This issue brief, developed by the National Association of Medicaid Directors (NAMD) in partnership with the Association of Maternal & Child Health Programs (AMCHP), lays out key background information and the elements of state strategies to address the excessive use of C-sections for low-risk, first time mothers. It draws heavily from the CMQCC White Paper published in 2011: Cesarean Deliveries, Outcomes, and Opportunities for Change in California: Toward a Public Agenda for Maternity Care Safety and Quality