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  1. Gams, Becky MS, APRN, WHNP-BC
  2. Neerland, Carrie PhD, CNM, FACNM
  3. Kennedy, Sheila DNP, APRN, CNM


Primary cesarean birth increases a woman's risk for hemorrhage, infection, pain, and cesarean births with subsequent pregnancies. A woman may experience difficulties with breastfeeding, bonding, and incorporating the newborn into the family structure. One urban, academic hospital in the Midwest participated in the American College of Nurse-Midwives Healthy Birth Initiative: Reducing Primary Cesarean Births Project. The project purpose was to reduce the rate of cesarean births in nulliparous, term, singleton, and vertex pregnancies. Strategies employed included use of intermittent auscultation, upright labor positioning, early labor lounge, one-to-one labor support, and team huddles. The baseline nulliparous, term, singleton, vertex cesarean rate in 2015 was 29.3%. In 2016, after 1 year of implementation of the project, the hospital decreased nulliparous, term, singleton, vertex cesarean rate to 26.1%-a reduction of 10%. In 2017, the rate was decreased to 25.3%-a reduction by 3.7%.