The brutal winter cold has wreaked havoc on our roads, creating the likes of crater-sized potholes that we haven’t seen in years. Your car will probably take some hard shots and bring on mounting car repairs. In fact, a survey conducted by Trusted Choice and the Independent Insurance Agents & Brokers of America found that half of car owners from 2009 to 2014 experienced vehicle damage due to potholes. 

Driving into a pothole puts enormous strain on your tires, wheels, and suspension. The shape and depth of the road hole and the speed you travel all play into the severity of potential damage, but there are other considerations as well. A lot of cars, for example, now come with performance tires, which come with short sidewalls that provide responsive cornering but with less area to flex and conform to a pothole edge compared to a taller conventional tire. As a result, performance tires are also more prone to sidewall cutting and blistering.

Any direct hit in a pothole could bring about near instant air loss and will require immediate replacement. Any tire that survives a pothole and has sidewall damage should also be replaced in short order.  Wheels also take a beating; drive into a really deep pothole and you may be replacing the tire and the wheel. And just think of what that pothole shock does to your car’s suspension.

It’s always a good civic duty to report potholes to your local municipality. Many major cities and states now have apps for sharing pothole locations. This time of year, town and city officials should be repairing the holes to thwart any further road degradation and curb vehicle damage and accidents.  

Should the worst happen and you experience pothole damage to your vehicle, most auto insurances will cover the damage, but may not cover normal wear and tear items such as tires. In the Trusted Choice survey, 31 percent of respondents who experienced pothole damage filed an insurance claim. The majority paid out of pocket for repairs.

How to survive pothole-ravaged roads

1. Slow down and pay attention to the road conditions. Don’t be fooled, thinking that some potholes are small. If they are filled with water they can be more than you bargained for.  Also, keep some distance between you and car you are following—that will give you time to react should there be a pothole hazard up ahead.
2. Avoiding potholes is the best bet, but if the impact is inevitable, try to at least partly slow down before entering, and drive straight into it. Turning into a pothole exposes more tire sidewall to potential damage. 
3. Be diligent after a pothole encounter. Any shake or shimmy in your car’s ride can mean something was damaged. Stop the car, check for visible signs of tire and wheel damage. Keep in mind that if the front tire ran over the hole, the rear tire probably did as well—check both. Also, if no damage is visible, it could mean the car threw a balance weight off a wheel or possibly suffered suspension damage.  Have everything checked by your mechanic.
4. Keeping your tires inflated to the recommended inflation pressure is one of the best guards for minimizing pothole damage to your tires and wheels. Under- or overinflated tires can affect a tires’ or wheel's resistance to pothole damage. Most cars now have a tire pressure monitoring system to alert the driver if a tire is losing air pressure. If your car does not have a tire pressure monitoring system, check the tire pressure when the tire has cooled to ambient temperature to be sure it’s not losing air from the pothole encounter.

See our tire buying advice and tire ratings.

—Gene Petersen

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

When you apply for a credit card or buy a smart phone, you have to sign what's usually a multipage contract with lots of legalese in tiny type. The contract is a take-it-or-leave-it deal: If you don’t sign it, you don’t get the card or the phone. So you sign it. No harm, no foul, right?

Wrong. Buried in the contract you signed there's often wording that says you’ve given up your right to sue the credit card or wireless company over any dispute you might have with it. That fine-print language is known as a forced arbitration clause, which typically says that you "agree" that a company can insist that any dispute that might arise between you and the company will be settled under the arbitration process.

That means, instead of going to court and making your case in front of a judge, you have to see an arbitrator, who is often chosen by the company. In an interesting—read: not consumer friendly—wrinkle, the company can keep choosing that arbitrator for repeat business, so there’s a huge incentive for the arbitrator to favor the company.

This arbitrator is typically not required to follow established law and procedure, and the arbitrator's decisions cannot be appealed, and are often kept secret. The fine print often says disputes will be considered by an arbitrator at a location chosen by the company, which could be far away from where you live.

Arbitration clauses also typically restrict you from joining with other consumers who have been mistreated in the same way by the same company. Because the costs for pursuing a claim effectively are typically more than the amount of a single claim, this restriction makes it far less likely that consumers will ever pursue claims. And that lets the company off the hook for its wrongdoing.

At Consumers Union, the policy and advocacy arm of Consumer Reports, we think forced arbitration is too often stacked against the consumer. The Consumer Financial Protection Bureau has issued a new report about this practice in consumer financial products, such as loans, cards and bank accounts.

The CFPB report finds that this restriction on consumers' ability to effectively pursue claims results in a windfall to financial service companies worth tens or hundreds of millions of dollars each year.

The report also found that more than 75 percent of consumers surveyed did not even know whether they were subject to a forced arbitration clause in their agreements with their financial service providers. And fewer than 7 percent of those covered by forced arbitration clauses realized that the clauses restricted their ability to sue in court.

“Basic legal protections have no meaning if companies can’t be held accountable under the law. The CFPB report clearly demonstrates why forced arbitration clauses are unfair to consumers and undermine the rule of law,” George Slover, senior policy counsel at Consumers Union, said.

The CFPB was created by the Dodd-Frank financial reform law to give a single agency authority to protect consumers in their dealings with banks and other lenders and financial-services companies. Dodd-Frank directed the CFPB to examine the prevalence of forced arbitration clauses in consumer financial contracts and the effect on consumers, and authorized it to regulate or ban the practice based on the findings.

Consumers Union is urging the CFPB to take action now to curb forced arbitration clauses so the consumer can freely choose how to resolve a dispute with a company.

“We hope the CFPB will now use its authority to prohibit forced arbitration from being a precondition for getting a credit card or a bank account,” Slover continued. “Banks and other financial services companies claim that arbitration is somehow better for consumers than going to court. But if that were really true, the banks and lenders wouldn’t need to force consumers to agree to it.”

This feature is part of a regular series by Consumers Union, the policy and advocacy arm of Consumer Reports. The nonprofit organization advocates for product safety, financial reform, safer food, health reform, and other consumer issues in Washington, D.C., the states, and in the marketplace.

Read other installments of our Policy & Action feature.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

After carefully reviewing our latest test results and considering performance across the model line, the Consumer Reports tire-testing team has come up with this list of the best tire brands.

Of course, before you buy, check our detailed test findings—we currently offer comprehensive all-weather ratings on over 170 models—to make sure you’re buying the best tire for your needs.

As you'll see below, many well-known brand names offer strong product lines. We're currently testing all-season, performance all-season, and winter tires with many new models from several brands. Will a new brand join the top tier? We look forward to finding out.

—Gene Petersen

Across the board, Michelin offers nearly a perfect blend of grip, handling, low rolling resistance for good fuel economy, and long tread life. In many instances, tread wear is class-leading, and Michelin has tread wear warranties on all replacement tires, including winter and summer tires. (Most competitors do not.) However, Michelin tires can be pricey and that holds back a lot of potential buyers. It’s too bad because if you factor in the outstanding tread wear, the Michelins might be a bargain compared to other tires with a lower price.

Top models

All-season: Michelin Defender

Performance all-season: Michelin Primacy MXV4. The Michelin Premier AS is a successor and initial testing suggests a worthy one.

Ultra-high performance: Michelin Pilot Sport A/S 3 (all-season), Michelin Pilot Super Sport (summer)

Winter: Michelin X-ice Xi3, Michelin Pilot Alpin PA4 (performance), Michelin Latitude X-Ice Xi2 (truck)

Truck: Michelin Latitude Tour (all-season), Michelin LTX M/S2 (all-season), Michelin LTX A/T 2 (all-terrain)

For more information, check our tire buying guide and Ratings.

Nipping at the heels, if not looking back at Michelin at times, Continental consistently offers high-scoring tires. Handling and impressive stopping grip on dry and wet roads are typical of this brand. As a bonus, they are attractively priced.

Top models

All-season: Continental ProContact EcoPlus (discontinued model in limited supply). The new TrueContact is being tested right now.

Performance all-season: Continental PureContact

Ultra-high performance: Continental ExtremeContact DW (summer)

Winter: Continental ExtremeWinterContact (truck). Currently being tested, the new WinterContact SI has outstanding snow traction.

Truck: Continental CrossContact LX20 EcoPlus (all-season)

Not every model is a hit, but in the last two years Goodyear has come on strong with some recommended truck and ultra-high performance tires. All-season car tires are a bit long in the tooth; still the Goodyear Assurance TripleTread All-Season car tire is impressive. If you need an all-season tire with great snow traction, the Goodyear Assurance ComfortTred Touring is it.

Top models

All-season: Goodyear Assurance TripleTread All-Season

Ultra-high performance: Goodyear Eagle F1 Asymmetric All Season, Eagle F1 Asymmetric 2 (summer)

Truck: Goodyear Assurance CS TripleTred All-Season, Goodyear Wrangler All-Terrain Adventure (all-terrain)

Known for ultra-high performance tires, Pirelli supplies original equipment rubber for many prestigious sports cars. Pirelli also offers some solid models for less exotic vehicles, too. Tread life is not always a strong point, but in recent years there have been updates with a “Plus” added to existing models, some of which we are testing now.          

Top models

All-season: Pirelli P4 Four Seasons. We are testing Pirelli P4 Seasons Plus.

Performance all-season: Pirelli P7 Cinturato A/S is big on dry and wet grip, and handling, though tread life and stopping on ice are just fair. We are anxious to see how the new P7 Cinturato A/S Plus performs in our tests.

Ultra-high performance: Pirelli P Zero Nero All Season, Pirelli P Zero (summer)

Winter: Pirelli Winter 210 Sottozero Serie II

Truck: Pirelli Scorpion Verde All Season Plus

This final ranking is a tough spot to call, as there are many fine brands vying for the title. Rather than make a single selection, we consider this a four-way tie. Here's the rundown: 

Hankook has the top-rated Dynapro AT-M in the all-terrain category, and it has a couple impressive ultra-high performance tires: the Hankook Ventus S1 noble 2 (all-season) and Ventus V12 evo2 (summer). The Winter I*cept evo has been around for a number of years and still impresses with its well-balanced grip on cleared and snow-covered roads. Absent are all-season tire models that the company is now updating.

Cooper is strong in truck tires. The Discoverer A/TW is an all-terrain tire with winter tire-like grip, and the Discoverer SRX is a very good four-season tire. The Cooper Discoverer A/T3, once a top-rated all-terrain tire, is a favorite around our neck of the woods and gets high marks in user reviews at ConsumerReports.org. Cooper makes some great car tires with the Zeon RS3-A (all-season) ultra-high performance tire being a recommended model. We are testing a few new all-season Cooper car tires currently.

Nokian expertise is targeted to winter tires, including the Hakkapeliitta R2 and the Hakkapeliitta R2 SUV. The best-kept secret, though, might be the WR G3 and WR G3 SUV—winter tires that you can keep on your car or truck all year long. Nokian can make sporty tires, too; the zLine is an outstanding summer ultra-high performance tire. The downside is Nokian tires are not cheap.

Yokohama tires have characteristically impressed us with their sporty flair in three-season weather. The Advan Sport V105 offers excellent dry and wet grip, responsive handling, and good tread life for a summer tire. For family cars, the Avid Ascend all-season tire offers very good dry and wet grip and impressive tread life.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

The great thing about energy-saving LED lightbulbs is that they’re designed to last a long time—often 23 years. And that’s why when some Cree LED spotlights died early in one of Consumer Reports’ tests—the most failures our lightbulb experts have seen for LEDs—it raised questions.

The dimmable Cree PAR38 Bright White LED spotlight replaces a 90-watt incandescent lightbulb and has a 27° beam angle. We paid $24 apiece at Home Depot. The model number is BPAR38-1503027T-12DE26-1U100. Here's what we found.

The tests. Our engineers conduct a number of different tests for brightness, energy use, light color, and more. Cycle testing tells us how the bulbs hold up after being frequently turned on and off. That on/off affects CFLs, but hadn’t affected LEDs, until now. Four of the eight Cree LEDs died after about a quarter of the way through the test.

And in our 3,000 hours life test, two of the 10 LEDs died, something that is unusual for LEDs but we have seen this in the past. One Cree LED went out before 500 hours and the other around 1,700 hours. This LED is meant to last 25,000 hours, or nearly 23 years when used 3 hours a day.

Need to know. Several visitors to HomeDepot.com commented that this LED failed very early on for them as well. The LED is Energy Star qualified, meaning it met Energy Star’s high standards when tested by a third party (not Energy Star and not Cree). And while Energy Star LEDs must have a warranty of at least 3 years, the Cree’s warranty is 10 years. This shows why you should save your receipt. And if you’re planning to buy PAR38 LEDs, especially for outdoor use with a motion sensor that frequently turns them on and off, consider the Great Value 90W PAR38 LED Soft White NonDimmable LED from Walmart. It’s $22 and a CR Best Buy.

One more thing. In our past tests Cree LEDs have done very well. We recommend the Cree 9.5-watt (60W) A19 Warm White Dimmable LED and at $8.50 it's a CR Best Buy. Our tests of the Cree PAR38 LEDs continue and we’ll continue to report on our findings. For more information, read  “How to get your money’s worth when buying an LED.”

—Kimberly Janeway 

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Last week, SanDisk, which produces memory cards for cameras, camcorders, smartphones, and other mobile devices for storing images and video, announced that one of its latest microSD SDXC memory cards would ship with 200GB of capacity. At $400, it’s a pricey card, but for people who shoots thousands of photos or capture hours and hours of video, it could make sense.

The new card received a lot of attention—at least on tech blogs—but it's actually not the biggest SD (or Secure Digital) memory card on the market. SanDisk also sells a full-size (or non-micro) version of its Extreme PRO SDXC memory card that comes with 512GB of memory and costs around $600. If you have a 16-megapixel digital camera, you’d be able to store more than 90,000 photos on that card (assuming they were JPEG files at the lowest compression setting).

However, that depends on the card working in your camera—and if you have an older model, it probably won't. There are several generations of memory cards in circulation, and before you buy one, you should make sure it's compatible with your camera. Here's what you need to know.

Find the best digital camera for your needs and budget: Check our camera buying guide and Ratings.

What types of SD cards are out there? Essentially, there are three types, which I’ve listed in order from newest to the oldest.  

• SDXC (at the moment, from 64GBs to 512GBs of storage); prices range from about $30 to $600
• SDHC (from 4GBs to 32GBs of storage); prices range from about $7 to $120
• SD (up to 2GBs of storage); prices are less than $10

Which memory cards are compatible with your digital camera? You’ll have to check your model's manual or the camera manufacturer’s website to be sure, but as a rule of thumb, the newest models are compatible with all three types of cards. And cameras generally are backwards-compatible (new models will accept older cards).

• Cameras compatible with SDXC cards can also use SDHC and SD cards
• Cameras compatible with SDHC cards can also use SD cards
• Cameras compatible with SD cards can only use SD cards

For more on memory cards, check out the SD Association’s website. (This is a trade group dedicated to establishing SD standards.) There’s also a lot of information on SanDisk’s and Lexar’s website, which both manufacture memory cards.

—Terry Sullivan

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Consumers looking for their next new car may be overwhelmed by the abundance of available features, especially if they haven’t been in the market for a few years. Great advances in convenience, infotainment, and safety mean tough choices, pricey options, and a cavalcade of acronyms. We can help.

Consumer Reports buys new cars for testing almost weekly, ensuring our staff has experienced just about every new feature that comes along. Some features are clever innovations that we wouldn’t be without, and some can be as much of a nuisance as a help. (Learn about how we test cars.)

Based on our experience, here are recommendations for features worth considering and those that you should just skip.

See our guide to infotainment systems.

Comfortable seats! Drivers can spend a lot of time in the car. If the seats aren’t comfortable, you won’t be happy with your car for long. Be sure as part of your test drive that you spend adequate time evaluating the seat,. Be sure each driver get’s a chance to assess the seats for at least 15 to 20 minutes.

Power driver’s seat with height-adjustable lumbar support. With greater fine-tuning ability than most manual seats, power seats can help most drivers find a much more comfortable driving position. Height-adjustable lumbar support is another key to long-term comfort. If the lumbar bulge is in the wrong place, it’s no more comfortable than having too little lumbar support.

Memory function for seats can be a marriage saver. This allows each driver to save key seatings and switch from one driver configuration to another with a simple button press. Often this feature can also store radio and climate preferences, as well.

Forward-collision warning, available in many new cars, is proving effective at reducing crashes. Using forward radar or cameras, the system tracks distance to the car ahead and how fast you’re closing on them. If you are closing in too quickly, risking possible collision without appropriate driver reaction (such as decelerating or braking), the system sounds a warning. Better systems can automatically apply the brakes if needed to avoid or minimize a crash.

A backup camera is like having eyes in the back of your head, reducing the risk for backing over or into something that might otherwise be unseen behind the vehicle. It’s both a safety feature and a convenience for  parking.

Rear cross-traffic alert takes seeing behind you to the next level by warning you when other traffic is approaching from the side as you back out.

Blind-spot monitoring signals when there’s a car in the blind spot beside you on the road. The best systems light up little yellow lights in the side mirrors where you should be looking anyway. They emit a chime if you signal a move toward a car next to you. We’ve found these systems to be very effective.,

Bluetooth connectivity allows you to answer a cell-phone call hands-free, without fumbling to answer the phone or risking a law violation. In addition, Internet-sourced audio can typically be streamed to the car wirelessly, provided you took the time to pair the phone to the car.

A USB port can be used to charge a device and play music through the stereo.

Voice controls can keep you from fumbling either with your phone or the car’s controls when  looking for the perfect song or trying to phone home. They’re also handy for entering a destination in the navigation system, even under way.!

Heated seats and steering wheel can be much appreciated during a cold winter.  Trust us, once you try these, you’ll never want to live without them.

Dual-zone automatic climate control allows the driver and front passenger to fine-tune temperature settings. Set and forget—the system will make adjustments as needed to keep everyone comfortable. It also has a safety benefit – in Auto mode, you’ll be fumbling less.

Automatic high beams take the stress out of driving on back roads at night by automatically turn off the high beams for oncoming traffic, and then turning them back up once the cars have past.. We’ve found some systems (such as Toyota’s) work much better than others (such as Chrysler’s), however.

Spare tire. Lots of cars come without them these days, so check before you buy. In many cases, a spare tire can be added for a fee.

Keyless entry makes a huge difference when you’re trying to open the car and have your hands full of bags, babies, or a briefcase. Just walk up and open the doors—sometimes by touching a sensor on the handle. Almost all cars with keyless entry also have pushbutton start. But even if they don’t, it’s easier to fish for the key once your hands are free.

Gesture/character recognition some cars are introducing separate touch pads to interface with their center screens, where you can scribe letters to enter addresses, for example. But they’re just as distracting and no easier to use than scroll wheels or simple touch screens.

iPod/iPad/HDMI audio/video adapter. Some cars come with special adapters to connect your phone to the car, unnecessarily tying you into one type of connector and one type of phone; they can’t really do anything USB or Bluetooth connections don’t.

CD/DVD player. With all the modern connectivity in cars and most people carrying their music libraries on their phones, CD players seem redundant. Plus, they take up valuable real estate on the dashboard. Similarly, iPads can carry movies as well as games, making rear entertainment systems another unnecessary expense and complication.

Start-stop systems turn the engine off at stoplights to save gas. But they often shudder or surge when they restart, and gas savings seem pretty minimal. Most of our drivers override them before they start out.

Built-in navigation brings a nice big screen and integrates with the car’s controls. But phone-based navigation often has better points of interest and voice recognition, and some factor traffic conditions.

Apps are feeding into more and more cars. Some of them are handy: Aha, Audible, Pandora, Stitcher, and Spotify, among others, make it easier to control playback than just using the direct Bluetooth connection in the car. But as quickly as new apps come along, any of them could become obsolete before you trade in your car. The systems that seem particularly ridiculous are those that require a separate umbrella app on your phone to interface with any app on the car, such as Toyota’s Entune system.

Wi-Fi in cars is the latest rage. GM rolled it out across its lineup for 2015, and select luxury cars have offered it for a few years. We don’t get it. Most cell-phone plans offer mobile hot spots. And the signal has to come from somewhere. Wi-Fi routers in your car require their own monthly 3G data subscription in addition to your new car payment.

Turbochargers are spooling up on engines large and small. The idea is that you can get more power from a smaller engine, and thus save gas compared with a bigger engine of similar power. Our tests haven’t shown any such fuel economy benefit from most turbocharged engines. What they do consistently boost is repair and maintenance costs. Often, turbos are unavoidable, but with many models, they are an option. Consider the full pros and cons before buying.

Cooled seats. While most of our staff clamors for heated seats, we’ve heard no such outcry for cooled seats, which add a lot of noise and complication for a sensation that’s more strange than comforting.

Lane-keeping assist is a new system that monitors the lane lines and electrically nudges the steering wheel to keep you between them. We haven’t seen statistics yet, but it seems to us that lane-departure systems are just as effective at warning you if you’re not paying attention, and they’re less annoying because they don’t give you the eerie feeling that someone else is tugging the steering wheel .

–Eric Evarts

Visit the 2015 Autos Spotlight special section for our 2015 Top Picks, Car Brand Report Cards, best and worst new cars, best and worst used cars, used-car reliability, new-car Ratings and road tests, and much more.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

No matter how far away you may be from family and friends during the holidays, it's likely children are at the top of everyone’s invite list. Likewise, winter break brings far away family getaways. Whatever the motivation to hit the road or skies, take time to plan travel to ensure the little ones are as content and safe as possible. Following these tips will help:

Stick with what you know

We’ve had mixed experiences with our investigations into renting car seats from car rental agencies. 

But even in the best of cases, use of a car seat that is unfamiliar to you can increase your odds for misuse and consequently reduce your child’s safety. Working with a familiar seat that is already adjusted to fit your child is a better and safer option. Plus, by using your own seat, you can save the often-significant seat rental fees. Admittedly you end up hefting your seat along, but child seats can typically be checked as baggage for free. Some manufacturers also make travel bags that protect the seat and make it easier to move. If you’ve purchased a ticket specifically for your child (as opposed to carrying them on your lap), be aware that they may be most comfortable and most “contained” by using their child seat on the plane, as well. Most are approved for airline use by the FAA but check the label to be sure. According to the FAA, most airplane seats should accommodate a child restraint that is no wider than 16 inches.

Check our car seat buying guide and Ratings. And use these other tips safe travel.

Know the law

If you’re traveling across state lines via car and have a child at or near booster-seat age, you may want to take a minute to check the booster seats laws for any state you may be traveling to or crossing through. Booster seat laws vary state-by-state and range from as young as four years of age to as old as eight years old and for kids who weigh as much as 80 lbs. What may be legal in your state may not be in another. Regardless of what your state law says, most kids don’t fit the vehicle seat belts correctly until they reach about 4-foot-9 (57”) in height. Use these booster seat guidelines to see if your child is ready for a vehicle belt or not. 

Be careful packing your car

Chances are that holiday travel will not only require the typical amounts of “kid stuff” but also the addition of gifts and other holiday-related items. Take care in packing your car to put heavier items low in the load space, secured so that they can’t become a projectile during a crash or even in the event of emergency braking. Obviously, take special care for items closely surrounding your children. After packing the car, perform a quick check by moving slowly and giving your brakes a quick punch in your driveway or on a clear road, without traffic behind you. Does the load stay put? If so, you’re good to go.

Expect the unexpected

Plan for the worst. If you’re traveling with kids, Murphy’s Law says your flight and train will be delayed or an accident on a major highway will lead to long hours in the car. Think ahead to packing additional snacks, games and other items, cell-phone charge cords, and pertinent contact information. Though most parents and caregivers do this anyway, take extra care to plan for the unexpected. If traveling by car and in cold climates, be sure to have warm weather gear for everyone in the car. You just never know. (Learn what to pack in an emergency kit.)

Most of all, enjoy the wonder of the holidays through your children’s eyes and enjoy their company. Time passes all too quickly!

—Jen Stockburger

Visit our Holiday Gift Ideas page throughout the season to find the best deals, time-saving advice, and much more.

Should you buy a car for Christmas?

Low-cost gifts for car lovers

7 dream cars for the holidays

Should you buy a car for Christmas?

Cars that don't make great holiday gifts (and ones that do)

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

This time of year you see plenty of "Sale" signs in stores. You might think just about everything is discounted after the holidays.

But Consumer Reports product research experts, who track prices all year long, have compiled a list of items that are typically discounted most deeply in January. So if you're shopping for the best deals, here are the things to put on your list.  

Want to know what's on sale the rest of the year? See our calendar of deals.

–Mandy Walker (@MandyWalker on Twitter)

It's the month for white sales, but buying new sheets might not be as simple as checking the pricetags.

Shopping tips

Don't shop on thread count alone. Our latest tests again confirmed that higher thread count doesn't guarantee better sheets. In fact the top-scoring percale sheets, which had a claimed thread count of only 280, were strong, shrank very little, and easily fit mattresses up to 17 inches high, even after we washed and dried them five times.

Make sure you can return them. Only 4 of 23 sets of queen-size sheets performed well enough for us to recommend them in our last test. As for the other 19, we found a litany of problems: Some fitted sheets easily ripped or came apart at the seams in our strength tests. Other sets had fitted sheets that popped off the corners of mattresses they claimed to fit, or flat sheets that fell short on the sides of the bed. And some wrinkle-free sheets weren't.

For more shopping tips, check out our sheet buying guide. Our Ratings show which sheets did best in our lab tests. If you're shopping for young children, see our crib bedding buying guide.

By the way, if you've ever wondered if it's possible to fold those fitted sheets neatly, watch the video below.

Ellipticals mimic the motion of running but without the impact.

Shopping tips

Every model is a little different. Don't buy an elliptical (or a treadmill) before using it in the store. That's especially important with elliptical exercisers because the movement is less familiar than walking or running, and each machine has a slightly different pedaling profile. See our elliptical buying guide for more shopping tips.

What price can tell you. In our tests we've found ellipticals that cost $2,000 and up were well-built and felt stable to our testers, more like the $5,000 machines at gyms. And they were less likely to have defects. But you can still get a good basic model for less. In our Elliptical Ratings (available to subscribers), the quality score reflects the severity and frequency of those defects.

Shopping tips

Check age suggestions When toy shopping for young children, follow the manufacturer's age recommendations displayed on the package. Although you might think that a more "advanced" toy will present a welcome challenge, in reality, it could be a source of frustration.  

Look for hazards Avoid magnets and toys that have them. Small magnets can be accidentally swallowed by children and they can do tremendous harm. The CPSC recommends keeping toys with magnets away from children younger than six.

For more shopping and safety tips, read our toy buying guide.

If you're shopping for older children, you probably know tablets for kids are hot. See how different models did in our lab tests; the video below provides some great shopping tips.  

Spending several thousand dollars on a treadmill can get you sturdier construction, better hardware, and more features. But you can get a decent machine that provides a great workout for much less.

Shopping tips

Take factors besides cost into account before buying. One important consideration is the amount of space you have for a treadmill. Nonfolding models take up as much floor space as a couch or dining room table. A folding treadmill can save you about six-square-feet.

Decide where you want to shop. Budget and midpriced treadmills are sold at large retailers such as Dick's Sporting Goods, Sears, Sports Authority, and Walmart. For more expensive brands, you'll generally need to hit a specialty fitness store. Whether you want to shop online for the best price or in a store, try the machine in person first. You might notice a problem--the deck is too short for you stride, for example--that you can't detect by sight or reviews alone.

Our treadmill buying guide provides lots more shopping tips; subscribers can also take advantage of our Treadmill Ratings to make wise buying decisions.

It's possible to find good TVs selling for a few hundred dollars, while others go for several thousand, and there are many sets that fall in between those extremes. Screen size, features, brand, and more affect the price. Our TV buying guide will help you get the most bang for your buck, no matter how much or how little you want to spend.

Shopping tips

It's hard to judge TVs well for yourself in stores. That's because TVs are usually set to a Retail or Store mode, which pumps up brightness and color to a level that looks great under fluorescent lights. Subscribers should consult our TV Ratings before hitting the stores to make sure you get a set that performed well in our lab tests.

Consider the size. Budget and room size permitting, we believe most consumers would be best served by at least a 40- to 42-inch screen for a primary TV. A 46- or 50-inch set is often preferable in rooms where you'll be sitting 8 to 10 feet or so from the screen. Consider an even bigger set for spacious family rooms. Just don't buy a jumbo screen and sit right on top of it: If you sit too close to a TV screen you might notice the picture elements (pixels) that make up the images, which can be distracting, especially with lower-quality content like you might get when streaming video. Ultra HD TVs, which have four times the number of individual picture elements (or "pixels") as 1080p models, allow you to sit closer to the TV without seeing the pixel grid; as a result, you may opt for a larger set without changing your seating distance.  

As temperatures plummet, you'll luckily find good deals on winter clothing this month.

Shopping tips

Time your visits. Shopping at the right time can save you even more, say the editors at Shop Smart magazine. Kohl's fans, for example, should check out the "Gold Star Clearance" racks, where prices are slashed up to 80 percent on weekend nights. Every Wednesday, shoppers who are 60 years old and older get an extra 15 percent off.

At Target, women's clothing is generally marked down on Tuesdays, men's on Wednesday, and kids' on Mondays. Markdowns at Marshalls and T.J. Maxx usually happen on Wednesday.

Look for deals in other departments. Another clothing item that will be cheap this month: Swimsuits.  

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Many women trying to conceive take their temperature at the same time every morning to predict their most fertile days. A number of over-the-counter numerous kits are designed to make the process simpler for you. The Bloom cervical ring, launched here at CES 2015, adds a high-tech twist to the process. The device tracks changes in your body's temperature and sends an alert to your smart phone when it determines the time is right.

The manufacturer, Prima-Temp, says that the device—a temperature sensor wrapped in medical-grade silicone—is sensitive to temperature changes of as little as 0.05° F. Once inserted, the Bloom is supposed to alert your phone when it detects the slight dip in body temperature that occurs one to two days before ovulation.

A Prima-Temp representative expects the Bloom cervical ring to be on the market this summer at a price of less than $200.

—Trisha Calvo

For more information on pregnancy, read our report "What to Reject When You're Expecting," and check our hospital Ratings, which include information on C-section rates at hospitals nationwide.

Click on the image above to find all of Consumer Reports' coverage from CES 2015.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Nearly 7 percent of deaths in the U.S. now stem from the flu or pneumonia, according to the national Centers for Disease Control and Prevention, approaching epidemic levels.

The flu is also widespread in 43 states. Here’s how you can avoid the illness, and what you should do if you come down with it.

1. Get your shot.

The CDC says that the vaccine this year is not a great match for the flu strain that is responsible for most of the illnesses being reported. But it still helps prevent some cases and may reduce the severity of your symptoms, says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. And there are other strains that may show up in the coming months that the shot will protect you against.

Find out how to get the right flu vaccine for you, and where to get it.

2. Scrub your hands frequently.

The flu virus can linger on surfaces, such as doorknobs, that then spread to you when you touch your mouth or nose. But to combat this, don’t scrub with antibacterial soap—it just contributes to antibiotic resistance and other health threats. Instead, use clean running water—the temperature doesn’t matter—and regular soap, and take your time. Lather up for 15 to 30 seconds, or the time it takes to hum “Happy Birthday” to yourself twice. Then rinse and use a clean towel to dry your hands. Damp hands are more likely to pick up and spread germs.

3. Use alcohol-based hand sanitizer as a backup.

Just make sure the product is at least 60 percent alcohol (ethanol or isopropanol). And make sure you put on enough so it takes at least 10 to 15 seconds to dry, says Elaine Larson, R.N., Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University.

4. Keep your distance during flu season.

Droplets containing flu germs spread when people cough, sneeze, or talk, and they can land on your nose or mouth up to about 6 feet away. And since symptoms start one to four days after the flu virus enters the body, you really don’t know who is a carrier and who is not. So try to avoid crowds, especially if you have underlying illnesses, says William Schaffner, M.D., an authority on infectious diseases and chairman of the preventive medicine department at Vanderbilt University School of Medicine in Nashville, Tenn.

"In the Southeast where flu started this year, we’re still seeing lots of hospital admissions and emergency department visits, so the season has not yet peaked,  unfortunately," he adds.

What to do if you still get sick

Finally, flu symptoms come on swiftly. If you suddenly have body aches, fever, sore throat, and coughing, chances are good that you have the virus. If you are in one of the high-risk groups, including people 65 and up and and children 5 and younger, get to a doctor right away for prescription antiviral medication, such as oseltamivir (Tamiflu) and zanamivir (Relenza). The drugs are effective in reducing the severity of symptoms if taken within 48 hours of getting sick and have been shown to reduce the risk of complications such as pneumonia and respiratory failure.

And if you're not in a high-risk group? The CDC says antiviral treatment also can be considered if your doctor thinks it's necessary. But be aware that the cure can be as bad as the disease: Antivirals can cause nausea, vomiting, and increase the risk of headaches.

—Sue Byrne

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

In my four days at CES 2015, I expected to see lots of laptops, tons of tablets, and many, many TVs. And I wasn't disappointed. But there were also some things I did not expect to come across at the show. Here's a sampling.

A printer that prints food

Hungry? Print yourself a cookie with XYZ Printing's 3D printer. (XYZ is the manufacturer of the popular DaVinci 3D printer line.) Import your own design (snowman? flower?) into the printer, and it prints out raw dough. Pop the dough in the oven, and you've got a cookie. You can also print designs made of chocolate. The printer isn't available yet, but when it is, a spokesperson said, it will be priced at "less than $2,000." That's a costly cookie.

A baby monitor that sings lullabies

This baby monitor does everything but change diapers. D-Link's HD Pan & Tilt Wi-Fi Baby Camera can, as the name says, pan and tilt to give you a wider view of baby's room, communicating with your mobile device. It has night vision, a motion sensor, and even a heat sensor that lets you know if your child's room gets too cold or too hot. It also has two-way audio so you can not only hear what's going on, but also speak to the baby. Five pre-recorded lullabies let you soothe your little one to sleep. If you'd rather lull baby to dreamland on your own, or read Junior a bed-time story, no problem—there's a memory-card slot that lets you play your own recordings. The company website lists the price as $230.

Check out Consumer Reports' coverage of CES 2015 with our special Insiders Guide.

Light bulbs that play music and more

Smart lighting has been around for a while. But a series of LED light bulbs from Sengled do a lot more than shed light. The Pulse and Pulse Solo have wireless speakers built in. They range in price from $60 to $170. Another, called Boost, acts as a Wi-Fi repeater to boost your signal strength. It lists at $50. The newest addition to the line is the Snap, a bulb with security features such as a camera and a microphone to enable you to monitor your home remotely. Pricing and availability haven't been announced.

—Donna Tapellini

Click on the image above to find all of Consumer Reports' coverage from CES 2015.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

The high cost of higher education is a huge burden for students and their families. And at a time when more jobs in today’s economy require at least some college experience, the rising prices of college—encompassing tuition, housing, food, books, transportation, and more—are affecting more Americans.

For years, educators have praised community colleges for providing specialized training for high-demand jobs, with flexible hours to meet most people's needs. That's captured the attention of some policymakers on both sides of the political aisle who want to make community college as free and universal as high school.

President Obama recently unveiled a proposal to provide two years of community college free for eligible students, working in partnership with the states. The proposal could benefit an estimated 9 million students, and a full-time community college student could save an average of $3,800 in tuition per year.

President Obama said the proposal was directly inspired by a new program launched in Tennessee by Governor Bill Haslam. That program, called Tennessee Promise, offers two years of tuition-free community or technical college to the state’s high school graduates, beginning with the class of 2015. 

At Consumers Union, the policy and advocacy arm of Consumer Reports, we think this idea has great potential. It could go a long way toward lowering the cost of education for many Americans, opening doors for people to find greater opportunity without having to mortgage their futures.

Plus, this proposal could reduce the need for enormously expensive student loans; Americans now owe $1.2 trillion in student loan debt, a figure that's tripled in the last decade. And it would make community college a much more appealing alternative to some sketchy, for-profit education programs—the ones that aggressively promote good jobs, but only leave students with poor training, lousy job placement, and a mountain of bills.

The Tennessee program is just getting started, and the president’s proposal faces a long and winding path through Congress. There are many questions about how these programs will work—How much they will cost in the long run? What standards should community colleges be held to?—that will have to be addressed.

We think President Obama’s proposal and Tennessee Promise mark the beginning of a very important conversation about raising standards of education in America. You shouldn’t have to take on decades’ worth of debt to get the skills you need to make a living. Expanding access to community college could be a real game changer, making quality education a reality for millions of people while providing greater financial security for generations to come.

This feature is part of a regular series by Consumers Union, the policy and advocacy arm of Consumer Reports. The nonprofit organization advocates for product safety, financial reform, safer food, health reform, and other consumer issues in Washington, D.C., the states, and in the marketplace.

Read other articles in our Policy & Action series.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Researchers Estimate at Least Two Percent of All Future Cancers in the U.S. Will Stem from CT Scans Alone – That’s Approximately 29,000 Cases and 15,000 Deaths Per Year

YONKERS, NY — X-rays have been used for almost 120 years and computed tomography, or CT scans, were introduced in the 1970’s. These newer scans allow doctors to see with unprecedented precision the inner workings of the human body through the use of multiple X-ray images.  Their use has grown from fewer than 3 million per year in 1980 to more than 80 million today.

CT scans emit a powerful dose of radiation, in some cases equivalent to about 200 chest X-rays, or the amount most people would be exposed to from natural sources over seven years.  A dose like this can alter the makeup of human tissue and create free radicals, molecules that can wreak havoc on human cells.  Human bodies can often repair that damage – but not always.  When they don’t, the damage can lead to cancer that can take from five to 60 years to develop, with risk that also depends on age and lifestyle.

Scientists have struggled to quantify the dangers of medical radiation and have often relied on evidence from the atomic bomb attacks in Hiroshima and Nagasaki.  But growing research now shows that today’s medical patients are being harmed, too.

The full story, titled “Radiation Risks – Overexposed” is featured in the March 2015 issue of Consumer Reports magazine and is available at www.ConsumerReports.org. “No one says that you should avoid a CT scan or other imaging test if you really need it, and the risk posed by any single scan is very small,” says Marvin M. Lipman, M.D., Consumer Reports chief medical adviser. “But the effect of radiation is cumulative, and the more you’re exposed, the greater your cancer risk.” So it’s essential that consumers always ask doctors why they are ordering an imaging test and whether their health problem could be managed without one.

Doctors order millions of radiation-based imaging tests each year, but recent research shows that about one-third of these scans serve little if any medical purpose.  Given the greater lifetime risk of cancer that comes with increased radiation, why is there so much overuse?

• Uniformed physicians. In a study of 67 doctors and medical providers caring for patients undergoing abdominal CT scans, fewer than half knew the scans could cause cancer. In another study, only 9 percent of 45 ER physicians said they knew CT scans increased cancer risk.

• Misinformed patients. Patients aren’t aware of the danger. A new Consumer Reports survey of 1,019 U.S. adults found that less than one in six patients are told by their doctors about the radiation risks of medical imaging. Also many patients had mistaken assumptions about the risks. For example almost as many (17 percent) U.S. adults were very  concerned about magnetic resonance imaging (MRI), which doesn’t emit radiation, as were concerned about CT scans (19 percent) which do emit radiation.

• Financial incentives. Most doctors are paid by volume, so they have an incentive to order tests. And many doctors have invested in radiology equipment or clinics.  Research shows such physicians order far more CT scans and other imaging test.

• Fear of lawsuits. Almost 35 percent of imaging tests are ordered mainly as a defense against lawsuits, not because of true medical need, according to a study presented at the 2011 meeting of the American Academy of Orthopedic Surgeons.

• Patient demand. If you or your child is in pain it’s normal to want an imaging test to find out the cause. But that’s often not necessary or wise. Also, many back-pain sufferers, for example, ask their doctors for an X-ray or CT scan (and many doctors acquiesce) even though expert guidelines say such tests are only warranted if the pain lasts more than a month.

• Lack of regulation. About one-third of the people in the CR survey assumed that laws strictly limit how much radiation a person can be exposed to during a CT scan. In fact, unlike mammography, there are no federal radiation limits for any kind for CT imaging. There are also no national standards for the training or certification of technologists who operate the imaging machines. Some states allow almost anyone to work the equipment. Finally, it has been reported that about one-third of scanners currently in use will not meet the Centers for Medicare and Medicaid Services safety features standards that will commence in 2016.

Young people are particularly vulnerable to radiation. New evidence comes from a 2013 Australian study that looked at more than 680,000 people who had CT scans before the age of 20 and compared them with some 10 million people younger than 20 who did not have a CT scan.  The researchers determined that for every 10,000 young people scanned, 45 would develop cancer over the next 10 years, compared with 39 cancers among 10,000 people not screened.

Overall, people scanned had a 24 percent increased cancer risk, and each additional scan boosted risk an additional 16 percent.  Children who had one before the age of 5 faced a 35 percent spike in cancer risk. Other researchers estimate that for every 1,000 children who have an abdominal CT scan, one will develop cancer as a result, and a 2012 study that looked at almost 180,000 British children linked CT scans to higher rates of leukemia and brain cancer.

Consumer Reports offers the following advice on what consumers can do before getting any radiation-based imaging tests done:

• Ask why the test is necessary. Patients should never turn down a test if it’s really needed – but they’re often not. People should ask why the test is being done, how the result will be used, what will happen if they don’t get the test, how much radiation they will be exposed to, and whether there is a radiation-free alternative like MRI or ultrasound that could be substituted.

• Check credentials. Consumers should ask whether the facility is accredited by the American College of Radiology, whether the CT technologists are credentialed by the American Registry of Radiologic Technologists, and whether the person interpreting the scans is a board-certified radiologist or a pediatric radiologist.

• Get the right dose for your size. The smaller or thinner someone is, the lower the radiation dose that’s required. The circumference of the chest, hips, thigh, or waist can also change the dose – so check before you get scanned if the person taking the test has factored all of that into the scan.

• Ask for the lowest effective dose.  The strength of the radiation dose used during a CT scan can vary tremendously, even when done in the same institution and for the same medical purpose. Avoiding the highest of those doses could almost cut in half the number of future radiation-related cancers, according to a 2013 study in the journal JAMA Pediatrics.

• Avoid unnecessary repeat scans.  The Institute of Medicine reports that $8 billion is spent annually on repeat testing, much of it unnecessary. It often happens because doctors may prefer to get a new scan rather than look at previous ones. Consumers should let their doctor know if they had a recent imaging test.  They should keep track of their scans, jot down the date, facility, and physician in a journal – and keep a copy on CD to show a new doctor.

It’s natural to worry if your child falls and hits his head. But parents—perhaps prompted by the growing concern about concussions, especially in sports—seem to be taking those accidents more seriously. The number of emergency room visits for head injuries in children has almost doubled in the past decade, according to the national Centers for Disease Control and Prevention.

And “more and more parents arrive in the ER with the idea that their visit won’t be complete without a head CT,” says James Duncan, M.D., a radiologist at Washington University in St. Louis who had studied the overuse of CT scans. In fact, almost half of children with head injuries seen in emergency rooms now get CT scans. But about one-third of them are not needed, says the American Academy of Pediatrics.

Read more about the surprising dangers of CT scans and X-rays and check our advice on when the tests are—and aren't—really needed.

In most cases a neurological exam, in­clud­ing questions about the injury and symptoms, can determine whether your child has a minor concussion. CT scans are necessary if the doctor suspects a skull fracture, bleeding in the brain, or other serious injury, or if your child was involved in a serious accident (like a car crash, falling off a bike without a helmet, or falling down five or more stairs) or is unconscious, has tingling on one side of the body, or suffers hearing or vision loss.

Read more about when children need imaging tests for hits to the head, with advice from the American Academy of Pediatrics.

—David Schipper

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Exclusive CR survey of real estate pros reveals which upgrades can boost a home’s selling price by up to 10 percent; Plus, money-wasting mistakes sellers should avoid

YONKERS, NY ― With housing prices at recent highs, it’s a great time to sell; and still-low interest rates also makes it a good time to buy a home.  Findings from a new, exclusive survey of more than 300 licensed residential real estate agents by the Consumer Reports National Research Center point to certain factors, such as smart pre-sale fix-ups and negotiable agent fees, that can financially benefit both sellers and buyers.

Fifty-three percent of real estate pros surveyed by Consumer Reports said the kitchen is among the most important rooms of the home to have in good shape before selling. Forty-two percent also said the same about bathrooms.

“You don’t have to spend a ton of money to increase the value of your home," said Dan DiClerico, senior editor for Consumer Reports. “Some simple, inexpensive fixes throughout the house can make it more appealing to potential buyers.”

Here are some other highlights from CR’s survey:

• The pros CR surveyed said the best time to sell a home is during the second quarter of the year (April through June) with April being the single best month.

• The main reasons people are selling today are because of job relocation and downsizing.

• Sixty-four percent said all or most of their buyers did their own housing-market research online.

Money-Wasting Home-Sale Mistakes

Here are some seller slipups to avoid:

• Overpaying the commission.  All agents (unless a relative or close friend) will charge a commission based on a percentage of the sale price, and may even lead sellers to believe that the fee is inflexible.  In Consumer Reports’ survey, 63 percent of the agents admitted to negotiating their fees at least half of the time.  And despite the widely held belief that 6 percent is the standard broker’s commission, almost half of the agents surveyed typically charge four percent or less.

• Overpricing a home. This is the most costly mistake, cited by 43 percent of the agents CR surveyed.  A home priced too high will just sit on the market. Expect buyers to know what the markets like; a good agent will show sellers the sale price for at least five similar homes nearby that sold in the past two months.

The full report, “How to Make Your Home More Valuable,” can be found at ConsumerReports.org and in the March 2015 issue of Consumer Reports magazine.  It also features five top ways to increase a home’s value, appliance upgrade recommendations, Ratings of toilets and interior paints, tips for making a home shine online, real estate agent secrets, and more.

Consumer Reports is the world’s largest independent product-testing organization. Using its more than 50 labs, auto test center, and survey research center, the nonprofit rates thousands of products and services annually. Founded in 1936, Consumer Reports has over 8 million subscribers to its magazine, website and other publications.  Its advocacy division, Consumers Union, works for health reform, food and product safety, financial reform, and other consumer issues in Washington, D.C., the states, and in the marketplace. 

Not all companies explicitly prohibit password sharing outside the household

YONKERS, NY ― Streaming media services are quite popular: 51 percent of American households say they subscribe to Amazon Prime Instant Video, HBO Go, Hulu Plus, Netflix, and/or WatchESPN, according to a December 2014 survey by the Consumer Reports National Research Center. However, the reach of streaming video services extends beyond that, as 46 percent of account holders admitted to sharing their log-in credentials with someone outside their home.

Netflix subscribers were the most charitable, with 46 percent admitting they shared their password. Hulu Plus was next with 37 percent, followed by Amazon Prime with 29 percent. The sample sizes for HBO Go and WatchESPN were too small to report percentages.

Consumer Reports investigated and found that it’s unclear whether people who widely share log-in credentials are breaking criminal laws, at least outside of Tennessee, which outlawed the practice in 2011. Some violations of online terms of service could potentially violate federal criminal laws. But the language in those agreements can be ambiguous, CR found.

“What’s interesting about the widespread sharing of streaming account passwords is how seemingly unconcerned the companies are about it – for now," said Glenn Derene, Electronics Editor for Consumer Reports.

Most streaming services let multiple household members watch programs on their own devices, whether they are home or on the road. Consumer Reports has the following rules of thumb:

• Definitely OK. Sharing your log-in credentials with family members living at home. Accessing your content on multiple devices.

• Probably fine.  Sharing log-in credentials with your kids living at college or on their own.

• To be avoided.  Broadly sharing credentials with acquaintances. For your own digital privacy, don’t use the same password for your streaming account that you use for e-mail, Wi-Fi, or other services.

Assuming streaming providers eventually decide to crack down on password sharing, it will be easy for them to do. HBO, for example, allows up to three concurrent content streams; engineers could throttle that back. Or they could force users to register a limited number of devices for use with their streaming service.

The full report can be found online at ConsumerReports.org, and in the March 2015 issue of Consumer Reports magazine.

Consumer Reports is the world’s largest independent product-testing organization. Using its more than 50 labs, auto test center, and survey research center, the nonprofit rates thousands of products and services annually. Founded in 1936, Consumer Reports has over 8 million subscribers to its magazine, website and other publications.  Its advocacy division, Consumers Union, works for health reform, food and product safety, financial reform, and other consumer issues in Washington, D.C., the states, and in the marketplace.

As more Americans move from traditional cigarettes to electronic cigarettes, poison-control centers are reporting an increase in calls about people sickened by the liquid nicotine used in e-cigarettes. Most of the poisoning reports involve kids.

The liquid nicotine used for vaping—users don’t smoke an e-cigarette, they “vape”—often comes in easy-to-open, brightly colored containers. And it might have a flavor that sounds more like candy than nicotine. We’ve seen such names as Peppermint Patty, Snickerdoodle, Bubble Gum, and Caramel Surprise among the thousands of flavors available.

It's not a stretch to see how these bottles would be appealing to children. What’s so alarming is that kids who come into contact with just a small amount of liquid nicotine can get terribly ill, suffering nausea and vomiting so bad they have to be rushed to the ER.

In fact, a single teaspoon of liquid nicotine is enough to kill a young child, according to the American Association of Poison Control Centers. That’s reportedly what happened last month in Fort Plain, New York, where police said a 1-year-old boy died after he swallowed liquid nicotine.

Check Consumer Reports' guide to e-cigarettes.

Yet despite the obvious dangers, there are no standards that require child-resistant packaging for these products. That’s why Consumers Union, the policy and advocacy arm of Consumer Reports, is lobbying Congress to put safeguards in place.

Senator Bill Nelson (D-Fla.) has introduced a bill called the Child Nicotine Poisoning Prevention Act of 2015. It would direct the Consumer Product Safety Commission to issue rules requiring safer, child-resistant packaging for any liquid nicotine sold to consumers.

Consumers Union, the American Academy of Pediatrics, and a long list of other public-interest and medical groups endorse this bipartisan bill. This legislation is one example of an ongoing effort to address the safety of e-cigarettes. Only e-cigarettes that are marketed for therapeutic purposes are currently regulated by the Food and Drug Administration, but the FDA is working on a rule that would give it greater authority over the products.

The rising number of calls to poison-control centers makes it clear that liquid nicotine packaging must be safer. Consumers Union will keep pushing lawmakers to take up Senator Nelson's legislation and approve it as quickly as possible to help keep our kids safe.

This feature is part of a regular series by Consumers Union, the policy and advocacy arm of Consumer Reports. The nonprofit organization advocates for product safety, financial reform, safer food, health reform, and other consumer issues in Washington, D.C., the states, and in the marketplace.

Read other articles in our Policy & Action series.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

A recent study shows that that most parents are still moving their children to a forward-facing car seat sooner than they should.

The parent survey, published in the journal Academic Pediatrics, was conducted in 2013—two years after the American Academy of Pediatrics recommended that parents keep children riding rear-facing in their car seats until the age of two. The main finding of the study was that despite the changing guidance on when to change how a child is situated, the most common age range when parents switched from rear facing to forward facing remained at 13 to 15 months.

On the positive side, researchers did find a 7 percent increase in parents waiting to move their child forward facing until they were 2. Another positive, the survey revealed that shift accompanied a corresponding 9 percent decrease in forward-facing use for the more vulnerable age group of less than 1 year old. No car seat allows a child weighing less than 20 lbs. and less than 1 year old to use a car seat in a forward-facing orientation.

The data didn’t surprise us. As many parents know, the rear-facing recommendation can be tough to stick with. But the reader comments that accompanied some of the related media coverage nont only gave an indication of just how challenging parents were finding this recommendation to implement but also were cause for concern.

In reading the particular reasons why parents were struggling to keep their kids rear-facing or why they had chosen to move to forward-facing earlier than we’d hoped, we realized that for at least some of those we had some insight or suggestions that may help. But we also know that every child and circumstance is different and that perhaps there are ideas, tips, or tricks that others have that may help to keep others to keep their kids as safe as they can. Based on the extensive research data we see and the number of crash tests we do, we know that rear-facing is simply the safest way for your child to ride.

See our car seat ratings and buying advice.

How to keep your kid safe

Understand why you’re doing it. Consider a head-on crash for a child in a rear-facing seat compared with a child in a forward-facing seat. When rear-facing, the plastic shell keeps the head, neck, and spine in alignment while allowing the child restraint shell, along with special padding and foam, to absorb the energy from the crash. Crash forces will be spread over larger areas of the body than they would be if seated forward-facing. Further, the head remains within the protective shell of the seat, helping to prevent the head from directly impacting the interior of the vehicle. When forward-facing, the child’s body is held back by straps while muscles, ligaments and tendons strain to control the head while stretching the spinal cord. All that fancy padding and foam you paid for is just along for the ride. The head is free to move forward out of the shell and make contact with whatever is ahead of it. There is no trend of broken legs or hips associated with children rear-facing in crashes, even so, the grim reality is that broken legs can be fixed, a damaged spinal cord or brain injury can not.

Don’t let the car seat define your timetable. Your child will most likely outgrow a rear-facing infant seat well before they are old enough to be turned forward. At that point when you’re replacing your child’s first seat with a brand new one, it seems logical for many to also make the forward-facing swap at that same time. But as we’ve said in our Real Child Seat Timeline, this is when you’ll actually be moving to a rear-facing convertible seat to make that homestretch to age two. That same seat will then spin around to become your forward-facing seat when its time.

Choose that convertible seat to fit your car. We have already established that in order to for your child to stay rear-facing until age two, you’re going to need a convertible car seat. Many of the comments we read, particularly from those parents with small cars, indicated that the infant seat was already taking up so much interior space that using a larger rear-facing convertible seat just wasn’t happening. Rear-facing convertibles most often do take up more room in the rear seat, but a couple of features may help. Unlike smaller infants that need a more reclined position to maintain proper breathing, a toddler in a convertible seat can sit a bit more upright.

You can’t go against manufacturer’s instructions for installation, but many times installing a convertible seat at the more upright end of the seat’s allowable recline range can gain you valuable inches. Look for a seat with a rear-facing recline indicator that has more than one zone or a range (rather than a single position) for installation.

You might also try installing your rear-facing convertible in the center rear seat. Sometimes installing in that position allows you to get just a bit more room between the car seat and the front seatbacks. Admittedly getting your child into the seat when it’s here is a bit more of a struggle, but if it gives you a couple of more months it may be worth it. And besides, the center seat is the safest position in the car.

They’re comfortable, really. Many parents objected to the appearance of their rear-facing child’s legs bent against the vehicle seatback as they got taller. That sentiment led to some formal comfort studies conducted by The Ohio State University on kids between the ages of 22 and 26 months where certain comfort indicators, as well as a parent’s knowledge of each child’s comfort level, provided insight into whether or not kids were comfortable when positioned rear-facing.

That research indicates that there is no comfort improvement for forward-facing kids versus rear-facing. Even though their legs appear to be in a position that would be very uncomfortable for most adults, they are just "bendy" enough that comfort is not the issue. Contrary to popular belief, analysis of the data on child injury also shows that there are actually more injuries to children’s lower extremities (legs) in forward-facing seats than in rear-facing seats since the legs are free to impact what’s ahead of them.

However . . .

Even with every parent’s best efforts to do the right thing and keep their child rear-facing as long as they can, many of the comments we saw from parents simply indicated that their children were so much happier forward-facing that they felt compelled to turn them. The happier child allowed for happier travel for the entire family and as others noted was key to allowing them to remain an attentive driver.

Only you know your child and your own situation. Some tips we have learned that might help include not referring to a forward-facing as being for a "a big kid" and thus recognized as a right of passage, and to never let a child ride forward-facing and then try and turn them back to a rear-facing position—they might not miss what they haven’t experienced.

We are looking for your help!

For those of you that have been successful at keeping your kids rear-facing up until age two, are there any ideas, tips or tricks that you could share with us and others that made keeping your child rear-facing easier? We’d love any insight you can provide! Share your thoughts at facebook.com/consumerreports.

—Jennifer Stockburger

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Every year 48 million Americans get sick from foodborne disease. That leads to 128,000 hospital visits and 3,000 deaths, according to the Centers for Disease Control and Prevention.

Food safety is a critical public-health issue, and the federal government has a big responsibility to help ensure the food we buy and feed our families is safe. Right now, food-safety oversight is divided among 15 different agencies administering some 30 laws, according to the Government Accountability Office.

For instance, beef and chicken safety falls under the U.S. Department of Agriculture, while eggs, milk, and many other foods are covered by the Food and Drug Administration. This fragmented, outdated system makes planning, coordination, and supervision difficult.

We can do better. We ought to have one independent agency focused on the safety of our entire food supply. There’s a bill in Congress that aims to do just that.

Called the Safe Food Act, it would consolidate food-safety authorities— inspections, enforcement, labeling, research—into a single agency.

Visit the Consumer Reports Food Safety & Sustainability Guide to learn about our work on arsenic in rice, gluten-free diets, GMOs, mechanically tenderized beef, and much more.

The agency created by the Safe Food Act would be entirely focused on safety, rather than being just one part of a large federal department with a wide range of missions. And it would be led by one administrator who would be accountable for food-safety programs—rather than this responsibility being split among several people.

Under the bill, the agency would be able to require the recall of all unsafe food, improve the inspections of food imported from other countries, and require full food traceability so we can better identify the sources of contamination outbreaks.

The bill is sponsored by Senator Richard Durbin (D-Ill.) and Representative Rosa DeLauro (D-Conn.), who have championed this idea for years.

Consumers Union, the policy and advocacy arm of Consumer Reports, supports this legislation to enhance food safety. Four years ago, Congress passed a landmark law to overhaul food-safety laws that dated to the Depression. Now we need a single agency that can take a uniform approach to ensuring our food is safe and concentrate resources on the greatest risks. We applaud the lawmakers for introducing the Safe Food Act, and we urge Congress to approve it.

This feature is part of a regular series by Consumers Union, the policy and advocacy arm of Consumer Reports. The nonprofit organization advocates for product safety, financial reform, safer food, health reform, and other consumer issues in Washington, D.C., the states, and in the marketplace.

Read other articles in our Policy & Action series.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.

Pregnant women put a lot of trust in their doctors and hospitals. But a Consumer Reports investigation of more than 1,500 hospitals in 22 states suggests that such trust may be misplaced. It found that in many hospitals, far too many babies enter this world through cesarean section.

While some C-sections are absolutely necessary for the health of the mother or baby, the high C-section rates in our low-scoring hospitals are “unsupportable by professional guidelines and studies of birth outcomes,” said Elliot Main, M.D., director of the California Maternal Quality Care Collaborative and former chairman of the department of obstetrics and gynecology at the California Pacific Medical Center in San Francisco, who reviewed our data.

Our Ratings reveal that C-section rates vary dramatically—even between neighboring hospitals. For example, almost 55 percent of pregnant women anticipating low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned—nonetheless undergo a C-section at Los Angeles Community Hospital. But at California Hospital Medical Center, also in Los Angeles, the rate of C-sections for low-risk deliveries is 15 percent; at Western Medical Center Anaheim, 28 miles away, it’s about 11 percent.

Or consider El Paso, Texas. At Sierra Medical Center, 37 percent of low-risk deliveries are C-sections; four miles away at University Medical Center of El Paso the rate is about 15 percent. It’s a similar story in Colorado. Denver Health Medical Center earned a top score with a C-section rate of about 8 percent, while nearby Presbyterian-St. Luke’s Medical Center got low marks for a rate of about 20 percent.

We found this startling scenario playing out over and over in communities large and small across the U.S. Because a hospital’s C-section rate can be hard to find, it’s likely that most families are unaware of the huge differences in medical practice.

And unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one. Overall, 66 percent of the hospitals in our Ratings earned our lowest or second-lowest score, while only 12 percent got either of our top two marks.

“We think it’s time those hidden numbers are brought to light,” said John Santa, M.D., medical director of Consumer Reports Health. “How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.”

Change is already afoot. Evidence on the fallout from too many C-sections has grown so alarming that numerous health organizations have made lowering rates a priority. In March 2014, two major women’s health organizations—the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM)—teamed to publish groundbreaking new practice guidelines aimed at preventing unnecessary cesarean births.

But hospitals can be bureaucratic institutions where the wheels of change move slowly. We’ll look at why C-sections remain so overused. And our Ratings—the most comprehensive ever on C-sections for individual U.S. hospitals—can help families choose the right place to deliver their baby.

We have rated more than 1,500 hospitals in 22 states on their C-section rates for low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned. Those states are: Arizona, California, Colorado, Florida, Iowa, Illinois, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New York, Nevada, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin. Click on the state you are interested, then sort by "Avoiding C-section." To see a hospital's specific C-section rate, click on its name, then scroll down the page until you see the heading "Avoiding C-sections." You can also download a PDF of the Avoiding C-section Ratings for all 22 states. 

Melek Speros of Austin, Texas, says her doctor warned her late in her first pregnancy that her pelvis might be too small to allow for a vaginal delivery. "I was really surprised because I'm 5'8" tall with a large frame," Speros said. Reluctantly, her doctor agreed to allow her to “try” a vaginal birth by inducing labor eight days before her due date at St. David’s South Austin Medical Center (which earned low marks in our Ratings.) When the induction didn’t quickly work, he recommended a C-section. "He said that a vaginal birth would be unsafe, that my baby could get stuck and suffer serious harm," Speros said.

She took him at his word, and delivered her first son by C-section as well as her second son two years later. That’s no surprise: Mothers who deliver a first baby by C-section are about 90 percent more likely to deliver subsequent babies that way, too. But with her third, in what she describes as "the culmination of my hopes and dreams about giving birth," Speros vaginally delivered a healthy 9-pound boy.

Speros’ experience—feeling pressured into a C-section without being informed about her birthing options—prompted her to change career plans, switching from lawyer to childbirth educator. And indeed getting reliable information about how hospitals approach childbirth can be  difficult. For example, while hospitals often target expectant mothers with ads featuring cherubic infants and cozy birthing rooms, they seldom publicize their rates for surgical deliveries.

There are times when a surgical birth is the safest option. For example, C-sections can be lifesaving when the outlet from the womb is blocked by the placenta (a condition called placenta previa) or the baby isn’t properly positioned for birth by, for example, lying sideways in the uterus instead of head down. And with modern obstetrical care, C-sections are quite safe.

But a C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks.

“C-sections increase the risk of mortality and complications,” says Kent Heyborne, M.D., chief of obstetrics at Denver Health Medical Center, which had the lowest C-section rate of any hospital in our Ratings with at least 5,000 low-risk deliveries over the two-year period included in our analysis. “But we’re just now becoming aware of the down stream effects.”

Carol Sakala, Ph.D., director of Childbirth Connection programs at the National Partnership for Women & Families, agrees. “Unless there is a definitive need for a C-section, vaginal birth has major benefits for moms and babies, both in the short term and throughout the course of their lives,” she said.

To begin with, although having a C-section may sound like a shortcut, it’s not. Speros says that although her C-sections went smoothly, it still took much longer to recover from them than it did from the vaginal birth of her third son.

And like others who've had abdominal surgery, she has lingering numbness at the site of the incision. Nineteen percent of women who’ve had a C-section report pain at the incision site being a major problem in the two months following delivery. That’s according to Listening to Mothers III, a national survey conducted by Harris Interactive for the Childbirth Connection of 2,400 mothers who gave birth to single babies in a hospital from July 2011 through June 2012. That compares with 11 percent of women who gave birth vaginally who cited a painful perineum (the area between the vagina and anus) as a major problem. And women with C-sections were more likely to say that the pain lasted six months or longer, too.

Life-threatening complications are rare whether babies are born vaginally or by C-section. But compared with women giving birth vaginally, healthy, low-risk women undergoing their first C-section were three times more likely to suffer serious complications—such as severe bleeding, blood clots, heart attack, kidney failure, and major infections—according to a 14-year analysis of more than 2 million women in Canada published in 2007 and cited by the new ACOG/SMFM guidelines.

And the risk of complications increases with each subsequent cesarean delivery. “Once you’ve had a C-section, there’s a big chance that all future births will also be by cesarean," Main said. "And that’s when the risks really start to rise.”

Vaginal delivery for uncomplicated births is also better for babies. They are less likely to suffer breathing problems and more likely to be breastfed, perhaps because it’s easier to get breastfeeding going when mothers are not recovering from major surgery. Some research suggests that over the long-term, babies born vaginally may be slightly less prone to chronic ailments such as asthma, allergies, or obesity, perhaps due in part to a protective effect from beneficial bacteria transferred from the mother during birth.

The number of C-sections performed in the U.S. has leveled off in the last few years, but is still up 500 percent since 1970. All those C-sections have not translated into substantially better outcomes for mothers and babies. The infant death rate in the U.S., while low, is higher than that of most other industrialized nations. And the maternal death rate actually increased slightly from 1990 to 2013, according to an analysis published May 2, 2014, online in The Lancet medical journal.

In part those grim statistics reflect the fact that American women today tend to be older and heavier going into pregnancy. But experts say that the main problem is a health care system that no longer values normal birth and focuses on scheduling labor, in part for patient and doctor convenience.

In the U.S. far fewer babies are born on holidays such as the Fourth of July or days around Thanksgiving or Christmas, we found when we examined three year's worth of data on births compiled for us by the Centers for Disease Control and Prevention. That could be because hospitals tend to schedule C-sections for times when they are well staffed—or because doctors, and even some mothers, may not want deliveries to interrupt their holidays.

That level of control requires increased use of interventions such as inducing, or starting, labor before a woman’s due date, which might increase the risk of cesarean delivery, or just scheduling a C-section from the start.

Another major problem is that many doctors intervene because they think that labor is moving too slowly and that longer labors lead to complications. But those assumptions are based on outdated information, says Aaron Caughey, M.D., Ph.D., chair of the department of obstetrics and gynecology and associate dean for women’s health research and policy at Oregon Health and Science University in Portland, Ore., and lead author on the new ACOG/SMFM guidelines.

The new guidelines help clear up when providers should act and when they have to be patient and let nature take its course. The absence of solid, up-to-date guidelines might have allowed other factors, including concerns about malpractice suits, to drive up the number of C-sections, Caughey says.

In addition, hospitals keeping watch on their financial bottom lines may turn a blind eye to high C-section rates. Medicaid and private health insurance pay about 50 percent more for C-sections than for vaginal births. Halving the total number of C-sections performed in the U.S. would save about $5 billion yearly, according to the Center for Healthcare Quality & Payment Reform, which advocates for higher-quality, lower-cost health care.

Our Ratings are based on the C-section rates for mothers who anticipate low-risk deliveries—that is, for women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned. While complications such as problems with the baby’s heartbeat could happen during labor and require intervening surgically, experts say that the vast majority of women in that low-risk category should be able to have a vaginal birth.

The average C-section rate for low-risk deliveries among the hospitals we looked at was about 18 percent—much higher than the national average of 12.6 percent in 2000, a benchmark we used to develop our Ratings. (Note that the average total C-section rate, which includes all cesarean deliveries not just low-risk ones, is 33 percent.)

And some hospitals performed much better—or worse—than average. C-section rates ranged from less than 5 percent at Saint Croix Regional Medical Center in Saint Croix Falls, Wis., to a high of almost 57 percent at Three Rivers Medical Center in Louisa, Ky.

So why do some hospitals have higher rates than others?

Unfortunately, we found no simple answers. Prospect Medical Holdings, the company that owns Los Angeles Community Hospital, says it treats “a significantly higher percentage of low-income and transient patients, many of whom have had little or no prenatal or primary care prior to delivery.” Those women may be at higher risk because of gestational diabetes or high blood pressure, a representative told us.

Our analysis did find slightly higher rates at hospitals in large urban areas compared with hospitals in smaller cities, perhaps because they see more women with risk factors not accounted for in our data or they have a larger proportion of first-time moms. But many similar hospitals serving similar populations manage to keep C-section rates low. For example, Saint Anthony Hospital in Chicago treats many low-income patients but still earned a high Rating, with a C-section rate of 9 percent of babies.

Our Ratings also confirm findings from other research showing significant regional differences. The lowest rates were in mountain states, the West coast, and the upper Midwest. For-profit hospitals also tended to have higher C-section rates.

But none of those factors come close to explaining the wide variation we found, the experts we consulted say.

Too often the medical establishment blames mothers. “They must be older, fatter, sicker, or they must be requesting C-sections,” Main said. “But that’s completely bogus. As a doctor I can convince almost any woman in labor to have a C-section.” Even after you account for things such as mothers’ age and weight, according to Main, you are still left with huge discrepancies of care.

Almost two-thirds of women in the Listening to Mothers survey who had their first C-section said their doctor was the decision maker, and more than one-quarter said they felt pressured to have the surgery.

“What it boils down to is culture,” Main said. “Culture of the hospital, the nursing staff, even the patients.” He points out that hospitals with a culture of facilitating vaginal birth—those that allow vaginal birth after cesarean, for example, or those where 10 percent or more of births are attended by nurse midwives—have far lower rates of C-sections.

A culture such as the one you find at Denver Health Medical Center, where Heyborne works. Lots of places say they have an “institutional philosophy” against too many C-sections, says Heyborne, but, “It's how we’ve translated that into action that makes a difference.” He says that as a teaching hospital, Denver Health is fully staffed with health care providers 24/7. “A lot of C-sections are done at 5 or 6 in the evening," Heyborne said. "We don’t have those pressures here. No one is trying to get home to dinner or the golf course.”

In addition he says that the hospital has firm policies against using interventions that might lead to cesareans, such as inducing labor without a medical reason. And Heyborne credits an active midwifery service. “About one-third of our births are managed by midwives and that helps keep the emphasis on natural birth processes.”

The Ratings are based on the C-section rates for mothers who anticipate a low-risk delivery—that is, women who haven’t had a C-section before, don’t deliver prematurely, ​and are pregnant with a single baby who is the proper position for delivery. The Ratings include all mothers, not just first-time mothers. ​The data the Ratings are based on do not include information on factors that may increase the risk for a C-section, such as heart problems in the mother or fetus, pregnancy-related high blood pressure, diabetes, obesity, or any other chronic disease.

The data come from the 22 states that had data available for us to analyze: Arizona, California, Colorado, Florida, Iowa, Illinois, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New York, Nevada, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin. 

It covers births during a two-year period between 2009 and 2012, depending on the state. We include hospitals with a minimum of 100 low-risk deliveries over that two-year period. 

For more details, read more on how we rate hospitals and our technical report on hospital Ratings.

Hospitals with high or low C-section rates

The table below shows the 10 hospitals in our Ratings with the lowest C-section rates that had at least 5,000 low-risk deliveries over two years.

The table below shows the 10 hospitals in our Ratings with the highest C-section rates that at least 5,000 low-risk deliveries over two years.  

To lower your risk of a C-section, take the following steps.

• Find out your hospital’s C-section rate. Start with our hospital Ratings. If your hospital is not included, ask the person who will deliver your baby about the hospital’s rates. Remember: lower is usually better. The average national C-section rate for low-risk deliveries, the measure used in our Ratings, is about 18 percent, a rate we consider too high. A more reasonable figure is 12.6 percent, the national average in 2000 and a benchmark we used to develop our Ratings. (Note that the average total C-section rate, which includes all cesarean deliveries not just low-risk ones, is 33 percent.)

• Choose your provider carefully. It’s good to know the C-section rates for your doctor, too, so ask whether his or her practice tracks their C-sections. “Even if they don’t know the exact percent, providers should be able to articulate their philosophy about supporting vaginal birth,” Caughey said. Also ask how the new ACOG/SMFM guidelines may affect the practice’s approach to labor and delivery. If your provider is unaware of the new standards, or is dismissive of them, you may want to find a different one.

• Watch your weight. If you are overweight, strive to shed excess pounds before becoming pregnant. Overweight and obese women have a much higher risk of C-section than normal weight women. And once you’re pregnant, talk with your provider about the healthy weight gain for you. Women who are overweight should plan to gain less than those who are not.

• Stay fit. Women who take part in structured exercise during pregnancy are less likely to need a C-section, research suggests. Talk to your health care provider about appropriate forms of exercise, such as walking, swimming, and aerobic or yoga classes for pregnant women.

• Don’t rush things. Doctors should not try to induce labor unless there’s a good medical reason—for example, if a woman’s membranes rupture (her “water breaks”) and labor doesn’t start on its own or she is two weeks overdue. Trying to induce labor before a woman’s body is ready can lead to surgical delivery if labor doesn’t progress.

• Don’t worry too much about big babies. The possibility of a large baby is frequently used to justify a cesarean delivery, but that’s not warranted, according to the new ACOG/SMFM guidelines. To begin with, methods used to assess the baby’s weight toward the end of the pregnancy are not very accurate. Also, babies typically have to be 11 pounds or larger to justify a C-section, according to Caughey.

• Get support during labor. Consider hiring a doula, a trained birth assistant who can provide physical and emotional support throughout labor and delivery. Women who have continuous support from someone who is not a friend, family member, or a member of the hospital staff labor for shorter periods and are less likely to need interventions, research shows. Ask your insurer if it will cover doula care.

• Ignore the clock. The new ACOG/SMFM guidelines call for allowing more time in each phase of labor and delivery. In general, decisions on whether to intervene should be based on how well mothers and babies are doing, not how much time has passed.

For additional steps you can take before and during pregnancy to help ensure the best possible outcomes, see our report "What to Reject When You’re Expecting."

And see these additional resources

American College of Obstetricians and Gynecologists Patient Resources

American College of Nurse Midwives Patient Resources

Childbirth Connection

March of Dimes Pregnancy

March of Dimes Nacer Sano

Office of Women's Health Pregnancy Resources

Sometimes a planned C-section is the safest option for you and your baby. And even if you’ve planned for a vaginal birth, complications may arise that necessitate a surgical delivery. All expectant families should discuss cesarean deliveries with their provider so that they understand what’s involved and are not caught off guard. The following steps can help ensure a safe, satisfying birth experience for you and your family.

• Be wary of early C-sections. Babies’ delivered before 39 weeks are more apt to have breathing problems or other issues. C-sections should not be scheduled before that point unless there’s a valid medical reason.

• Discuss your preferences. Ask if a birthing partner can be with you in the surgery room and recovery area. When will you be able to hold and breastfeed your baby? Skin-to-skin contact between moms and babies right after delivery facilitates bonding and breastfeeding.

• Ask for antibiotics at the time of surgery. That reduces the risk of infection. You don’t need them afterward unless you develop an infection.

• Ask that your uterus be closed with two layers of stitching. If you decide to have another baby vaginally, so called double-layering stitching will hold more securely during labor and delivery.

• Request measures to prevent blood clots. That might include wearing inflatable devices on your legs until you can walk on your own or taking a prescription blood thinner. Ask the nursing staff to help you get up and move around as soon as you are able to do so.

• Ask for help breastfeeding. Getting started breastfeeding as you recover poses extra challenges. A lactation consultant can provide invaluable support and advice.

• Marshal support. Plan to have extra support at home so you can focus on recovering and getting to know your new baby.

We have rated more than 1,500 hospitals in 22 states on their C-section rates for low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned. Those states are: Arizona, California, Colorado, Florida, Iowa, Illinois, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New York, Nevada, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin. Click on the state you are interested, then sort by "Avoiding C-section." To see a hospital's specific C-section rate, click on its name then scroll down the page until you see the heading "Avoiding C-sections." You can also download a PDF of the Avoiding C-section Ratings for all 22 states.

Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.