The Leapfrog Group’s 2023 Maternity Care Report Finds Increased Cesarean Delivery Rates During COVID-19 Pandemic

May 23, 2023

For the first time, average episiotomy rates meet Leapfrog’s reporting standard of 5% or less


Washington, DC (May 23, 2023)—The Leapfrog Group, a national nonprofit upholding the standard of patient safety in hospitals and ambulatory surgery centers, today released its 2023 Maternity Care Report, which measures hospitals on three maternity medical interventions: cesarean sections (C-sections), episiotomies and early elective deliveries. While hospitals are making significant improvements in reducing episiotomies and steadily reducing early elective deliveries, the average rate of Nulliparous, Term, Singleton, Vertex (NTSV) C-sections increased significantly during the COVID-19 pandemic. The report uses final data from the voluntary 2022 Leapfrog Hospital Survey and is the only source to publicly report these measures by hospital.

NTSV C-sections refer to mothers with first-time pregnancies that have reached at least 37 weeks of gestation and have a single baby in the head-down position, making this population least likely to need a C-section. From 2015, when Leapfrog first publicly reported this measure, to 2020, progress on reducing C-section rates was slow and showed limited improvement. More than half of reporting hospitals met the standard (23.6% or lower) in 2020, but now, three years later, only 42.3% meet the standard. 

“Employers pay for half of US births, and they want the highest quality experience for women and their families. That’s why Leapfrog transparently reports on rates of maternity interventions by hospital, so employers, women, and families have access to this critical information,” said Leah Binder, president and CEO of The Leapfrog Group. “We are gratified to see real progress on early elective deliveries and finally on episiotomy which is a testament to the power of publicly reported data. The same, however, cannot be said about NTSV C-sections, which is seriously concerning.”

The two other measures included in Leapfrog’s 2023 Maternity Care Report, episiotomies, and early elective deliveries, showed improvement:

  • Episiotomies, defined as an incision made in the perineum to make the vaginal opening larger during childbirth, is on average, below Leapfrog’s standard for the first time, with an average national rate of 4.6%. Since 2012, episiotomies have declined by 63%.
  • Early elective deliveries, defined as scheduled C-sections or medical inductions performed without a medical reason before 39 weeks, have dramatically declined from over 17% in 2010 to 1.8% in 2022. The Leapfrog standard is 5%.

“The increase in NTSV C-sections reflects the stress hospitals were under during the COVID-19 pandemic; labor and delivery units were overwhelmed, support persons were limited, and C-sections increased to avoid long labors,” said Elliott Main, MD, Stanford University OB-GYN, California Maternal Quality Care Collaborative founder, and chair of the Leapfrog Maternity Care expert panel. “However, we know C-sections put mothers at greater risks for complications and should never be performed without a full discussion of short- and long-term risks; hospital leadership should take a hard look at this report and their numbers to start making actionable change that improves outcomes for mothers.”

As the U.S. faces a growing maternity care crisis, improving quality, access, data collection, and publicly available information on maternal care will improve maternity care within hospitals. The Leapfrog Group will expand its work on maternal care reporting, including collecting data on rates by race and ethnicity and whether hospitals provide beneficial services, like support from midwives and doulas, lactation support, postpartum tubal ligation, and others.

The report uses final hospital data from more than 2,300 hospitals, representing 74% of U.S. hospital beds. To learn more about Leapfrog’s maternity care measures, visit Leapfrog’s public reporting website.


About The Leapfrog Group

Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps for patient safety. The flagship Leapfrog Hospital Survey and new Leapfrog Ambulatory Surgery Center (ASC) Survey collect and transparently report hospital and ASC performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. The Leapfrog Hospital Safety Grade, Leapfrog's other main initiative, assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents, and infections. For more, follow us on Twitter and Facebook, and sign up for our newsletter.

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