Cesarean delivery is a frequent, easily obtainable, and meaningful event in obstetrics that has frequently been used as a quality indicator. However, its utility as a widespread marker of quality has several limitations. The cesarean delivery rate does not account for variation in levels of maternal care with varying maternal and fetal conditions. Attempts to risk adjust with the nulliparous, singleton, term, vertex cesarean, or the vaginal birth after cesarean rates fall short as, in obstetrics, it is the outcome of 2 patients, the mother and the infant, that ultimately matters. Newer and more sophisticated measures are increasingly available and offer greater potential to improve care for mothers and babies. However, much work is needed to create better quality metrics for obstetric care that can be measured and validated to truly reflect the quality of care women are receiving.