In 2023, Kaiser Permanente Vallejo reported a Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Section rate higher than the California average. Cesarean births when not medically necessary can increase the risk of maternal morbidity, infection, and complications in future pregnancies. Recognizing this as a critical patient safety concern, a team of labor and delivery nurses at Kaiser Permanente Vallejo took the lead on designing and implementing a multi-faceted quality improvement initiative to reduce unnecessary primary cesareans.

By January 2024, the NTSV rate peaked as reported to the California Maternal Quality Care Collaborative (CMQCC). In response, clinical nurses launched a comprehensive, evidence-based strategy to reduce unnecessary primary cesareans, improve maternal safety, and realign practices with best standards of care.

Key interventions included the implementation of a revised Safe Birth Checklist, rollout of an Induction of Labor (IOL) Toolkit, staff participation in Spinning Babies physiologic birth training, initiation of a new Oxytocin dosing protocol, and ongoing nurse-led chart reviews of NTSV cesarean cases. These efforts were reinforced by education during huddles, the launch of a monthly “Safe Birth Newsletter,” and the use of patient-facing tools such as QR code–enabled handouts and the creation of a Labor Walk.

As of Q2 2025, Vallejo has reduced its NTSV Cesarean rate, with further improvements expected by year-end. This trajectory reflects the direct impact of nurse-led innovation, accountability, and advocacy.

This initiative reflects a sustained, collaborative effort led by bedside nurses to improve patient outcomes and align clinical practices with national quality benchmarks.

Each intervention was crafted with patient experience and safety at its core, reflecting the values of our Professional Practice Model. Through vigilance, voice, and advocacy, nurses are redefining the birth experience — safely, respectfully, and equitably.