C-section reduction

Reducing C-sections among low-risk, first-birth mothers

Across the U.S., birthing hospitals face growing pressure to reduce unnecessary cesarean births. Because a C-section is a major surgical intervention—with risks of bleeding, infection, longer recovery, and implications for future pregnancies—health systems and clinicians are working to ensure that low-risk pregnancies are given optimal support for safe vaginal delivery.

Trends in U.S. C-section Rates

• Historically, the U.S. experienced a rapid rise in cesarean births: from 1996 through 2009, the overall rate increased by about 60 percent, reaching roughly 32.8 percent in 2010–2012.

• More recently, the national C-section share has remained in the low 30s. In 2023, the cesarean delivery rate rose 1 percent to 32.3 percent of all births.

• For 2024, provisional reporting indicates the rate climbed to 32.4 percent.

However, when focusing on low-risk, first-birth mothers (i.e. nulliparous, singleton, term, vertex — often referred to as the NTSV or “low-risk first birth” cohort), the rates tell a more critical story:

• From 2022 to 2023, the low-risk (NTSV) cesarean rate increased from about 26.3 percent to 26.6 percent — the highest level seen since around 2013.

• That 26.6 percent figure remained unchanged from 2023 into 2024, per CDC’s Vital Statistics Rapid Release.

• Notably, that rate of ~26.6 percent is well above the national Healthy People 2030 target of 23.6 percent for low-risk first births.

Scholarly and oversight groups also sound alarm:

• The 2025 Leapfrog report highlights that after a promising decline in NTSV rates through 2019, the trend has reversed, with upward pressure since 2020.

• A JAMA Health Forum analysis noted that more first-time mothers are undergoing C-sections, partly driving the increase in overall cesarean rates.

In short: the overall C-section rate in the U.S. continues to hover near one in three births, and the proportion of low-risk, first-time mothers having C-sections has climbed above 26 percent — exceeding aspirational national goals.

Progressive efforts to improve C-section rates

Healthy People 2030 set a national target for low-risk, first-birth c-section deliveries at 23.6%, and many states are making great headway. California, for instance, has reached a statewide average of 25.2% for low-risk, first-time births.

The concern around C-sections has reached a broad, national audience as mainstream media outlets have begun to report individual hospital C-section data. Families can now compare maternal care data online and make informed decisions about where they would like to deliver.

In a study from the American Journal of Obstetrics and Gynecology, researchers found that the likelihood of a C-section can depend highly on the hospital in which the woman gives birth.

Both large-scale and smaller community hospitals have become hyper-aware of their C-section rates and are beginning to monitor rates for OB/GYNs and OB nurses individually to ensure compliance and safety.

How OB hospitalists can support hospitals in reducing C-section rates

OB hospitalists—physicians dedicated to hospital-based obstetric care (not in private practice)—are uniquely positioned to help bend the curve downward. Some of the ways they can influence better outcomes include:

1. Continuous labor support and oversight
   Because hospitalists are on site 24/7, they can monitor labor progress more closely and intervene early when labor stalls or becomes protracted, reducing “convenience” C-section decisions.

2. Support with communication and patient education
   Hospitalists can partner more directly with patients and families during labor, helping to calm fears, explain progress, and maintain transparency about when cesarean is or is not indicated.

3. Protocol and threshold review
   Hospitalists may participate in or lead efforts to refine admission, induction, and labor-management protocols to avoid premature C-section calls (e.g. premature diagnosis of “failed labor”).

4. Consultation support to other providers
   They can back up private OB/GYNs, midwives, and family physicians by lending obstetric expertise in tricky situations—providing a “second glance” to avoid overly defensive decisions.

5. Fetal monitoring interpretation
   Their constant presence in the labor unit often makes them more practiced in interpreting fetal heart tracing subtleties, distinguishing those tracings warranting intervention from those manageable by conservative measures.

6. Optimizing decision-to-delivery intervals
   ACOG guidelines suggest decision-to-delivery intervals for emergency cesareans ideally be under 30 minutes. On-site hospitalists facilitate rapid mobilization in emergencies, supporting both safety and trust in nonemergent pathways.

Evidence of Impact & Success Stories

One OBHG hospital partner provides a compelling example. Through collaboration with hospital leadership, private physicians, and their hospitalist team, they reduced their C-section rate from about 40 percent to 20 percent over a three-month period. Key contributing factors included:

• Transparent reporting of C-section rates by OB/GYN and nursing staff

• Empowering nurses to advocate for patients during labor

• Weekly interdisciplinary case reviews focusing on recent C-sections

This experience reaffirms the potential for relatively modest changes in process and culture to “move the needle” significantly.

Conclusion & Invitation to Collaborate

The data are clear: while U.S. cesarean rates remain elevated, the rising rate of low-risk, first-birth C-sections is especially concerning. The current ~26.6 percent NTSV rate is well above national targets and signals room for improvement.

OB hospitalists can be powerful catalysts in helping hospitals manage labor with more vigilance, better protocols, and enhanced teamwork. Hospitals that partner with hospitalist services often see improvements in patient safety, clinician support, and C-section reduction.

If your hospital is seeking to reduce cesarean overuse and improve maternal outcomes, we’d be happy to explore how an OB hospitalist partnership might support your goals. Reach out, and we can share data, models, and success stories tailored to your context.

Learn how our partnerships work and reach out to speak with us today regarding what a hospital partnership could provide your team.