Background: Cesarean births (CB), while lifesaving, are associated with three of the top ve leading causes of maternal mortality in the United States. Since the onset of COVID-19 there has been an increase in CB rates, the rst since 2009. CB rates peaked at 26.3% for low-risk birth givers during COVID despite the national decline of births over that time. It is unclear why CB rates increased during COVID-19; however, some regional studies reported increases in utilization of intrapartum interventions during the initial phases of COVID-19. Induction of labor (IOL), anesthesia utilization and augmentation of labor are all intrapartum interventions that have been linked to the increased risk of CB. It is unclear how COVID-19 impacted the relationship between intrapartum interventions and CB. Purpose: Guided by the Social Ecological Model, the purpose of this dissertation was to (1) to examine the trends in intrapartum interventions and CB during COVID-19 (2) determine if COVID-19 inuenced the likelihood of intrapartum intervention utilization and (3) determine if COVID-19 moderated the relationship between intrapartum interventions and CB. It is hypothesized that COVID-19 will positively moderate the relationship between intrapartum interventions and CB. Methods: This study was a retrospective population-based cohort study utilizing the Center for Disease Control Vital Statistics System Natality Public Use File (CDC NCHS). Birth data from January 1, 2018- December 31, 2021, was used to examine the use of intrapartum interventions prior to and during COVID-19. The rst manuscript utilizes an ARIMA time series analysis of intrapartum interventions and CB with COVID-19 as the timepoint. The second manuscript uses multinomial logistic regression analysis with intrapartum interventions as the primary outcome variable and COVID-19 was the exposure variable. Covariates included: birth giver race, age, weight gain, provider type, chorioamnionitis status, and neonatal birth weight. The nal paper utilized a logistic regression model where the primary outcome variable was method of birth, intrapartum interventions was the exposure variable, and COVID-19 was the interaction factor. Covariates included: birth giver race, age, maternal weight gain, chorioamnionitis status, and neonatal birth weight. Results: There was an increase in the trend of CB during COVID-19 and a decrease in the utilization of no interventions. COVID-19 weakened the relationship between intrapartum interventions and CB. COVID-19 when examined in isolation reduced the effect of intrapartum interventions on CB risk. Throughout the entire study period intrapartum interventions that included utilization of anesthesia increased the odds of CB. However, the ORs for intrapartum interventions declined slightly during COVID-19. This aligns with the moderation analysis showing COVID-19 weakened the association between intrapartum interventions and CB.