Alameda Health System Highland Hospital is one of 111 California hospitals that met or surpassed a federal target aimed at reducing Cesarean births (C-sections) for first-time mothers with low-risk pregnancies, according to the California Health and Human Services Agency (CHHS).

The agency announced the achievement awards to hospitals on behalf of Smart Care California, a coalition of public and private health care purchasers that collectively purchase or manage care for more than 16 million people statewide – or 40 percent of all Californians. View the complete list of hospitals.

“We are proud to be recognized for our efforts to reduce C-section births and provide safe and comprehensive care to both the mother and baby for the second year in a row,” said Dr. Sophie Shabel, interim chair, of Department of Maternal Child Health at Highland Hospital.

Research finds that after 20 years of annual increases, there has been progress in reducing the state’s low-risk first birth C-section rate. The 111 hospitals that made the Smart Care C-Section Honor Roll account for 45 percent of the 242 hospitals that offer maternity services in California.

“The decline in California’s rate for low-risk, first birth C-sections will lead to healthier babies and mothers,” said CHHS Secretary Diana Dooley. “Thanks to the hospitals and their staff for their hard work in achieving this measurable progress.”

To respond to a rapid rise in unnecessary C-sections across the United States, the U.S. Department of Health and Human Services adopted the Healthy People 2020 target of reducing nationwide C-section rates for low-risk, first-births to 23.9 percent. In October 2015, Smart Care California began its focus on this issue as well.

“It’s encouraging that so many hospitals are making great progress to reduce their unnecessary cesarean deliveries, especially well in advance of the Healthy People 2020 target,” said Julie Morath, President, and CEO of the Hospital Quality Institute.

While life-saving in some circumstances, unnecessary C-sections can pose serious risks to mothers—higher rates of hemorrhage, transfusions, infection and blood clots—and babies—higher rates of infection, respiratory complications and neonatal intensive care unit stays.

Evidence suggests that a woman’s chance of having a C-section largely depends on where she delivers and the practice pattern of her physician and clinical team. Even for low-risk, first-birth pregnancies, huge variation exists in hospital C-section rates. Rates in California hospitals range from less than 15 percent to more than 60 percent. Experts find that variation of this magnitude is a signal of a problem that needs to be addressed.