The objective was to assess the effectiveness of a multifaceted strategy for improving the appropriateness of indications for cesarean sections in two public Spanish hospitals. A multifaceted strategy was used including the adoption of a consensus protocol with indications for emergency and prescheduled cesarean sections, continuing education and improvement, and the correction of deficiencies in organization. A pre and post-intervention design was applied. The overall appropriateness rates for emergency cesarean sections increased from 68.3 to 84.3% in Son Llatzer Hospital, and from 80.0 to 92.0% in the hospital in Menorca. The overall cesarean section rates at the end of the post-intervention period decreased (not statistically significant) from 17.5 to 15.8% and from 29.0 to 22.0%, respectively. The multifaceted strategy applied seems to be effective in increasing the appropriateness of cesarean sections and possibly in decreasing the cesarean section rate.