The Obstetrics Initiative: Safe Births. Healthy Moms & Babies.


The Obstetrics Initiative (OBI) is a data-driven quality improvement project working to support vaginal delivery and safely reduce the use of cesarean delivery among low risk births, with improved or stable rates of maternal and neonatal morbidity.  

National and Regional Variation in Rates of Cesarean Delivery

OBI is focused efforts on reducing cesarean delivery among Nulliparous (first time delivering) women, who are carrying a Term (>=37 weeks) and Singleton pregnancy with baby in a Vertex (head down) presentation.  These are known as NTSV deliveries and they account for 30- 35% of the approximately 110,000 deliveries that occur annually in Michigan.  NTSV deliveries are considered at “low risk for cesarean delivery” but it is important to recognize that many NTSV patients have comorbidities which can still complicate care and necessitate cesarean delivery. 

Cesarean delivery rates have been increasing in the United States since the 1970s and today, one in three births are by cesarean delivery.  Among Michigan maternity hospitals, the mean NTSV cesarean delivery rate was 26.6% in each of the last three years, several percentage points greater than the Healthy People 2020 goal of 23.9%.  There is also five-fold variation in Michigan hospital NTSV CD rates (9.1% - 44.1%) which we see as a compelling target for efforts to safely reduce primary cesarean delivery. 

Cesarean births among low-risk, first-time mothers have been the largest contributor to the recent rise in cesarean rates, and account for the greatest variation in cesarean rates between hospitals. High rates of cesarean delivery are an increasingly recognized patient safety concern, with higher rates of complications compared to vaginal delivery. Cesarean birth is the most common inpatient operation in the U.S. and is associated with an increased risk of hemorrhage, hysterectomy, infection, and other complications for the woman and infant. Despite these risks, rates of cesarean delivery, both nationally and in Michigan, have increased since 1997. Cesarean delivery can serve a critical need, but the varying rates of cesarean delivery across the state suggest that some may not be medically necessary. Cesarean delivery rates are an important quality issue for patients and maternity clinicians alike. OBI’s first initiative is to safely lower the cesarean delivery rate among low-risk patients in Michigan hospitals.  Compared with vaginal birth, cesarean deliveries incur higher rates of hospital readmission and morbidity, higher costs, and often commit women to repeat cesarean delivery in future pregnancies.

OBI believes working to support vaginal delivery and  safely  reduce the use of cesarean delivery among low risk births meets the Triple Aim.

OBI believes working to support vaginal delivery and safely reduce the use of cesarean delivery among low risk births meets the Triple Aim.

What does OBI provide?

The Obstetrics Initiative:
•    Facilitates a statewide community of maternity hospitals and maternity clinicians
•    Promotes consistent and standardized approaches to obstetrical care
•    Supports evidence-based labor and delivery practices
•    Provides educational webinars
•    Promotes evidence-based resources and tools
•    Presents data-driven insights into areas for focused quality improvement
•    Provide the opportunity to share experiences, outcomes (challenges AND successes), and best            practices so that all can learn
•    Supports hospitals to develop their own site-specific goals with regards to obstetric care,                      specifically around supporting vaginal births and safely reducing cesarean births

Cesarean Delivery Rate

The Obstetrics Initiative (OBI) provides Obstetrics Reports to help you understand how your hospital’s vaginal and cesarean delivery rates as well as how your hospital compares to peer hospitals across the state. OBI recognizes there a number of factors that determine your hospital’s cesarean delivery rate. Through our Obstetric Reports, OBI provides reliable, actionable data to help to identify opportunities for improvement in maternal and neonatal outcomes. OBI supports hospitals to determine what their safe and optimal rate may be and to understand how hospitals have been able to safely achieve better rates.

Comparing hospital rates of cesarean section can be deceiving if there is not proper assessment of the clinical factors responsible for the decision to perform cesarean delivery.  Some variation in hospital cesarean rates is due to clinically important patient differences (body mass index, rates of comorbidities, previous surgical history), but hospital resources, personnel, and culture also play a strong role.  OBI believes significant variation in hospital rates of cesarean delivery suggests that there is an opportunity to reduce use of cesarean section. Safe reduction of the rate of primary cesarean deliveries requires different approaches.


Engage maternity providers and hospitals in a collaborative effort to safely reduce the use of primary cesarean delivery and improve health outcomes of Michigan women and infants.


1.    Build a community of maternity Michigan providers committed to safely reducing the cesarean delivery rate of low-risk births with improved or stable maternal and neonatal morbidity.
2.    Promote evidence-based processes to improve the quality of obstetric care.
3.    Utilize the OBI Registry’s Obstetric Reports as reliable, actionable data to identify                  opportunities  for quality improvement in maternal and neonatal outcomes and focus on                effectiveness of care.
4.    Provide educational webinars and a centralized resource of evidence-based labor and delivery             practices that support intended vaginal birth for low-risk patients.
5.    Improve the culture of care, awareness, & education around pregnancy and safe birth processes.

OBI helps.JPG