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there has been a coordinated push to cut C section rates in other states and in births covered by Medicaid, the health coverage program for low income Americans. The Centers for Disease Control and Prevention is funding projects to reduce scheduled births that aren’t required medically. The Joint Commission, which accredits hospitals, is requiring hospitals with more than 1,100 births annually to report on their cesarean births and elective deliveries. The March of Dimes launched an education campaign to urge women to wait for natural labor, and the American College of Obstetricians and Gynecologists has publicly proposed ways to reduce the rates, such as using a doula to support women in labor. Still, many hospitals don’t act until dollars are at stake, said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. That’s what happened with Hoag, which Main said is now becoming a model for

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