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Supporting Vaginal Delivery for Low-Risk Mothers
(SOAR)

SOAR is a Colorado hospital-based patient quality improvement initiative to promote birth safety and outcomes by helping hospitals lower their first-time, low risk cesarean section rates through evidence-based care.
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Cesarean births, while lifesaving when medically necessary, carry increased risks of complications for birthing people and babies—especially with repeat procedures. In Colorado, Cesarean rates vary significantly across hospitals, with wide gaps by race, ethnicity, and payer. Reducing primary Cesareans is a critical strategy for improving maternal and neonatal outcomes, advancing health equity, and curbing rising healthcare costs. SOAR addresses these challenges by empowering hospitals with the tools and support needed to implement proven clinical and system-level changes.

The hospital where a person gives birth is one of the most significant predictors of whether they will undergo a Cesarean delivery—often outweighing individual clinical factors or medical history. This suggests that care decisions are frequently influenced more by institutional practices than by patient need, reflecting inequities in obstetric care. The SOAR initiative aims to ensure that all birthing people receive safe, evidence-based, and equitable care, regardless of their identity, socioeconomic status, or geographic location.

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Hospitals participating in the SOAR initiative have shown measurable progress in improving maternal care, including:

  • Reductions in NTSV Cesarean rates (nulliparous, term, singleton, vertex births)
  • Increased use of evidence-based labor management protocols
  • Stronger interdisciplinary teamwork and communication across care teams
  • Improved trauma-informed care and informed consent practices, promoting more respectful and patient-centered experiences

To maintain momentum and focus on long-term success, SOAR invites hospitals that meet and sustain the Healthy People 2030 target for NTSV Cesarean rates (≤23.6%) to join a dedicated sustainability cohort. As of 2025, 30% of participating hospitals have achieved this benchmark and are continuing their improvement efforts as sustainability sites.

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Hospitals participating in this initiative must maintain their status as Active Participants in CPCQC by fulfilling five levels of engagement:

Enrollment

The hospital has signed a Data Use Agreement (DUA) with CPCQC and selected a QI initiative to implement.

Coaching

The hospital attends one virtual QI Coaching session with CPCQC per quarter (4 per year).

Survey Completion

Submit a survey about its practices related to the selected QI initiative at least twice per year.

Meeting Participation

-At least 1 hospital team member attends monthly virtual initiative meetings.

-Hospital representation at one annual forum.

Data Submission

-Submit monthly QI initiative data disaggregated by race, ethnicity, and payor.

-Submit a survey about hospital practices related to the selected QI initiative topic at least twice per year.

Adapted from the NNPQC and NICHQ publication “A Framework for Measuring Hospital Engagement Participation in PQC Quality Improvement Initiatives”, 2024