Published by Linda Washburn, northjersey.com
New Jersey hospitals performed worse — not better — in lowering the rate of Cesarean deliveries for newborns in the most recent report on the quality of maternity care, released Tuesday.
Only nine of 48 hospitals where babies are delivered brought the rate of such surgery down to the national goal level, said the report. That compares with 15 hospitals that had reached the goal set by the federal Health and Human Services Department a year earlier.
Some of the busiest hospitals for childbirth — such as CentraState Medical Center in Freehold and Hackensack Meridian Health Hackensack University Medical Center — have C-section rates over 40 percent, far above the national and state averages.
The state “can and must do better to reduce C-section rates,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute. “Now is the time for hospital leadership to prioritize maternal and child health throughout New Jersey.”
No one says the goal should be zero C-sections. Surgical births are sometimes necessary for the health of the mother and baby. The government said hospitals should strive to do no more than 23.9 percent of births via C-section.
Hospitals separated by less than 5 miles can provide vastly different childbirth experiences. For example, Holy Name Medical Center in Teaneck has a C-section rate of 16.2 percent, compared with Hackensack’s rate of 41.0 percent.
“The hospital where an expectant mother delivers her baby should not be the determining factor of whether or not she has a surgical birth,” Schwimmer said, noting the wide gaps among New Jersey hospitals.
More than 100,000 babies are born each year in New Jersey, and about 40 percent of their deliveries are covered by Medicaid, the state insurance program for low-income people.
C-sections cost more than vaginal childbirth and result in longer hospital stays. For the mother, the procedure carries a higher risk of complications such as infection or the formation of blood clots. And babies born without being squeezed through the birth canal have a higher risk of respiratory problems and lack exposure to the mother’s bacteria, which can help their developing immune system.
New Jersey’s C-section rate has remained stubbornly high for years.
The state ranked fourth — behind Mississippi, Louisiana and Florida — in 2016, with an overall rate of 36.1 percent, according to the federal Centers for Disease Control.
New Jersey mothers also are twice as likely as the national average to die in the year after giving birth.
Their deaths may be related to the unusually high rate of surgical deliveries, experts say. That issue — and the highest-in-the-nation mortality gap between black babies and white babies — are among the health care priorities of Gov. Phil Murphy’s administration.
“This data should be a wake-up call that improving maternal health in New Jersey requires transparency” and new ways to make hospitals more supportive to mothers and babies, said Jill Wodnick, a childbirth educator at Montclair State University. She led a group marking New Jersey’s first Maternal Health Day earlier this year.
Women crave information that allows them “to understand the quality of maternity care” and the facilities available at various hospitals, she said. In California, for example, consumers can search by ZIP code for information about the birth practices and quality metrics at their hospitals.
Use of this information, combined with the right financial incentives, could lead “New Jersey to see vast improvements in its maternal and infant health outcomes, across all races,” Schwimmer said.
The report Tuesday from the Leapfrog Group, a Washington, D.C.-based non-profit that provides quality comparisons of hospitals, found that C-section rates varied greatly across the state, from 14 percent at CarePoint Health-Christ Hospital in Jersey City to 42.1 percent at CentraState.
Leapfrog measures the rate for first-time, full-term, singleton births with the baby’s head down. The data are from either the 2016 calendar year or the year ending June 30, 2017, depending on what the hospital submitted.
The use of episiotomies also varied widely, from 1.3 percent at Virtua Memorial Hospital in Mount Holly to 36.6 percent at JFK Medical Center in Edison.
An episiotomy is an incision to widen the birth canal. Although it was once routine, recent research has found that more selective use results in fewer problems for the mother in terms of tears, pelvic-floor defects or loss of bladder or bowel control.
The average rate of episiotomies has been declining nationally but remains above the goal of 5 percent. In New Jersey, only 11 hospitals met that goal.
One bright spot is the declining rate of early elective delivery, when labor is induced or a C-section performed before 39 weeks of pregnancy. The rate has declined nationally to an average of 1.6 percent, due in part to hospitals’ efforts after their rates were publicly reported.
In New Jersey, only two hospitals exceeded the goal of 5 percent: Englewood Hospital Medical Center, where the rate was 10.3 percent, and Hackensack, where the rate was 7.1 percent. Nineteen hospitals reduced the rate to zero.
The Leapfrog Group noted that two hospitals did not publicly report their quality data for 2017: Atlanticare Regional Medical Center Mainland Campus and Hudson Regional Hospital (formerly called Meadowlands Hospital Medical Center).
The state health commissioner said he was pleased to see the results from Leapfrog on maternity care.
“A number of hospitals perform quite well,” said the commissioner, Dr. Shereef Elnahal. “Our goal is to create a maternal care quality collaborative to spread the best practices that the highest-performing hospitals are achieving and make sure that as many hospitals as possible can replicate them.”