As Black Maternal Health Week draws attention to the urgent need for change, a new report is raising alarm bells over the disturbing gaps in care that Black mothers continue to face—even within the same hospital walls.
According to the Leapfrog Group’s newly released 2025 Maternity Care Report, one in five hospitals in the U.S. shows a significant racial disparity in cesarean section (C-section) rates. The troubling twist? These disparities exist within the same facilities—meaning that Black mothers are more likely than their white counterparts to undergo C-sections, despite similar health profiles and risk levels.
This report, compiled by the nonprofit Leapfrog Group—an organization that has spent 25 years championing patient safety through transparency—analyzes maternity practices across hospitals that collectively account for 80% of all inpatient beds in the U.S. It’s the only report of its kind drawing from such an extensive data pool, and its findings spotlight serious issues that disproportionately affect Black women.
A Crisis Hidden in Plain Sight
Black women in the United States are nearly three times more likely to die from pregnancy-related complications than white women, according to CDC data. This isn’t new information, but the Leapfrog report adds a more granular layer—highlighting that these inequities are not just between regions or income levels but can be found within the same hospitals, in rooms just a few doors apart.
“The data shows that in 20% of hospitals, Black patients face higher odds of a C-section compared to white patients—even when they’re both low-risk, first-time mothers,” said Katie Stewart, Director of Health Care Ratings at Leapfrog. “That’s not just a statistical anomaly. That’s a systemic problem.”
A Return to Old Habits
The report also notes that after a period of steady decline, C-section rates are on the rise again, particularly among low-risk mothers. One in seven hospitals still lacks policies to prevent early elective deliveries—procedures that often lead to complications and increased costs without clear medical benefit.
Midwife access remains limited, especially in Southern states where maternal mortality rates are highest. And while some progress has been made—episiotomy rates, for instance, have dropped significantly since Leapfrog began publicly reporting them in 2012—the overall picture still paints a troubling scenario for expecting Black mothers.
More Than Numbers: Real Lives at Stake
For LaToshia Rouse, a certified birth and postpartum doula and founder of Birth Sisters Doula Services, these statistics reflect the lived realities of countless Black families she’s worked with.
“Too many Black women don’t feel heard or respected during labor,” Rouse shared. “That kind of environment doesn’t support safe or healthy births. Hospitals need to move away from convenience-based routines and start honoring the physiological birth process.”
She points to simple, evidence-based changes—like encouraging movement during labor, allowing more time for natural progression, and fostering collaboration with doulas—that could make a world of difference.
The Quiet Revolution Led by Doulas
Doulas are not doctors or nurses. They don’t deliver babies. But they do deliver something just as vital: trust, advocacy, and emotional support. And increasingly, they’re being recognized as a key piece of the solution to racial inequities in maternal care.
Research shows that patients with doulas are less likely to have a C-section and more likely to feel empowered during their birthing experience. For Black women navigating a health system marked by bias and gaps in communication, doulas can be literal lifelines.
Many doulas also share cultural and lived experiences with their clients, building a rapport that fosters trust and reduces stress—an often-overlooked but critical factor in maternal outcomes.
“A doula helps make sure the patient’s voice doesn’t get lost,” Rouse explained. “They’re a coach, a witness, and a source of strength in a system that can otherwise be overwhelming.”
What Can Be Done?
The Leapfrog Group urges families to do their homework: ask hospitals about their C-section rates, access to midwives, policies around early deliveries, and whether they support doula services. Transparency is the first step toward equity.
For Black mothers especially, Stewart emphasizes the importance of building a birth support team. “Whether it’s a doula, a trusted friend, or a family member, having an advocate can make a big difference,” she said.
Resources like the Black Doulas Association and DONA International can help connect families with culturally informed support.
The Bottom Line
The disparities revealed in Leapfrog’s report aren’t just data points—they’re a wake-up call. They remind us that behind every statistic is a mother who deserved better, a family navigating trauma, and a future that demands action.
The message of Black Maternal Health Week is clear: equity in childbirth shouldn’t be a privilege. It should be the standard.
