Hospitals Cut C-Section Rates with Innovative Strategies

When Dr. Elizabeth Bostock assumed leadership of the obstetrics department at Rochester General Hospital in New York in 2019, she encountered a significant challenge: nearly 40 percent of healthy, first-time mothers were undergoing cesarean deliveries. This statistic starkly exceeded the federal government’s recommendation of 24 percent for such births. While cesarean sections can be crucial in emergencies, their overuse can lead to prolonged recovery times, complex future pregnancies, and even serious risks to the mother’s life.

“Most of the worst disasters I’ve seen in my career — hemorrhages, sepsis — are related to C-sections,” Dr. Bostock stated. “There is inherent risk in doing abdominal surgery.” Recognizing the need for change, Dr. Bostock implemented a series of targeted strategies to address the high cesarean rates at her facility.

In 2021, the hospital began routing low-risk patients to midwives, aiming to provide more individualized care. This shift allowed for increased support for vaginal deliveries, which can often be safer for both mothers and infants. In 2023, a new checklist was introduced, mandating specific steps to encourage vaginal delivery before considering surgical intervention.

Perhaps the most significant initiative involved direct conversations with physicians about their personal surgery rates. These discussions aimed to foster accountability and encourage a more judicious approach to cesarean deliveries.

While cesarean rates for first-time mothers in the United States generally rose during this period, Rochester General Hospital experienced a remarkable decline. The rate dropped steadily, reaching an impressive 25 percent in 2023. According to an analysis by the New York Times, this reduction is among the steepest at the 1,600 hospitals that regularly report cesarean rates to the Leapfrog Group, a nonprofit organization dedicated to publishing health care quality metrics.

The success at Rochester General serves as a potential model for hospitals across the country, demonstrating that focused interventions and open communication can lead to substantial improvements in maternal health outcomes. By addressing the root causes of high cesarean rates and promoting safer delivery methods, hospitals can enhance the overall experience for mothers and their families.

In a landscape where cesarean sections are often viewed as a standard procedure, the approach taken by Dr. Bostock and her team highlights the importance of evaluating individual circumstances and prioritizing patient safety. As other hospitals consider similar strategies, the hope is that more mothers will benefit from safe, effective, and supportive childbirth experiences.