The latest report on maternal health from The Leapfrog Group shows progress on all three health measures, but there is room for improvement, the CEO says.

  • A record percentage of hospitals achieved Leapfrog’s target for nulliparous, term, singleton, vertex cesarean delivery rates.

  • Early elective deliveries have decreased dramatically.

  • Episiotomy rates are the lowest Leapfrog has measured.

The latest data on maternal health are encouraging, but there still is substantial room for improvement in some areas, says Leah Binder, president and CEO of The Leapfrog Group in Washington, DC.

The Leapfrog Group recently released its 2021 Maternity Care Report, which measures hospital maternity care performance against best practices in three high-risk areas: cesarean deliveries, episiotomies, and early elective deliveries. Data from Leapfrog’s most recent hospital survey shows progress across all three measures. (The report is available at this link.)

Leapfrog provides this summary of the latest results:

  • Modest progress has been made with nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates. A record 51% of hospitals achieved Leapfrog’s NTSV cesarean delivery standard of 23.9% or less. In 2019, less than 42% of hospitals achieved the standard.

  • Substantial progress has been made with lowering early elective delivery rates. From a 17% starting point in 2010, the number decreased to 1.6% in 2020. Almost 92% of hospitals meet Leapfrog’s standard of an early elective delivery rate of 5% or less.

  • The average episiotomy rate among reporting hospitals decreased to 5.2% in 2020. In 2015, the rate was more than 10%. The 2020 rate of 5.2% is the lowest rate since Leapfrog began publicly reporting the measure. Leapfrog’s target rate is only slightly lower at 5%.

“We’re very enthusiastic about progress on early elective deliveries,” Binder says. “We’re seeing a very significant drop in early elective deliveries, and it is now at the rate it will always be, which is virtually zero. That is an extraordinary credit to the healthcare system for identifying this problem and addressing it rapidly.”

The episiotomy rate also is good news, but there is room for improvement. “There obviously is some leadership behind that effort because we’re seeing some good results overall, and even stronger results in some particular hospitals,” she says. “We are not seeing that kind of progress with C-sections. That is concerning. We’re not seeing the reduction in unnecessary C-sections that we need.”

Binder says she is concerned about not just the lack of progress in reducing cesarean delivery rates, but also the variation in the rate among hospitals.

“The variation tells us that whatever effort there is to reduce C-sections is not getting enough traction. There’s no sense of urgency revealed by these numbers,” she says. “There is no pattern of efforts we are seeing when we look at those rates. With the other measures, we see a pattern that indicates a national effort to improve, but we don’t see that with C-sections. That is concerning.”

Variation exists in the three measures by state, Binder notes, but there is no pattern by type of hospital. There seems to be a lack of leadership on reducing cesarean deliveries.

“Hospital leaders should look at these data and see how you are doing on these rates compared to neighboring hospitals. If you are doing well, you should recognize that and celebrate it with your team,” Binder says. “If you’re not doing well, you should address that. When there is effort from the very top of leadership to set goals and meet them, it happens.”


  • Leah Binder, President and CEO, The Leapfrog Group, Washington, DC. Phone: (202) 292-6713.