INTRODUCTION: To decrease the nulliparous, term, singleton, vertex (NTSV) cesarean section (CS) rate at a single tertiary care center. We hypothesized the NTSV CS rate due to labor dystocia would decrease after the intervention. METHODS: Quality improvement interventions were instituted over 7 months, including education on labor dystocia, recognition of NTSV patients, implementation of necessary skills, guidelines to support labor progression, and improvements in team communication. A retrospective chart review was performed over the 6 months prior and 6 months after intervention period. Primary outcomes included NTSV CS rates and indication for CS. Secondary outcomes included adverse maternal and neonatal outcomes. RESULTS: There were 1,079 NTSV patients during the pre-intervention (n=421) and post-intervention (n=658) timeframes. The NTSV CS rate downtrended but was not statistically different between the pre- and post-intervention timeframes. The NTSV CS rate due to labor dystocia down-trended but was not statistically different. There were no differences in the neonatal adverse outcomes pre- and post-intervention. Rates of chorioamnionitis/endometritis (4.1% pre- versus 9.9% post-intervention; P=<.01) and hospital readmission rates (0.3% pre- versus 2.7% post-intervention; P=.01) were both significantly increased in the vaginal delivery cohort after the intervention. Differences in other maternal adverse outcomes pre- and post-intervention were not statistically different in the vaginal delivery nor CS cohort. CONCLUSION: Despite not being statistically significant, there was a notable clinical difference in the NTSV CS rate following this quality improvement initiative. However, the potential associated increases in chorioamnionitis/endometritis and postpartum readmission rates should be considered.