As a resident, I'm privileged to work in two different settings with, interestingly, vastly impressive cesarean rates. We cover primarily at an academic center with one of the lowest CS rate in the state (27%) but also a community hospital where the CS rate is nearly 45%. Both hospitals have embraced a laborist model of care to some extent, but the community hospital remains predominantly run by physicians in private practice with multiple and often simultaneous responsibilities (i.e. they may have laboring patients but also GYN cases or office hours). I think contributing factors to the academic centers significantly lower cesarean rate is multifold --- but one of the biggest differences I see is a collaborative care model embracing midwives as primary providers and emphasis on evidence based medicine in the academic setting.
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