Date of Completion
Fall 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Brandee Temmis
Second Advisor
Dr. Corinne Cochran
Abstract
Problem: Cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients is an important maternal health quality indicator, as potentially unnecessary cesarean births can increase maternal morbidity and affect subsequent pregnancies. Healthy People 2030 established an NTSV cesarean birth rate target of 23.6%. At the participating hospital, rates demonstrated variability and frequently exceeded this benchmark, supporting evaluation of an existing initiative promoting safe vaginal birth. Aim of the Project: The project aimed to evaluate the effectiveness of the Supporting Vaginal Delivery for Low-Risk Mothers (SOAR) initiative in reducing NTSV cesarean birth rates while maintaining neonatal safety and assessing program adherence. Review of the Evidence: Evidence supports SOAR and its standardized, evidence-based labor management practices, interdisciplinary collaboration, and outcome monitoring as strategies for safely reducing primary cesarean births. Studies evaluating SOAR practices have demonstrated reductions in NTSV cesarean birth rates across participating hospitals. Project Design: A summative program evaluation was conducted using the Centers for Disease Control and Prevention Program Evaluation Framework. Data were collected retrospectively and prospectively over a 10-week evaluation period. Outcome, process, and balancing measures were analyzed using descriptive statistics, benchmarks, organizational targets, percentage-point differences, and visual trend analysis. Intervention: SOAR incorporated standardized, evidence-based labor management practices supporting vaginal birth among eligible NTSV patients. Providers followed standardized order sets, nurses implemented evidence-based labor practices, and interdisciplinary collaboration was promoted. The evaluation assessed NTSV cesarean birth rates, program adherence, and neonatal outcomes. Significant Findings/Outcomes: The average NTSV cesarean birth rate decreased from 25.0% before the initiative’s launch to 16.6% during the six months following the launch. Post-launch monthly rates remained below the 23.6% benchmark. NTSV patient identification achieved 100% consistent adherence, while opportunities for improvement were identified in protocol adherence, documentation, and interdisciplinary communication. Five-minute Apgar scores below 7 remained uncommon, with minimal pre- and post-launch change. Implications for Nursing: Lower NTSV cesarean birth rates following the initiative’s launch, while neonatal outcomes remained stable, suggest SOAR may support nurses and providers in promoting vaginal delivery among eligible NTSV patients. Continued evaluation of SOAR may further inform nursing practice and efforts to safely reduce NTSV cesarean births across maternity care settings.
Recommended Citation
Hopkins, Denise, "Program Evaluation of Hospital Initiative to Reduce Nulliparous Term Singleton Vertex Cesarean-Section Rate" (2026). All Doctor of Nursing Practice (DNP) Scholarly Projects. 98.
https://fuse.franklin.edu/dnp-project/98
Rights
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