A statewide program will put 100 Florida hospitals under a microscope over one of medicine’s most common and most debated procedures.

The Florida Perinatal Quality Collaborative at the University of South Florida’s College of Public Health will launch the Safe Reduction of Primary Cesarean Birth initiative Jan. 1. It will run 18 months, and participating hospitals will meet monthly to review recommendations and receive support. Each hospital will be placed on a team with a coaching group that includes a nurse and a physician.

Florida’s C-section rate was about 36.3% of live births in 2024, according to the CDC. Lori Reeves, the collaborative’s executive director, said rates at Florida maternity hospitals are up 10% from the start of 2022. The initiative aims to bring that number down 10% by June 2028.

The collaborative says the gap between hospitals is the real problem. Dr. Jessica Brumley, director of USF Health’s Division of Midwifery and a state co-lead for the initiative, said some hospitals have a 15% rate, while others perform C-sections on as many as 55% of low-risk patients.

“That doesn’t make sense,” Brumley said. She dismissed the idea that high-risk patient loads explain the difference. “Some people like to say, ‘Well, that’s a really high-risk hospital,’ but Tampa General is a really high-risk hospital, and our rates are nowhere near that,” she said.

Brumley warned that cesarean births carry higher rates of hemorrhage and infection, longer recoveries, and a greater chance a baby ends up in neonatal intensive care. Reeves, who said she had an emergency C-section herself, stressed that the procedure can save lives and that the goal is to avoid unnecessary ones.

Hospitals will first collect data and review their low-risk C-sections to find what is driving their rates. The effort is the collaborative’s largest, and a 2022 state law already requires every Florida maternity hospital to take part in at least two of its initiatives. “We believe that the sheer scale of this is going to help move the numbers for the state of Florida,” Reeves said.

The program leaves open a question for hospitals, doctors, and expectant mothers. How much of a delivery decision belongs to the physician and patient in the room, and how much to a statewide quality program?

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