Colorado hospitals are outperforming the national average in reducing cesarean section (C-section) rates, a new report shows.

But there’s a catch: Not all Colorado hospitals are improving.

The Leapfrog Group, which conducted the study via hospital survey, set a national 2030 C-section target at 23.6% of live births.

Colorado’s rate in 2023 was 21.9%.

But across the 31 Colorado hospitals that provide delivery services and responded to the survey, the C-section rate can vary from 10.3% at Delta County Memorial Hospital to 32.5% at St. Thomas More Hospital in Canon City, according to the study.

This wide variation isn’t just happening in Colorado.

“Variation in Colorado and elsewhere in the U.S. is concerning,” said Katie Stewart, director of Health Care Ratings at Leapfrog Group.

An advocate for health care transparency, the Leapfrog Group is a watchdog organization that analyzes data to assist patients in making informed decisions, according to the group’s website.

“It does show that where you deliver may come with a risk as to whether you end up with a C-section or not,” Stewart said.

A C-section — a surgical procedure used to deliver a baby through incisions made in the abdomen and uterus — can be a life-saving procedure, but it also comes with risks and complications for the person giving birth and the baby.

These risks can include infection, blood loss or clotting and injury to organs like the bladder or bowel, even death. It also requires a longer recovery. Typically, four-to-six weeks compared to just a few days for a vaginal birth.

The risks can be short-term or affect future pregnancies.

Health experts view lower C-section rates as a step toward more patient-centered, empowering care for women.

“By maintaining low C-section rates, we empower women to have natural deliveries whenever possible, minimizing unnecessary surgical risks and allow for quicker recoveries,” Dr. Devin Bateman, AdventHealth Regional chief medical officer, said in an email. “Our goal is to provide whole-person care that respects each woman’s unique birthing journey.”

Headquartered in Florida, AdventHealth is a Seventh-day Adventist nonprofit health system with facilities in nine states, including four in Colorado, all of which have C-section rates lower than the state average.

To address unnecessary C-sections, Denver Health participated in an initiative that focuses on the health care provider and nursing education. This included best practices to ensure clinical criteria are evaluated before recommending a cesarean section.

“Central to our approach is a collaborative, patient-centered model of care,” Dane Roper, a Denver Health spokesperson, said in an email to The Denver Gazette.

“We have cultivated a team-based environment where patients are active participants in mode of delivery discussions, healthcare providers transparently share medical insights and recommendations, and shared decision-making empowers birthing parents to make informed choices about their birthing experience.”

Denver Health, the safety net provider for the metro area, achieved the standard with 20.9% of births being done by cesarean.

The hospital also provides a doula program, which offers emotional and physical support during labor, that studies have shown is associated with positive delivery outcomes such as reducing C-sections and premature births.

At 32.5% of its live births by C-section, St. Thomas More Hospital in Cañon City has the highest rate in the state.

CommonSpirit Health, which operates St. Thomas More, has since improved its C-section rate dropping to 27.6% in 2024, Lindsey Radford said.

“CommonSpirit Health is committed to meeting the highest standard of care when supporting mothers through childbirth,” Radford said in an email. “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.”

Moreover, St. Thomas More Hospital has implemented a program called “Spinning Babies” — a maternity care approach dedicated to fetal positioning to make labor smoother, safer and shorter.

The hospital is also looking to hire a perinatal specialist to focus on pregnancies at high risk for complications, Radford said.

HCA HealthONE operates six, rated hospitals — all with rates higher than the state’s in 2023.

Stephanie Sullivan, an HCA HealthONE spokesperson, said that the hospitals were “on track” to meet the national target of 23.6% by 2030.

“Because this data is lagging, many of our HCA HealthONE hospital rates have already achieved improvement, namely HCA HealthONE Aurora, HCA HealthONE Rose and HCA HealthONE Swedish are all meeting the stated goal,” Sullivan said in an email.

The health system is closely monitoring C-section deliveries and is involved in a March of Dimes of study aimed at preventing early elective deliveries before 39 weeks, Sullivan said.

Home to a nationally recognized Maternal Fetal Institute, St. Luke with 27.4% of its birth by C-section is sought after by families with high-risk, unborn babies.

“These comprehensive services attract a higher volume of mothers who require C-sections, leading to higher rates for this procedure,” Sullivan said.

Sullivan added: “The health and welfare of mother and child is always our top priority.”

The hospitals in the UCHealth system declined to report their C-section rates.

C-section rates had been improving before the COVID-19 pandemic, but have since begun to slide, Stewart said.

“What we’re finding nationally is that there has not been progress on this measure,” she said.