s assistant chairperson of the OBGYN department at Kapiolani Women and Children’s Medical Center and delivers about two dozen babies a month.

Dr. Pratt lists three major reasons for the increase: more women are requesting C-sections without a medical reason. For instance, they want to deliver their babies on a certain date. Also, there’s liability pressure, and mostly, because either mom or baby is at higher risk medically. “There’s more multiple pregnancies. We have more invitro-fertilization. We’re having women who wait later to have their babies,” says Dr. Pratt. There could also be concern about the baby’s health and well-being.

DOH data, county-by-county, shows Honolulu’s C-sections increased 14% in a decade, followed by Maui at 13%, Kauai at 11%, and the Big Island at 9%. By race, Filipino women had a 14% jump in C-sections, women of Chinese ethnicity had a 13% hike, and Caucasian, Japanese, and Native Hawaiian mothers saw an 11% increase during that same time period between 2000 and 2010.

Dr. Pratt says each birth really has be tailored to the patient’s needs and medical conditions. “Their own ideas of how many children they want to have in their family, what their particular risks are, what their cultural beliefs are,” she adds.

Also, remember, a C-section is major abdominal surgery – so patients can potentially be at higher risk for complications.

Interestingly, in 1965, the national rate for C-sections was just 4%. In 2012, it’s jumped to almost 33% – a third of all babies born in the U.S.


From – http://www.leapfroggroup.org/patients/c-section#hawaii

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Hospital Name City State Rate Target Performance
Castle Medical Center Kailua HI 23.9% Declined to Respond
Hilo Medical Center Hilo HI 23.9% Declined to Respond
Kaiser Foundation Hospital – Moanalua Medical Center Honolulu HI 18.1% 23.9% Fully Meets Standard
Kona Community Hospital Kealakekua HI 23.9% Declined to Respond
Kuakini Medical Center Honolulu HI 23.9% Declined to Respond
Maui Memorial Medical Center Wailuku HI 19.0% 23.9% Fully Meets Standard
North Hawaii Community Hospital Kamuela HI 17.1% 23.9% Fully Meets Standard
Pali Momi Medical Center Aiea HI 23.9% Does Not Apply
Straub Clinic & Hospital Honolulu HI 23.9% Does Not Apply
The Queen’s Medical Center Honolulu HI 17.3% 23.9% Fully Meets Standard
Wahiawa General Hospital Wahiawa HI 23.9% Declined to Respond
Wilcox Memorial Hospital Lihue HI 26.5% 23.9% Substantial Progress


According to the 2008/2009 Guide to a Healthy Birth, which got it’s data from the Center for Disease Control preliminary data for live births occuring in 2006.

Hawai`i had an increase of 74.1% from 14.7% in the year 2000 to 25.6% in the year 2006

“The World Health Organization recommends that the cesarean section rate for industrialized nations should not exceed 15%.  A safe range, as determined by WHO experts, is 10-15%.

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