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Reducing Primary Cesareans

An Innovative Multipronged Approach to Supporting Physiologic Labor and Vaginal Birth

Gams, Becky, MS, APRN, WHNP-BC; Neerland, Carrie, PhD, CNM, FACNM; Kennedy, Sheila, DNP, APRN, CNM

The Journal of Perinatal & Neonatal Nursing: January/March 2019 - Volume 33 - Issue 1 - p 52–60
doi: 10.1097/JPN.0000000000000378
Feature Articles

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%.

Nursing Practice and Education, University of Minnesota Medical Center, Minneapolis (Ms Gams); University of Minnesota Masonic Children's Hospital, Minneapolis (Ms Gams); University of Minnesota School of Nursing, Minneapolis (Dr Neerland); University of Minnesota Health, Women's Health Specialists Clinic, Minneapolis (Dr Neerland); and Southside Community Health Clinic, Minneapolis, Minnesota (Dr Kennedy).

Corresponding Author: Becky Gams, MS, APRN, WHNP-BC, University of Minnesota Medical Center, Nursing Practice and Education, 2450 Riverside Ave #MB435, Minneapolis, MN 55454 (

The authors acknowledge the work and collaboration with the following: Ann Forster-Page, Brianna Barth, Annie Liljegren, Sara Vipond, Jess Vaughan, Anna Jacobsen, Melissa Avery, and Samantha Sommerness.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication: August 1, 2018; accepted for publication: October 21, 2018.

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