Hospitals can significantly reduce cesarean birth rates through targeted quality improvement initiatives, according to new guidance from the American College of Obstetricians and Gynecologists. States including California, Maryland, and Iowa have demonstrated substantial success by implementing standardized labor management protocols and clinician education programs.
Key solutions include fostering a transparent safety culture that emphasizes continuous improvement and engages entire health care teams. Successful units develop champions who advocate for positive change and ensure patient voices are included throughout quality improvement projects. Patient safety bundles, checklists, and care pathways help minimize unnecessary variation and promote health equity.
Clinical strategies focus on addressing known drivers of cesarean births. These include establishing standardized definitions for labor arrest, implementing structured communication practices like patient-centered huddles to manage indeterminate fetal heart rate tracings, and providing training in fetal positioning maneuvers. Evidence-based interventions such as continuous labor support, pain management options, and allowing greater movement during labor can prevent unnecessary cesarean deliveries.
Data collection proves essential for improvement. Hospitals should calculate cesarean birth rates disaggregated by race, ethnicity, and other demographic factors to identify disparities. Black women currently experience higher cesarean rates due to systemic inequities rather than clinical differences, underscoring the need for targeted interventions.
Optimizing practice environments through adequate staffing, equipment access, and training creates conditions that support vaginal births. Engaging patients through informed decision making and discussing birth preferences during prenatal care ensures respectful, patient-centered care that aligns with evidence-based practices.
See: “Quality-Improvement Strategies for Safe Reduction of Primary Cesarean Birth” (May 2025)
