Louisiana’s nulliparous, term, singleton, vertex (NTSV) cesarean birth rate was 33.2% in Q3 of 2020, and some individual facilities had NTSV cesarean birth rates exceeding 50% during that time. In January 2021, the Louisiana Perinatal Quality Collaborative (LaPQC) began implementing AIM’s Safe Reduction of Primary Cesarean Birth patient safety bundle in 42 of the state’s 49 birthing facilities. The LaPQC completed the Labor Culture Survey with all participating facilities and is now working to implement and stabilize processes to make labor cultures more supportive of vaginal birth. Between January 2021 and January 2022, the NTSV cesarean birth rate declined from 30.3% to 27.5% among participating facilities. The LaPQC continues to host regular data reviews and QI planning sessions with the now 44 participating facilities and host clinical trainings to support the safe reduction of low-risk cesarean births.