A year ago New Jersey’s 49 hospitals that deliver babies announced an initiative to reduce cesarean-section deliveries by nearly a third eventually.
The success of that effort was mixed, as seen in data released last week by the state Department of Health and the Leapfrog Group. Overall, the state’s rate of surgical births remains at about 30 percent, a quarter higher than the national target of less than 24 percent.
Eight hospitals, though, now meet Leapfrog’s metrics for the use of C-sections, early elective deliveries and episiotomies — five of them in South Jersey. They include Cooper University Hospital, Inspira Medical Centers in Elmer and Woodbury, Virtua in Voorhees and Jefferson Washington Township Hospital.
N.J. hospitals have had better success reducing early elective deliveries, often considered an unnecessary use of C-sections, from more than 3 percent of infant deliveries in 2016 to less than 1 percent in 2018. Likewise episiotomies — which make a surgical slit in the birth canal to ease delivery — declined from 13 percent of deliveries in 2016 to 10 percent last year.
N.J. Health Commissioner Shereef Elnahal said C-sections are major surgery that increases the risk of complications such as maternal bleeding, infections and blood clots. “While these procedures can save lives, too many women in our state are experiencing preventable C-sections, which are putting them at unnecessary risk for injury or death,” he said.
New Jersey has seen an increase in maternal mortality to above national levels, driven by one of the largest racial gaps in outcomes in the United States. The most recent data shows that for each 100,000 live births in New Jersey, 46.5 black women and 12.8 white women die within a year of pregnancy. Infant mortality is below the national average.
In addition to the initiative by hospitals to reduce unnecessary surgical births, the Department of Health has launched a new online maternal center as part of its effort to use research data and statewide outreach collaboratives to end preventable maternal morbidity. The state also is spending $4.7 million to train doulas and birth coaches, and changing its Medicaid payment rules to discourage early elective deliveries.
Such efforts can make a big difference. After AtlantiCare created a special advisory and review committee and identified ways to reduce unnecessary C-sections, it was able to cut such births in half in less than two years — to just a fraction of a percentage point above the 24 percent target.
Continuing to collaborate and sharing evidence of what works looks like the best path to getting New Jersey’s maternal mortality rate down where it belongs.