EBB 403 - Why Is My Hospital's Cesarean Rate So High (or Low)? with Dr. Emily White VanGompel, Family Medicine Physician and Research Scientist

Organizational culture on labor and delivery units significantly influences cesarean birth rates, often overriding clinical risk factors. Dr. Emily White VanGompel, a family physician and researcher, explains that unit culture—defined by the collective attitudes, beliefs, and norms of the staff—dictates decision-making processes during labor. Hospitals with lower cesarean rates often cultivate a "culture of safety" that prioritizes psychological safety, allowing nurses and patients to speak up without fear of hierarchy. Key interventions include implementing non-pharmacologic labor support, such as movement and aromatherapy, and fostering team-based care models that include midwives. While the ARRIVE Trial has shifted clinical practice toward 39-week inductions, these decisions often reflect institutional beliefs rather than definitive evidence, highlighting the need for hospitals to align their internal culture with evidence-based practices to improve maternal and neonatal outcomes.