"The biggest change is that more physicians are offering VBACs to patients," said Catherine Van Wert, manager of the obstetrics department there. The term VBAC is an acronym for vaginal birth after Cesarean and refers to patients who attempt to have a normal delivery after they have had one or more Cesareans.

The difference between for-profit and nonprofit institutions is not always clear. Cesarean rates at West Valley, for example, have fallen since it changed ownership and became a nonprofit hospital last year. But Northridge and Valley Presbyterian, which were ranked high in the health research group report, are both run as nonprofit institutions. Kaiser also is a nonprofit facility yet its Cesarean rate in 1989 was less than half that of the other facilities.

Dr. Bruce Flamm, a Kaiser physician in Riverside who has been critical of high Cesarean rates, said the argument that the uterus might rupture "has been used for decades to support automatic repeat Cesareans." He said that, on the contrary, studies show VBAC is a safe procedure and that the mortality rates for such deliveries is no higher than for all deliveries.