Due to Iowa’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate exceeding the Healthy People 2030 target rate of 23.6%, the Iowa Maternal Quality Care Collaborative (IMQCC) began implementation of AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 43 of the state’s 56 birthing facilities. Since the start of implementation in May 2021, participating facilities have received monthly education on evidence-based practices, quality improvement, and family-centered care. Provisional data show a 16% reduction in the statewide rate of NTSV cesarean births from 25.0% in Q1 2021 to 21.1% in Q1 2022. During the same time, non-participating facilities experienced an increased rate of low-risk (NTSV) cesarean births. IMQCC continues to sponsor labor support workshops, provide one-on-one and small group coaching, and support birthing facilities in collecting and interpreting institutional data to advance AIM patient safety bundle implementation work.