Rochester (N.Y.) General Hospital, part of the Rochester Regional Health System, has seen a dramatic decline in cesarean section rates among healthy, first-time mothers — from 40% in 2019 to 25% in 2025, according to a Nov. 24 analysis published in The New York Times.
Here are five ways the hospital achieved the reduction:
- Leadership accountability: Elizabeth Bostock, MD, who has served as chair of obstetrics since 2019, reviewed individual physician rates and held direct conversations to address outliers.
- Midwifery model: Beginning in 2021, low-risk patients were routed to midwives. By 2024, the midwifery group became its own department with independent decision-making authority.
- Surgical payment reform: In 2020, the system expanded a policy in place at Rochester Hospital that equalized reimbursement for cesarean and vaginal deliveries to all five of its hospitals.
- Labor management protocols: The hospital implemented a checklist to encourage vaginal deliveries in 2023. Staff also received training on positioning techniques through Spinning Babies, a group dedicated to educating parents and providers about fetus positioning, with visual guides available in nurses’ work areas.
- Incentives and education: Rochester Hospital participates in New York Medicaid’s value-based incentive program, which paid $40 million to hospitals working toward the state’s 18% target rate for cesareans. Additional efforts include patient education classes on induction expectations and early cervical ripening with balloon placement.
