Florida Perinatal Quality Collaborative

Located at:


Promoting Primary Vaginal Deliveries


Promoting Primary Vaginal Deliveries (PROVIDE) Initiative

Stakeholders across the state and the U.S. have begun to take note of cesarean delivery rates, including their impact on morbidity, mortality, and health care costs.
A recent analysis of Florida birth certificates showed roughly one-fifth of the hospitals (21%) meet the Healthy People 2020 national goal for Nulliparous Term Singleton Vertex (NTSV) cesarean section deliveries of 23.9% or less. The primary cesarean delivery rate, which drives the overall cesarean rate, among low-risk first-birth deliveries in Florida ranges from 6.6% to 59.5%. This wide variation suggests clinical practice patterns may contribute and provides an opportunity for improvement. 

Project Goal

The goal of the PROVIDE Initiative is to improve maternal and newborn outcomes by applying evidence-based interventions to promote primary vaginal deliveries at Florida delivery hospitals and ultimately reduce NTSV cesareans.

  • PROVIDE Initiative Resources

    Online Tool Box for PROVIDE Hospitals

    This Tool Box contains tool kit documents, algorithms, example policies and educational materials, and more. This resource is updated regularly throughout the project.

    Newly Added Tool Box Resources:

    - Updated ACOG Committee Opinion on Approaches to Limit Interventions in Labor and Birth (2019) 

    Additional Resources:

  • Archived Webinars

    February 14, 2019 - Where We Are, Where We Are Going, and Managing the OP Baby

    December 13, 2018 - The Safety and Benefits of Outpatient Cervical Ripening

    October 11, 2018 - Improving and Sharing Data

    August 9, 2018 - The Early Labor Walking Path:  A Tool to Reduce Admission in Early Labor and Reduce Primary Cesarean Section

    June 14, 2018 - Second Stage of Labor: Push it Real Good

    May 10, 2018 - Intermittent Auscultation for Low Risk Women

    March 8, 2018 - Lessons Learned from Implementing an Induction Policy

    February 8, 2018 - Overcoming Resistance to Change

    January 11, 2018 - Where to Start

    November 9, 2017 - Finding Your Cesarean Reduction Opportunities (PROVIDE Data)

  • Participating Hospitals

    Baptist Hospital of Miami

    Bayfront Health BabyPlace

    Bayfront Health Spring Hill

    Boca Raton Regional Hospital

    Broward Health Medical Center

    Florida Hospital Altamonte

    Florida Hospital Celebration Health

    Florida Hospital Memorial Medical Center

    Florida Hospital Orlando

    Florida Hospital Tampa

    Gulf Coast Medical Center

    Halifax Health Medical Center

    HealthPark Medical Center Lee Health

    Homestead Hospital

    Jackson North Medical Center

    Cape Coral Hospital Lee Health

    Manatee Memorial Hospital

    Mease Countryside Hospital

    Memorial Hospital Miramar

    Memorial Hospital West

    Memorial Regional Hospital

    Morton Plant Hospital

    Mount Sinai Medical Center

    NCH North Naples Hospital

    Parrish Medical Center

    North Florida Regional Medical Center

    North Shore Medical Center

    Orange Park Medical Center

    Osceola Regional Medical Center

    Sacred Heart Hospital

    Sarasota Memorial Healthcare System

    South Lake Hospital

    South Miami Hospital

    St Joseph's Hospital North

    St. Joseph's Hospital South

    St. Joseph's Women's Hospital

    Tampa General Hospital

    The Women's Hospital at Jackson Memorial

    Tradition Medical Center

    UF Health Jacksonville

    Wellington Regional Medical Center

    West Boca Medical Center

    West Kendall Baptist Hospital

    Winnie Palmer Hospital for Women & Babies

    Winter Park Memorial Hospital

Initiative Impact

For most low-risk nulliparous, term, singleton, vertex (NTSV) pregnancies, cesarean birth increases risk of hemorrhage, infection, uterine rupture, abnormal placentation, cardiac events, psychological stress, longer hospital stays, increased pain, and increased postpartum re-admissions. Cerebral palsy and neonatal seizure rates have remained unchanged since 1980. Cesareans are associated with impaired neonatal respiratory function, neonatal intensive care unit admission, difficulty breastfeeding, and lifelong health (Main et al 2011; Smith et al 2016).

Costs associated with cesareans are significant for insurers, government, taxpayers, and consumers. Studies have shown that each cesarean costs $5,000 to $10,000 more than a vaginal birth. Based on Florida reports, maternal hospital cost savings for each Medicaid and private insurance cesarean delivery would be about $4,000. Primary cesarean deliveries are a major contributor to the large increase in cesarean delivery rates in the United States over the past two decades.

Participation in this initiative helps hospitals work in a collaborative with resources to help you implement evidence-based quality improvement recommendations. It also offers an environment to learn together with others on the best strategies, methods and tools to adapt and implement. Hospitals that participate in multi-organization quality improvement collaboratives achieve more gains faster than those who do so alone. Past participants have found it useful to not have to “reinvent the wheel.”