Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2023


Doctor of Nursing Practice (DNP)

Primary Advisor

Linda Cassar, DNP, RNC-OB, CNE; Loral Patchen, PhD, MSN, CNM, IBCLC


Cesarean Section, Primary, African American, First Stage Labor, Second Stage Labor, Disparities, Caregiver Education


Background: Cesarean section delivery rate in the United States has reached an alarming rate of over 30%. African American women experience a higher cesarean birth rate compared to Caucasian Women. The repeat c-section rate for all patients is greater than 80%. These findings underscore the need for intervention to reduce primary cesarean section deliveries in African American Women.

Objective: This quality improvement project aimed to implement caregiver education on the ACOG/SMFM definition of the first and second-stage labor arrest disorder to reduce primary cesarean section birth for African American women.

Method: This pre-and post-intervention quality improvement project was conducted on a Labor and Delivery unit at a large academic medical center. African American women between the ages of 18-40 who are nulliparous, full-term >37.0 weeks, and singleton pregnancy were included in the data collection. This was completed via retrospective chart review.

Results/Finding: The data was analyzed in SPSS using Pearson’s Chi-Square test. The pre-intervention sample size was 79 patients with 34 cesarean sections and 45 vaginal births. In the post-intervention sample, there were 62 patients with 23 cesarean sections and 39 vaginal births. The primary cesarean section birth rate decreased from 43% in the pre-intervention period to 37.1% in the post-intervention period. The p-value was 0.476 and while statistically not significant, there is a clinical significance to this finding.

Conclusion and implication: The reduction in the primary cesarean section rate of 5.9% indicates that the educational intervention was clinically impactful. A larger sample size is needed to demonstrate statistical significance.

Open Access


Available for download on Tuesday, May 30, 2023

Included in

Nursing Commons