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

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.

Between 1997 and 2008, the cesarean delivery rate in Michigan increased from 20.0% to 31.4% (ref).  During this time, there were increases in the proportion of pregnancies delivered by a first cesarean delivery.  By 2015, the rate of first deliveries by cesarean in Michigan was 19.4% which is 53% greater than it was in 1997 (ref).   This pattern of practice was also observed nationally (Ananth CV et al. Epidemiology 2017; ref).  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 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.