• Nike cofounder Phil Knight made the biggest publicly recorded charitable donation of 2025.
• Knight and his wife, Penny, pledged $2 billion to cancer research.
• Billionaire Warren Buffett was also a top donor, giving over $1.3 billion.

Nike cofounder Phil Knight topped the list of the biggest charitable donors this year.

The billionaire and his wife, Penny, pledged $2 billion to Oregon Health & Science University (OHSU) to support the Knight Cancer Institute — more than double the size of the second-largest donation.

That's according to the Chronicle of Philanthropy, which released its annual list of the largest publicly announced gifts this week.

Knight, whose net worth sits at $31.2 billion, per Bloomberg Billionaires Index, has a decadeslong philanthropic relationship with OHSU.

The Knight Cancer Institute was named in honor of Phil and Penny Knight after they donated $100 million to the institute in 2008. They have since donated millions more.

"Wealthy donors often give their largest donations to nonprofits with which they've built long-term relationships, and this gift is a good example of that," Maria Di Mento, a senior editor at the Chronicle of Philanthropy, told Business Insider.

Warren Buffett dominated the list with four megagifts, donating more than $1.3 billion across the Susan Thompson Buffett Foundation, the Howard G. Buffett Foundation, the NoVo Foundation, and the Sherwood Foundation.

At 95, Buffett remains one of the world's leading philanthropists. Despite ranking among the wealthiest people on the planet with a net worth of about $150 billion, he is famous for his frugal lifestyle, from living in the same Omaha home he bought in the 1950s to eating McDonald's breakfasts and driving a modest car.

Jackie and Mike Bezos — Jeff Bezos's mother, who died in August, and stepfather — also ranked among the year's biggest donors with a $500 million gift to UNICEF USA for its Child Nutrition Fund.

They aren't new to large-scale philanthropy — in 2022, the couple committed $710.5 million to the Fred Hutchinson Cancer Center in Seattle to boost cancer research and care.

The Chronicle of Philanthropy tracks only publicly announced gifts to nonprofit organizations, excluding anonymous or unconfirmed contributions.

• The surge of drones in Ukraine has made it extremely difficult to pull off traditional casualty evacuations.
• A Ukrainian officer said troops often have to wait for darkness, bad weather, or smoke to obscure the battlefield.
• Drone surveillance has eliminated the "golden hour," a critical period in which a life can be saved.

Ukrainian soldiers can’t always rush out to rescue their wounded comrades. Instead, they often have to wait for inclement weather or for someone to stir up a bit of chaos to cloak their evacuations, a senior military officer told Business Insider.

The significant drone presence means that the "battlefield is visible 100%," making it all but impossible for Kyiv's forces to pull off traditional casualty evacuations, Ukrainian Col. Valerii Vyshnivskyi said in an interview, reinforcing warnings about the effect that uncrewed systems have on front-line medical care.

Vyshnivskyi, Kyiv's senior representative to the NATO-Ukraine Joint Analysis Training and Education Centre, an initiative which uses real-time lessons from the conflict to inform Western defense planning, said that soldiers sometimes have to wait for nighttime, fog, or rain — when visibility is difficult — to evacuate their wounded comrades.

He said that soldiers also manufacture poor visibility with smoke grenades, but this tactic risks drawing Russia's attention.

Drones are surging on the battlefield, giving both Ukrainian and Russian forces persistent surveillance options and the ability to carry out precision strikes in a miles-wide kill zone that extends in either direction along the front line.

Movement in the kill zone has become extremely dangerous and has effectively erased the long-held hope of getting wounded troops critical life-saving trauma care within the "golden hour" — the first 60 minutes after a severe injury when medical treatment determines whether a soldier lives or dies.

Vyshnivskyi said that the situation has "changed dramatically" since the start of Russia's full-scale invasion; golden hour has been replaced by a golden day, or some longer stretch of time.

Although it can be difficult, there are ways to get wounded troops out of the kill zone. Ground robots, for instance, have become an increasingly popular choice for Ukraine because they lower the risk for medical crews. Vyshnivskyi said that Kyiv's forces plan out routes for the small vehicles, sometimes working at night under the cover of darkness.

However, Russian drones will also track the robots. And Ukrainian troops have said that they experience technical issues at times, which could leave wounded soldiers exposed and vulnerable.

Further complicating the situation is that evacuation and logistics routes are increasingly under attack. Ukraine has tried to remedy the threat by covering key roadways with anti-drone netting, but soldiers have told Business Insider that Russia can still find small holes to stage attacks.

Even farther back from the front lines, there is still a risk. Combat medics and soldiers have told Business Insider that Russia attacks medical vehicles, while international governing bodies have accused it of striking healthcare facilities. Moscow has denied these allegations.

"We know how to resist enemy artillery," Vyshnivskyi said. "We have counter-battery measures — we implement them and are quite successful in that. But drones are still a big challenge."

His assessment reflects past warnings from combat medics and soldiers fighting in Ukraine, as well as Western officers training Kyiv's forces, that drones have made immediate casualty evacuations nearly impossible, forcing a change in the approach to medical treatment.

American generals predicted years ago that high-intensity future warfare could upend the type of combat medical care that US forces enjoyed when they could achieve air superiority and send in helicopters to whisk injured troops away for treatment.

With small drones now threatening just about anything that moves near the front line and advanced surface-to-air missiles positioned to shoot down aircraft, those grim predictions have become a deadly reality in Ukraine.

Both sides in this war have taken heavy losses since the full-scale Russian invasion began in 2022, though neither has publicly disclosed any official figures. Ukraine is believed to have suffered some 400,000 casualties, while Western officials think Russia has surpassed a staggering 1.1 million dead and wounded.

Vyshnivskyi said that, in a war against Russia, NATO would face the same casualty evacuation challenges and likely see more soldiers killed and wounded than in the war in Ukraine.

NATO leaders, warning that the alliance could find itself at war with Russia, are taking into account the possibility of heavy losses and are pushing to find solutions to the problem of life-saving care in a battlespace infested with drones.

Earlier this month, NATO hosted an event in London for companies to showcase medical technology that could solve some of the issues Ukraine is facing on the battlefield, including how to conduct casualty evacuations under constant surveillance.

British Army Col. Niall Aye Maung, the medical branch head for NATO's ACT and the medical advisor to the alliance headquarters in Brussels, told Business Insider that some of the solutions featured at the event have a dual purpose — for use in Ukraine in the immediate term and in the West during a potential future high-intensity conflict.

"NATO is certainly posturing itself to be able to manage that scenario because of the lessons learned" in Ukraine, he said.

• OpenAI has joined the Silicon Valley trend of hiring former British politicians.
• George Osborne, who previously ran the UK Treasury, said on Tuesday he was joining the ChatGPT maker.
• Osborne will lead OpenAI for Countries, the global arm of the startup's $500 billion Stargate initiative.

Tech companies are snapping up former world leaders and politicians — and OpenAI is the latest to join the party.

The ChatGPT maker has hired former British chancellor George Osborne to run the global arm of its Stargate AI infrastructure initiative.

"I recently asked myself the question: what's the most exciting and promising company in the world right now? The answer I believe is OpenAI," wrote Osborne, who ran the UK Treasury from 2010 to 2016, in a Tuesday X post confirming the move.

Osborne takes the role of managing director and head of OpenAI for Countries, an initiative launched by the AI startup in May that will see OpenAI partner with nations to build data centers and expand its $500 billion Stargate project beyond the US.

The former finance minister, who was a member of parliament in the right-leaning Conservative party until 2017, is the latest ex-British political heavyweight to join a US tech firm.

Rishi Sunak, the former UK prime minister, took on roles at OpenAI rival Anthropic and Microsoft as an advisor in October, while ex-deputy prime minister Nick Clegg worked as a senior executive on Meta's global affairs team from 2018 until stepping down at the start of 2025.

British political salaries are dwarfed by the earnings of even midlevel employees at US tech companies. British prime ministers earn an annual salary of around £174,000 ($232,000), while salaries for research engineers at Meta can be as high as $400,000.

Osborne's arrival comes as OpenAI continues to bulk up its executive ranks. The AI startup hired former Instacart and Meta exec Fidji Simo as its new CEO of applications in May, and this week hired veteran Google executive Albert Lee to lead its mergers and acquisitions team.

• At least 10 affiliates of the world's biggest HR group, SHRM, have posted statements clarifying their independence.
• The messages followed an $11.5 million discrimination verdict against the main org, which it plans to appeal.
• "The intent is to inform our audience," said Rafael Rivera, CEO of SHRM's largest affiliate.

Some of the largest affiliates of the Society for Human Resource Management have publicly reaffirmed their operational independence from the trade group after it lost an employee-discrimination lawsuit in a $11.5 million verdict.

Business Insider identified LinkedIn posts from 10 US affiliates that reference the case that led to the so-called "nuclear" verdict on Dec. 5. That includes SHRM's largest affiliate, in Southern California, which has roughly 3,500 members. All the posts stress how the groups operate independently from SHRM international, which is based in Virginia.

"While we are an affiliated chapter of SHRM, we are not governed by SHRM's management, and we were not involved in this case," said New York City SHRM.

"We have our own bylaws, board, finances, programming, and strategic priorities," wrote Chicago SHRM.

NYC SHRM and Chicago SHRM say they have around 1,400 and 1,000 members, respectively.

Similar statements were posted on LinkedIn by SHRM affiliates in the northeastern US, Texas, Oregon, Illinois, and California. The vast majority of affiliates have not publicly commented on the legal situation.

SHRM says it has 556 chapters worldwide. The organization sends some funds to its chapters, which may encourage local members to get certified and may also require members to pay dues to the international organization. Chapters are one kind of affiliate; state councils, of which there are 51, are another.

The organization said in response to Business Insider's questions that the independence of its affiliates "has always been the case."

"We actually make a point of reminding our chapters and state councils that they are separate legal entities and make their own operational decisions," SHRM representative Eddie Burke said in an email. He didn't respond to questions about the substance of the posts.

The lawsuit that SHRM lost earlier this month was filed in 2022 by Rehab Mohamed, an Egyptian woman who worked at the association as an instructional designer from 2016 until 2020. She said in her complaint that she was racially discriminated against by a white supervisor and faced retaliation for complaining to management.

A Colorado federal jury found SHRM liable on both fronts. The association was hit with $1.5 million in compensatory damages and $10 million for punitive damages. SHRM has said it plans to file an appeal and that the jury's decision "does not reflect the facts, the law, or the truth of how" it operates.

Jane Billbe, president of Washington State SHRM, told Business Insider in an email that its post "was intended to provide clarity for our members and stakeholders — not to distance ourselves from SHRM."

The California affiliate, the Professionals In Human Resources Association, wrote on LinkedIn that its code of ethics requires "that everyone involved with PIHRA act with integrity, comply with applicable laws, and treat others with dignity and respect, free from discrimination, harassment, or retaliation."

Rafael Rivera, the affiliate's CEO since 2010, told Business Insider that he couldn't recall ever issuing a statement like it and believed some of his group's members were unaware of the distinction between the affiliate and main branch, or that SHRM had just lost an employee-discrimination case.

"The intent is to inform our audience that may not have the information," he said. "They may assume that we're one and the same."

It's not the first time SHRM and its chapters haven't seen eye-to-eye. In 2016, SHRM sued a Northern California chapter for planning to hold its "HR West" event out of state without buy-in from SHRM chapters covering the cities where the event was to be held. The suit was dropped after the judge suggested that the agreement between the two parties wasn't as airtight as SHRM had asserted.

Burke, the SHRM spokesperson, said that chapter "is no longer part of our affiliated network."

Some of the SHRM affiliates that posted on LinkedIn after the recent verdict wrote that they were speaking out because they'd been receiving inquiries from members concerned about the lawsuit and their affiliate's relationship to SHRM international. Some chapters require their members to also be members of SHRM, which increased its annual fee by 13% earlier this year, to $299. Burke said SHRM wouldn't be increasing dues this year.

In addition to membership, SHRM sells access to HR educational materials and credentialing programs, and bills itself as "the foremost expert, researcher, advocate, and thought leader on issues and innovations impacting today's evolving workplaces."

Ahead of the trial, SHRM made an unsuccessful bid to have the plaintiff's lawyers barred from portraying it as a specialist in HR best practices. During the proceedings, the plaintiff argued that SHRM botched its own HR investigation into Mohamed's accusations of discrimination and retaliation.

One SHRM affiliate, DallasHR, said in its statement on LinkedIn that the verdict underscored the need for HR professionals to support and learn from one another.

"This is a validation of one of the core reasons DallasHR exists," the group said. "Too often we assume in our organizations we are 'all trained up' and 'that would never happen here.' But none of us should rest on yesterday's knowledge."

• My Gen Alpha sister's Christmas list highlights the cyclical nature of teen fashion choices.
• Y2K brands like Ed Hardy and Hollister have caught her 15-year-old eye this year.
• Her wish list aligns with some Gen Alpha trends and the recent surge of brands like UGG.

Every year, my 15-year-old sister sends my family her Christmas list, and it gives me a snapshot into the hallways of high schools for Gen Alpha.

As the youngest of three sisters, she sends the list to our mom, our eldest sister, and me to divvy up how we see fit. I've come to expect it to be long and detailed down to the exact style and color she's looking for.

However, this year I was caught off guard by the presence of some brands that my 30-year-old sister and I, a 26-year-old, were obsessed with at her age. Fashion is cyclical, but it's always interesting to see it unfold in real time, even if it makes me feel like I'm ancient.

My little sister is a dancer, so I wasn't shocked to see workout gear from popular athleisure brands, such as Lululemon, Alo, and Nike. The big surprises came from her requests for items I hadn't thought about since middle school. She asked for Victoria's Secret vanilla-scented body mist, flair leggings, and Ed Hardy sweatsuits, which were hot when I was growing up, for example.

Brands like Hollister and UGG have each had a strong year in 2025, with double-digit year-over-year sales growth in their most recent quarters. They're making big comebacks with Gen Alpha teens, according to Piper Sandler's semi-annual Taking Stock With Teens survey, published in April.

My sister is no different, with multiple styles of UGG shoes and a specific Hollister item making the long list.

Although a lot of the items sparked nostalgia for me — the Nike Elite backpack was a must-have when I was growing up — she also requested some brands that have popped off more recently. Fast-fashion brand PrettyLittleThing and Kim Kardashian's Skims are still establishing themselves as go-to options for young shoppers, such as my sister, for example.

Here's the full list of what my sister wants to see under the tree this year.

• Pink iPad
• Light pink Beats Studio Pro headphones
• Lululemon exercise set
• Lululemon backpack and keychain
• Skims tops
• Nike Elite backpack (pink or black)
• Black Alo workout set
• Nike workout gear (socks, leggings, and a jacket)
• Pink Stanley tumbler
• Victoria's Secret flair leggings and jacket
• Bare Vanilla Victoria's Secret body mist
• Goddess by Burberry perfume
• Carolina Herrera Good Girl Blush perfume
• Pandora bracelet
• UGG shoes (mini, slippers, or Lowmel)
• "NOOO PLATFORM Tazz Uggs"
• PrettyLittleThing set
• Ed Hardy sweatsuit (pink, red, white, black)
• Light pink Moon Boots
• Deer print blanket
• Hollister pink puffer jacket
• Ferrero Rocher chocolate

Her one caveat: We don't have to buy everything on the list. Thank goodness.

• Kirsty Craig was named a Tech Fellow at BlackRock, one of the firm's highest technical honors.
• She helped build Asimov, an agentic AI platform for the firm's investors.
• Craig, the only woman to become a fellow this year, said her advocacy has informed her success.

For 15 years, BlackRock's Kirsty Craig has operated as a kind of "translator" inside the world's largest asset manager, sitting between portfolio managers making big bets and engineers building the systems that help inform those decisions to get both sides aligned on driving returns.

This skill set is part of what earned Craig, head of research, data, and AI strategy for portfolio management tech, the title of Tech Fellow, one of the firm's high technological distinctions, held by only two dozen of its thousands of engineers. Craig is one of five new fellows that the firm announced on December 16, recognized for supercharging the asset manager's investment team. This year, she is the only woman and the only fellow who works outside of Aladdin, the lucrative spine of BlackRock's investment technology.

When it comes to her impact on how $13.5 trillion money manager BlackRock uses AI, Craig said she's especially proud of her role in Asimov, the agentic AI platform for the firm's fundamental equity business. The "virtual investment analyst" was unveiled by Chief Operating Officer Rob Goldstein at the firm's investor day in June.

It leverages AI to automate workflows and research, as many firms race to adopt the technology to speed up what were once monthslong investment processes.

Now, as a fellow, Craig is even more embedded in BlackRock's efforts to stay ahead, as the firm continues to center on technological prowess.

'Tip of the spear'

At first, Craig wasn't sure she'd become a tech fellow, largely because her work is different than most of the other fellows who work squarely within BlackRock's data analytics and risk platform, Aladdin. Her team of around 60 software engineers, data engineers, and data scientists "sits at the horizontal" across various investment capabilities to help drive investment research.

She found out about the honor at the beginning of the month when a meeting was added to her calendar.

When she heard the news, Craig started by telling the manager who had nominated her, her sponsor during the application process, her team, and her family, "but they've got no idea what it means," she told Business Insider.

Nish Ajitsaria, BlackRock's co-head of Aladdin product engineering and the co-executive sponsor of the fellows program, said that existing tech fellows knew Craig not only for her innovation with AI in investing, but for her collaborative efforts. He described Craig as an "AI native," and added that her team is at the "tip of the spear" when it comes to applying AI to investment.

Craig's time at different offices — Edinburgh, San Francisco, and now Philadelphia — has, she thinks, given her a strong foundation of horizontal leadership across teams.

"I am responsible for really trying to find the dial movers across data, AI, and technology that really help our investment pillars drive investment research," she said of her work.

Craig has learned how to communicate with both investors and Aladdin technologists, and said that building deep trust with both groups has been key to her success.

"If you put both of those different personalities or personas together, quite often they're talking above or below each other. They struggle to connect. So for me, it's really been being able to translate both and then come up with a strategy in the middle," she said.

Visible leadership

For Craig, being a woman in a position of visible leadership is "a huge honor." Of the 24 tech fellows, five are women, including Craig. Women make up 43.8% of BlackRock's global workforce and 33.1% of senior leadership, according to data from January 1, 2025, posted on the firm's site.

Craig said being involved in BlackRock's women and LGBTQ+ resource groups has informed her other work at the firm, especially in how they've taught her how to collaborate with people from across divisions and explain complicated topics.

"If anything has probably helped me with, one, building my network; two, softer presentation skills; and then three, around how to communicate with impact," Craig said. With the title, she hopes to help more junior female technologists "lean in."

For Ajitsaria, it's also important to have a diversity of expertise in the program and ensure that fellows represent all arms of BlackRock.

Expectations beyond the title

When it comes to driving technology strategy itself, Craig said she's excited to keep figuring out how to leverage AI in active investing. Right now, her team is thinking about how to expand the scope of agentic research, potentially to areas like fixed income and macro investing.

As she continues to soak up the news, Craig is also preparing for a very different big life change. Her partner is scheduled to give birth in early January, so, with the due date mere weeks away, Craig said they've kept all celebrating fairly tame so far.

"We did go out for a meal. Nothing has been purchased, apart from cribs and bottles," she said. "Definitely some more celebrating will be done post January 6."

• Where does Wall Street like to eat lunch?
• We set out to find some of the hot spots — besides all of the slop bowl chains.
• Favorites ranged from fine dining to casual delis.

For lunch on most days, the average Wall Streeter might opt for what has affectionately come to be known as a slop bowl. Think Cava, Chipotle, Sweetgreen: $18 for some combination of vegetables, chicken, and rice.

But on occasion, either with clients or colleagues, New York's finance workforce still likes to spend their midday break somewhere that's not a fast-casual chain.

I asked around to find out what some of their favorite spots are these days.

While the list below is by no means exhaustive — there are over 23,000 restaurants in New York — it offers a glimpse into where Wall Street likes to eat, from high-end joints to deli counters.

• The CMO at Monday.com has held executive marketing roles at Google, Amazon, and Vimeo.
• Harris Beber said he uses 3 P's to determine if a job is the right fit: people, product, and position.
• The CMO said he uses those criteria so he doesn't get swayed by whatever offer is in front of him.

It's human nature to reach for the shiny object in front of you — but Monday.com's CMO says it's worth pausing before you accept the first job offer that comes along.

Harris Beber has acted as the CMO of Vimeo, Global CMO of Google Workspace, and also held marketing executive positions at other companies including Amazon. He's no stranger to changing jobs — and he believes switching roles can be the right move when the work no longer feels fulfilling.

In the past, Beber told Business Insider that he's explored new roles in times when he was doing really well at work but feeling unfulfilled. That feeling can't last forever, he said.

"Eventually your work will suffer, your performance will suffer, and it doesn't end well for anyone," Beber said.

To avoid acting out of desperation or necessity, Beber said he tries to map out his next role before he gets to the point of needing a new job. The CMO said it's important to know your criteria for success when thinking about what's next.

"What is really important to you? What are your non-starters? And if you can look at those objectively, then when you have opportunities, you can measure it against something objective," Beber said.

He said he's used 3 P's to determine if his last few roles were the right fit: people, product, and position.

In regards to the first P, Beber said he tries to evaluate whether the people he's going to work with are right for him. He said it's "not easy to get up every day" and work with people you don't like or who don't treat others well.

In one job, Beber said he worked for a difficult leader who yelled, "put intense pressure" on the team, and treated him and others poorly. He said he would never work in that kind of environment again.

Beyond working with respectful coworkers, Beber said it's also important to make sure that the people you work alongside have complementary skills that will help you work well together.

If you're a marketer, when it comes to evaluating the product you're selling, Beber said, it's important to understand the user base and product offerings.

"Do you care about it? Does it excite you? It's really hard to sell something to other people if you don't understand it or aren't excited by it," the CMO said.

Beber said he made the mistake of once taking the wrong role at a sports tech startup. He said he really liked the people, but he's "not a sports person," and didn't understand the product. Beber said he ultimately didn't find happiness in that job.

When it comes to evaluating the position, Beber said he wants to find a role where he feels aligned and can add value to the company.

"Is what I'm great at? What the company needs?" Beber said.

Beber said he's felt the most fulfilled in his career when those three criteria line up. People are "really good at selling themselves" on why an opportunity seems perfect in the moment, he said, which is why measuring the offer against something objective is critical.

When someone makes you a job offer, "they're going to tell you every reason why you're perfect for the role and why it's going to be great," Beber said. "But as anyone goes into a new role, very rarely is it exactly what you thought it would be."

In 2020, the Department of Health and Human Services released "Healthy People 2030," a set of objectives designed to improve the nation's health outcomes. This year, at the halfway point, Business Insider decided to check how the country was doing against its goals.

One topic stood out. When it came to reducing low-risk cesarean sections, the US was "getting worse," a bright red banner warned.

"It's a cesarean epidemic," said Dr. Emiliano Chavira, a practicing obstetrician and maternal-fetal medicine specialist in Los Angeles. "There's a minimization of what the long-term risks are, what's happening to our public health, and how this affects mothers."

The more we dug, the more we realized there was a gap between the procedure's public perception as a routine, normal part of giving birth and what experts were saying. We set out to figure out why.

We also wanted to better understand the complexity involved in a procedure that can be life-saving and is also performed around double the rate the World Health Organization says is "ideal" for maternal and infant health.

We interviewed more than 30 practicing and retired obstetricians, nurse midwives, and labor and delivery nurses. We spoke with more than 25 academics who study C-section rates and maternal health outcomes.

Because hospitals don't always publicly disclose how frequently their doctors perform C-sections, we compiled our own data. We requested information from every state and Washington, DC. By the time of publication, we had answers from 29 states and DC. We compiled findings from over 1,700 hospitals.

We learned that doctors delivering babies have to make tough calls, and that the immediate and widespread availability of cesarean surgeries is critical to safe maternal care.

At the same time, dozens of providers told Business Insider that concerns for the health and safety of women and their newborns aren't the only influences. Doctors told us they performed C-sections because they feared lawsuits, or because there weren't enough staff, available beds, or time to support safe vaginal deliveries.

In reviewing decades of research, Business Insider also learned that indirect financial incentives appear to drive higher C-section rates since the surgeries are more profitable, cost-effective, and perceived to be more protective in the event of a lawsuit.

These interviews and our data analysis underlined a common theme: Too many C-sections endanger the health of women and their newborns, but a higher C-section rate appears to be better for a hospital's bottom line.

First, we set out to get C-section rate data from hospitals across the US

Early in our reporting, we learned that the rate at which doctors performed C-sections in the US skyrocketed since the late 1960s, when the surgery first became widespread. It tripled within the first decade, then doubled again by the early 2000s.

We wondered if elective C-sections were driving up the rate, and then found that only about 2.5% of babies are delivered in the US that way.

We learned that researchers in the 2000s found that pregnant women in the US are increasingly older, more likely to be obese, and are more frequently diagnosed with other complications, such as diabetes — all factors increase the chance that a baby will be most safely delivered by C-section.

That didn't explain one of the most surprising lessons: Doctors at different hospitals perform C-sections at wildly different rates, studies repeatedly found.

Controlling for a constellation of factors — hospital obstetric care levels, delivery volume, urban or rural location, maternal age, race, health, and income — multiple studies show one of the biggest risks for undergoing a medically unnecessary C-section is the hospital a woman delivers in.

A woman looking for the C-section rate at her nearby hospital may not find it. Some hospitals voluntarily disclose their rates in response to annual consumer surveys; many do not. Business Insider set out to build a more complete picture.

State health departments collect data on all babies born in their state, including when, where, and whether they're born vaginally or by cesarean surgery. Business Insider requested this data from all 50 states and Washington, DC.

Eleven states would not produce data that identified individual hospitals. Of those, 10 — Arizona, Arkansas, Colorado, Connecticut, Hawaii, Idaho, Missouri, Nebraska, and South Dakota — said the data was confidential by department policy or state law. The Louisiana Department of Health said the state does not track C-section rates by hospital, the only state in the country to say this.

Twenty-eight states require a formal public records or data request, sometimes for fees that reach $1,500. By the time of publication, 18 states and Washington, DC, produced data for Business Insider.

Kentucky's first-time and low-risk C-section hospital rates produced state-wide averages that differed significantly from those reported by federal agencies, so Business Insider excluded them from our analysis.

Eleven states release C-section rates by hospital on publicly accessible websites, which Business Insider pulled directly.

In total, 29 states and Washington, DC, provided at least one of three types of C-section rates for hospitals that delivered, on average, 100 or more babies a year: overall, first-time, and low-risk.

All regions produced hospitals' overall C-section rates, which include women undergoing their first C-sections and women who have undergone the procedure before.

Twenty-three states and Washington, DC, produced first-time C-section rates at 1,242 hospitals. We analyzed this rate because maternal health experts stress the importance of limiting first-time surgeries. Her first surgery almost always leads to others, which in turn increases her risk of developing more severe complications.

Eighteen states and Washington, DC, provided low-risk, or NTSV, C-section rates at 1,097 hospitals. Experts look at the rate doctors perform surgeries on women with low-risk, NTSV pregnancies — women who are pregnant for the first time, are at full term, are not delivering twins, and whose babies are head-down rather than breech — since they are the least likely to require surgery to most safely deliver their babies.

Relying on expert guidance, Business Insider considered low-risk C-section rates to be the most authoritative for comparing across different hospitals. Women with low-risk pregnancies may still have other complications, such as preeclampsia, which would most likely require a C-section to safely deliver their newborns. Experts overwhelmingly agree that low-risk C-section rates are still the best available metric.

For states that did not produce low-risk C-section rates by hospital, Business Insider relied on first-time C-section rates. If neither low-risk nor first-time C-section rates were available, we used the overall C-section rate.

In total, we analyzed at least one of three types of C-section rates from 1,744 hospitals that collectively delivered an average of over 2.6 million babies annually — around 70% of the babies born nationwide each year.

Nearly one in three were delivered by C-section, Business Insider's data shows, around the same as the national C-section rate over the last two decades.

Then we calculated each hospital's average C-section rates

Health departments provided annual C-section rate data over different time periods. Twenty-six states and Washington, DC, provided data for at least five years, all since 2018. Florida's data is the oldest, ranging from 2015 to 2019. Public websites for California and New York each provided one year of hospital C-section rates in 2024 and 2022, respectively. Hospital C-section rates may have since changed.

Guided by input from maternal health experts, Business Insider calculated individual hospital overall, first-time, and low-risk C-section rates as an average over all years provided. This helped ensure that the rates we examined weren't outliers.

Since we used a hospital's average, the rates Business Insider used may still reflect higher rates for hospitals with some years of high C-section rates, even where they have worked to curb their C-section rates year-over-year.

Next, we mapped the hospitals' locations and compared their C-section rates to others close by

We found that hospital average C-section rates swung to extremes, dipping as low as 4% overall at a hospital in Alaska and as high as 62% overall at a hospital in Florida.

To track how individual hospitals impact care, we first matched each hospital to addresses in the US Centers for Medicare and Medicaid Services' hospital general information database. Using the latitude and longitude of each address, Business Insider then deployed a Python programming script that used geospatial data to identify each hospital's nearest neighboring hospital in our dataset.

Next, we compared C-section rates across each hospital and its nearest neighbor. Business Insider identified hundreds of hospitals with higher rates than the next closest hospital, including 158 hospitals with an average low-risk C-section rate at least 25% higher than that of the next closest hospital.

Business Insider created a searchable map, which, for the first time, maps hospitals across 29 states and Washington, DC, and makes C-section rates publicly available to compare across nearby hospitals.

Hospitals change ownership — and names — frequently. Business Insider used the hospital name provided by each state's department of health. Hospital names in our database may have since changed.

We determined whether a hospital was for-profit, and whether that impacted C-section rates

What's the difference between neighboring hospitals with wildly different C-section rates? Decades of studies show a correlation between profits and higher C-section rates. Dozens of doctors, nurse-midwives, and labor and delivery nurses told us hospitals looking to maximize revenues and keep operating expenses low are indirectly incentivized to keep surgery rates high.

To investigate further, Business Insider used the US Centers for Medicare and Medicaid Services' hospital general information data to determine if a hospital is nonprofit, for-profit, or public. Business Insider used SEC filings, court filings, and previous news coverage to further determine and confirm operational model and ownership of individual hospitals across the 29 states and Washington, DC.

Business Insider also confirmed that the hospital's operational model had not changed at some point during the analyzed data period. If it had, we factored that change into the analysis.

We found that across nearly all 29 states and Washington, DC, for-profit hospitals, on average, performed C-sections at higher rates than other hospitals. Collectively, for-profit hospitals across Business Insider's analysis overall had a 20% higher first-time C-section rate and a 14% higher low-risk C-section rate than other hospitals.

C-sections are more profitable and more cost-effective than vaginal deliveries, experts and repeated studies found. Our findings are consistent with many studies that found that indirect financial incentives appear to drive higher C-section rates.

In the spring of 2016, obstetrician Dr. Jesanna Cooper's practice hired a nurse-midwife to deliver babies at Princeton Baptist Medical Center, a hospital in Birmingham, Alabama. The nurse-midwife was the center's first in about 20 years.

The impact on care was transformative, said Cooper, who practiced at Princeton Baptist for nearly a decade. She learned to safely support far more vaginal deliveries, and the number of C-sections she performed soon plummeted, she said.

Cooper wasn't alone. Between 2018 and 2023, doctors at Princeton Baptist on average cut into fewer than one in six women with low-risk pregnancies, according to data analyzed by Business Insider. The hospital's average rate in those years was nearly half of Alabama's statewide average, and dramatically lower than all of Birmingham's other hospitals, according to Business Insider's analysis.

The success was bitterly won. Delivering more babies vaginally was a years-long, "all-out, knock-down fight" against the hospital's administrators and the momentum of the US medical system, Cooper said. It was a fight for more staff; a fight for more time and beds for laboring women; and a fight against a medical system that rewards a different metric: profit.

Though C-sections can be vital, often life-saving surgeries, they're a frequently overused major abdominal surgery. US doctors perform them at double the rate the World Health Organization says is "ideal" for maternal and infant health, and nearly twice the rate of Finland and Sweden.

Women aren't asking for more C-sections; 2.5% of US babies are born by elective C-section each year. Instead, experts say, C-sections are more lucrative and cost-effective than vaginal deliveries, and are perceived to be more protective in the event of an expensive malpractice lawsuit. Hospital systems looking to maximize revenues and keep operating costs low are indirectly incentivized to keep surgery rates high.

How each hospital is run dramatically impacts how many surgeries its doctors perform, and C-section rates can swing wildly from hospital to hospital.

To track this, Business Insider analyzed C-section rates at over 1,700 hospitals with an average of at least 100 births each year, from 29 states and Washington, DC.

At hundreds of hospitals in Business Insider's analysis, surgeons performed C-sections at far higher rates than doctors practicing at the nearest neighboring hospital, likely serving similar patient populations.

The data suggests that for-profit healthcare systems appear more susceptible to high rates.

Vijay Chaudhuri, a vice president of Hudson Regional Health, the parent company of Hudson Regional Hospital, now known as Secaucus University Hospital, told Business Insider that the hospital closed its labor and delivery department in April, 2023, and did not otherwise respond to Business Insider's reporting.

Dr. Manuel Alvarez, who oversees care at Palisades Medical Center, said hospital leadership made a concerted effort to lower C-section rates and safely support more vaginal births, which included routine monthly trainings, evidence-based care protocols, and promoting a workplace culture more supportive of vaginal deliveries.

"The rate of C-sections is something we have been addressing," a spokesperson for East Los Angeles Doctors Hospital's parent company said in a statement to Business Insider. The spokesperson said the hospital planned to close its obstetrics department in January 2026 "due to declining deliveries over the last year."

Spokespeople for Providence Memorial, Las Palmas Medical Center, Adventist Health White Memorial, and Merit Health Biloxi, now known as Memorial Hospital Biloxi, did not respond to Business Insider's queries by phone and email.

Doctors delivering babies make tough calls. The stakes are high, doctors told Business Insider, and a routine delivery can quickly turn into an emergency that requires immediate surgery.

Many providers also told Business Insider that C-sections are often performed because doctors fear the crushing expense, professional damage, and personal distress suffered in a malpractice lawsuit. C-sections are perceived to be more protective in the event of a lawsuit alleging injury to a baby. Obstetricians are among the doctors most likely to face a legal threat at least once in their career, a 2023 study found, and a lawsuit filed over the serious harm or death of a baby can result in tens of millions of dollars in jury awards.

Business Insider's reporting showed that C-section rates aren't intractable. Experts said that rates can safely come down at hospitals that prioritize making careful, evidence-based changes.

"Some providers say this is too big for me," Cooper said, "but some try to fight it."

At Princeton Baptist, Cooper and the labor and delivery team fought to safely support more women to deliver vaginally. For a while, they won.

The most common inpatient surgery in America

C-sections are the most common inpatient surgery in the country. More than 32% of all babies born in the US are delivered by C-section. Many could likely have been avoided, maternal health experts say. One large study estimates that up to 19% of all births should be C-sections to protect women and their babies, leaving as many as 13% possibly performed needlessly in the US.

That suggests that around one in 10 pregnant women in the US — as many as half a million women each year — undergoes a medically unnecessary C-section, leaving her at higher risk of blood clots, hemorrhages, infections, and more likely to develop dangerous complications in future pregnancies.

Not all hospitals perform these surgeries evenly. Cesarean surgery rates across US hospitals swing to extremes, dipping as low as 4% overall at a hospital in Alaska and as high as 62% overall at a hospital in Florida, according to Business Insider's analysis.

At Princeton Baptist in Birmingham, Cooper and her colleagues maintained one of the lowest rates of C-sections performed on women with low-risk pregnancies — those who are pregnant for the first time, are at full term, are not delivering twins, and whose babies are head-down rather than breech — of any hospital in Business Insider's analysis.

In many ways, it was an outlier.

The hospital is located in a low-income, Black-majority neighborhood of Birmingham, Alabama. Nationwide, Black women are more likely than other women to undergo medically unnecessary C-sections.

Cooper credited most of their success to working with midwives. Across the US, women with low-risk pregnancies cared for by midwives have better health outcomes and lower chance of undergoing a C-section, according to several recent studies.

Cooper also said she and other providers at Princeton Baptist had enough staff and available beds to support women in long vaginal deliveries.

"If you don't have enough nurses, you don't have enough beds, or you don't have space for women to labor," said Cooper, "you're going to do things that increase the risk of a section."

Dr. Manuel Alvarez, who also chairs obstetrics, gynecology, and reproductive science at Hackensack University Medical Center and the Hackensack-Meridian School of Medicine, said his hospitals track individual and share provider C-section rates, hold routine monthly trainings on supporting vaginal deliveries for doctors and nurses, and implemented evidence-based protocols to ensure "women have the best chance of a vaginal delivery."

All doctors ordering a C-section must first consult with a nurse and another doctor, he said, which helps promote a workplace culture more supportive of vaginal deliveries.

Dozens of other hospitals maintained strikingly high C-section rates. Doctors at Valley Baptist Medical Center — Brownsville, a for-profit hospital in Brownsville, Texas, delivered over half of the 14,500 babies born at the hospital by C-section between 2018 and 2024, Business Insider's analysis showed. Of those, nearly 3,600 babies were delivered to women who underwent a C-section for the first time.

Experts look to prevent first-time C-sections, since they almost always result in more. At Valley Baptist, 99% of pregnant women with one or more prior C-sections underwent another over the same seven-year period.

Some hospitals treat women with high-risk pregnancies and may have a higher overall or first-time C-section rate to best protect the lives and safety of those women and their newborns. To better evaluate a hospital's potential for performing medically unnecessary C-sections, experts and federal health agencies look at the rate doctors perform C-sections on women with low-risk pregnancies, since they're the least likely to require surgery to safely deliver their babies.

Women with low-risk pregnancies may still be obese, be older, or have other complications, such as preeclampsia, which may mean delivering their babies by C-section is safest. Still, dozens of experts told Business Insider that low-risk pregnancies are the most useful metric for evaluating the quality of a hospital's maternal care.

At Valley Baptist, doctors performed C-sections on half of all women with low-risk pregnancies, on average, over seven years. That's double the low-risk C-section rate of the next closest hospital, less than 5 miles away.

Valley Baptist's spokesperson did not respond to Business Insider's queries by phone and email.

Large swings in low-risk C-section rates underline the dramatic influence a hospital has on women in its care. Controlling for a constellation of factors — hospital obstetric care levels, delivery volume, urban or rural location, maternal age, race, health, and income — multiple studies show one of the biggest risks for undergoing a medically unnecessary C-section is the hospital a woman delivers in.

Our first-of-its-kind map allows users to search hospitals across these regions and makes C-section rates publicly available to compare across nearby hospitals.

'That all goes back to money'

In the American medical system, money dominates care. Most US hospitals operate as "fee-for-service," meaning they bill and garner reimbursements for each service they provide. Each baby they deliver nets reimbursable fees.

A C-section performed by an obstetrician is more highly reimbursed than a vaginal delivery. In 2020, the surgery averaged around $17,000 in insurance reimbursements, compared to just under $11,500 for vaginal birth, according to a 2022 study.

The surgery is also more cost-effective. Hospitals maximize reimbursements from labor by keeping delivery volume high, according to former hospital administrators and recent industry analysis. The more babies delivered, the higher the collective payout.

For hospitals and providers looking to increase delivery efficiency, it's simple math. A vaginal delivery can take days, while a C-section takes less than an hour.

Those indirect incentives appear most acute at for-profit hospitals motivated to deliver higher shareholder returns. Across nearly all states in Business Insider's analysis, surgeons at for-profit hospitals perform C-sections at higher rates, on average, than other hospitals. Overall, for every 1000 women with low-risk pregnancies, around 289 will undergo a C-section at for-profit hospitals, compared with 254 women at all other hospitals — a 14% increase.

Acceptable outcomes, acceptable cost

There are proven, evidence-based strategies for hospitals to safely reduce unnecessary C-sections.

In April 2025, the American College of Obstetricians and Gynecologists recommended that hospitals safely lower low-risk C-section rates by fostering a workplace culture more supportive of vaginal birth. This means hospital leadership commits to standard, evidence-based protocols for common diagnoses that lead to C-sections, like when labor has "failed to progress," or interpreting electronic fetal heart rate monitors, which decades of research show can trigger unnecessary C-sections when misread.

Hospital staffing also matters. C-section rates were 11% lower in hospitals with enough staff to assign at least one nurse to care for every woman in labor, according to one large study. Many hospitals don't employ enough nurses to reach that benchmark. Nurse salaries are among a hospital's most significant costs, making up around 30% of all facility expenditures. Hospitals hoping to trim staff overhead may cut nursing staff first. For-profit hospitals employ markedly fewer nurses for every patient in their care than other hospitals, according to a 2025 study.

In 2020, Newsweek and US News & World Report named Princeton Baptist one of the top maternity hospitals in the country, one of only two hospitals in Alabama to achieve the distinction.

That quality of care didn't balance the cost.

Princeton Baptist saw a 70% increase in the number of babies doctors delivered there between 2018 to 2022. To generate even more revenue, Cooper said she brought in significantly more pregnant women with private insurance to increase reimbursements.

It still wasn't enough. To avoid C-sections, Cooper said, she needed available hospital beds and enough nursing staff to support a woman as she labored for up to three days. That's far more hospital overhead for a vaginal birth that's ultimately less lucrative than a C-section that takes less than an hour.

"There is so much systemic pressure to get more people delivered so you can get the next person in," Cooper said. "And that all goes back to money." Ultimately, the price was too high.

In 2023, Tenet Healthcare, one of the largest for-profit medical systems in the US and then Princeton Baptist's majority owner, closed the hospital's labor and delivery department. Nationwide, more than 500 hospitals have closed their labor and delivery departments since 2010.

Tenet diverted all remaining deliveries to nearby Brookwood Medical Center, a much larger hospital that delivered five times the number of babies as Princeton Baptist each year.

Doctors at Brookwood performed low-risk C-sections at double the rate, on average, as Princeton Baptist, Business Insider's data showed. In 2024, Brookwood doctors operated on nearly one in three women with low-risk pregnancies — among the highest low-risk C-section rates in the state.

David McKinney, the spokesperson for Orlando Health, the parent company of Brookwood and Princeton Baptist as of late 2024, referred Business Insider's questions to Tenet. Multiple Tenet spokespeople did not respond to Business Insider's queries.

In the end, the fight overwhelmed Cooper. Exhausted and burned out, she left the practice in late 2022, less than a year before Princeton Baptist closed the labor and delivery department's doors.

"It's hard to be an outsider in your own field," she said. "It's a hard enough field to be in anyway."

Without intervention, hospital C-section rates almost always rebound to meet the demands of the US medical system, said Dr. Steven L. Clark, an obstetrician at Baylor College of Medicine in Texas, who has studied the US C-section rate over decades.

It's economics, Clark said: "This is the rate which gives the American population acceptable outcomes for acceptable cost."

In most states, hospitals are not required by law to participate in initiatives aimed at safely lowering C-section rates. When left to themselves, hospitals rarely prioritize reducing medically unnecessary cesareans, more than a dozen healthcare providers and two former hospital administrators told Business Insider. Most default to concern for their bottom lines.

But not always.

States including California, Iowa, and New Jersey have successfully supported more vaginal deliveries at hospitals participating in state-led initiatives to improve maternal care.

At the beginning of 2025, dozens of Alabama hospitals volunteered to participate in a state-led initiative to safely lower their collective first-time C-section rate by 20% by 2027. Brookwood, under new management by Orlando Health, is among them. The hospital with the highest low-risk C-section rate in the state is not.

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