Safely Averting NTSV Cesarean Births
Background
OBI is working with 65+ hospital teams in Michigan to support physiologic birth, offer more respectful and person-centered care, and prevent unnecessary cesarean births.
The Problem
The national Nulliparous Term Singleton Vertex (NTSV) cesarean rate is high and varies substantially across hospitals. The NTSV cesarean rate in Michigan is significantly higher than the national average.
23.6%
Healthy People 2030 NTSV Cesarean rate goal
28%
Michigan’s average NTSV cesarean rate
11-41%
Variation in NTSV cesarean rate in Michigan hospitals
Aim
By December 2025, 50% of participating hospitals will achieve their NTSV cesarean goal.
Goals
- Increase the percent of NTSV cesarean births for dystocia that meet ACOG/SMFM criteria
- Increase the percent of NTSV cesarean births for abnormal/indeterminate fetal heart rate tracing that have documentation of management with an algorithm
- 70% of participating hospitals have a process for NTSV cesarean case review
- Reduce the percent of participating hospitals with an NTSV cesarean rate over 30%
- Increase the number of participating hospitals with an NTSV cesarean rate below the HP2030 target of 23.6%
Implementation Resources
Initiative Background
Clinical Guidance for Labor Dystocia
- Labor Dystocia Criteria Chart
- Labor Dystocia Publications
- Doing the Dance with Dystocia. Presented by Lisa Kane Low, PhD, CNM, FACNM, FAAN. OBI Webinar Series, April 2024. (OBI Members Only) View the Recording & Slides.
Clinical Guidance for Management of Category II Fetal Heart Tracings (FHTs)
- Management of Category II Fetal Heart Tracings (FHTs) Publications
- Electronic Fetal Monitoring: Standardized Interpretation & Management. Presented by Rebecca L. Cypher, MSN, PNNP. OBI Webinar Series, June 2024. (OBI Members Only) View the Recording & Slides.
QI Planning & Implementation Tools
EHR Templates
OBI Category II Fetal Heart Rate Tracing Management Algorithm
Webinar: Statewide Strip Rounds and Best Practices for Case Review
Presented by Jourdie Triebwasser, MD, MS, Molly Stout, MD, MSCI, Michelle Moniz, MD, MSc, & Jessi Ems, BSN, RN. OBI Webinar Series, September 2025.
OBI Members Only: View the Recording & Slides.
Webinar: Reclaiming the Role of the Nurse in Labor Support
Presented by Ellie Suse, MSN, MPH, RN, Lisa Kane Low, PhD, CNM, Bailey Brinks, BSN, RNC-NIC, Jessi Ems, BSN, RN, Maria Lebron, BSN, RN, and Meghanne Powers, BSN, RN. OBI Webinar Series, June 2026.
OBI Members Only: View the Recording & Slides.
OBI Labor Dystocia Compliance Measure Specifications
Algorithms based on ACOG/SMFM compliance criteria.
OBI Members Only: View the Measure Specifications.
Clinician Engagement
OBI Criteria Badge Buddy
A two-sided, 4”x 3” inch badge buddy that can be used as a fast reference reminder for Labor Dystocia compliance criteria and Category II FHR monitoring interventions.
Consider printing these for all members of your clinical team!
Moving our Mamas (MOMs) Labor Support Training
To host a hands-on labor support training class for your maternity care staff, please contact Patricia Klassa, MSN, APRN, CNS-C, C-EFM, IBCLC ([email protected]) and Cheryl Bellamy, DNP, APRN, CNM, CNS-C, C-EFM ([email protected]).
Patient Engagement
Labor Support Guide
Use this guide to identify, discuss, and select options for labor support with your team.