Support Vaginal Birth and Reduce Primary Cesareans Toolkit

The Toolkit to Support Vaginal Birth and Reduce Primary Cesareans is a comprehensive, evidence-based “how-to” guide designed to educate and motivate maternity clinicians to apply best practices for supporting vaginal birth. Cesarean births among low-risk, first-time mothers have been the largest contributor to the recent rise in cesarean rates, and accounts for the greatest variation in cesarean rates between hospitals. 
The Toolkit contains key strategies and resources to:
  • Improve the Culture of Care, Awareness, and Education for Cesarean Reduction
  • Support Intended Vaginal Birth
  • Manage Labor Abnormalities and Safely Reduce Cesarean Births
  • Use Data to Drive Reduction in Cesareans

NEW! Toolkit Section! CMQCC has released an addendum to the Supporting Vaginal Birth Toolkit. This brand-new content provides additional evidence-based tools and resources to effectively integrate midwifery care and doula support into the hospital setting and how to best support those who transfer to the hospital from a community birth setting. There is an emphasis on birth equity and team-based care to improve outcomes for all birthing people.  This supplemental section was developed with a Task Force of hospital and community-based midwives and doulas, along with a patient advocate, nurses, and physicians.

Complete with this added content, the toolkit is available for anyone to download after logging into CMQCC's website. If you do not already have a CMQCC Account, you will need to complete a brief survey to initialize an account.


Toolkit to Support Vaginal Birth and Reduce Primary Cesareans (with Addendum Part V), (2022)


Slide Set for Professional Education - NEW Addendum Only (2022)

Webinar Link: Addendum Introduction: Integrating Midwives, Doulas, and Community-Based Birth Care (2022)

The Implementation Guide (2016)

Original Slide Set for Professional Education (2016)

Webinar link: Introduction to the Toolkit to Support Vaginal Birth and Reduce Primary Cesareans (2016)


Individual sections of the toolkit are also available to download by clicking on the links below:

Appendix A – Summary of the Obstetric Care Consensus on Safe Prevention of the Primary Cesarean Delivery (ACOG /SMFM 2014)

Appendix B – Safe Reduction of Primary Cesarean Births Bundle (AIM, 2015)

Appendix C – Tools Arranged by Section

Appendix D – Tools Arranged by Topic

Appendix E – CMQCC Birth Preferences Guide

Appendix F – Coping with Labor Algorithm

Appendix G – Guide to Second Stage Management of Malposition

Appendix H – Cesarean Birth Performance Measures

Appendix I – Informed Consent for Elective (Non-Medically Indicated) Cesarean Birth

Appendix J – Pre-Cesarean Checklist for Labor Dystocia or Failed Induction

Appendix K – Labor Dystocia Checklist

Appendix L – Labor Duration Guidelines

Appendix M – Spontaneous Labor Algorithm

Appendix N – Algorithm for the Management of the Second Stage of Labor

Appendix O – Active Labor Partogram

Appendix P – Algorithm for the Management of Category II Fetal Heart Tracings

Appendix Q – Algorithm for the Management of Intrapartum Fetal Heart Rate Tracings

Appendix R – Induction of Labor Algorithm

Appendix S – ACOG Key Labor Definitions

Appendix T – Model Policies: Fetal Surveillance; Freedom of Movement; Induction of Labor; Pain Assessment and Management