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N.J. hospitals’ plan to reduce C-section rates looks strong

Posted July 4, 2018

Published on the Press of Atlantic City

New Jersey’s 49 hospitals that deliver babies began an initiative in April that is intended to reduce cesarean-section deliveries 10 percent by next June and by nearly a third eventually.

C-sections, in which babies are delivered not through the pelvic opening but by cutting through the maternal abdomen, increase health risks for mothers and babies. Since they are major surgery, mothers experience greater incidence of bleeding, cardiac complications and infection. Surgically delivered infants have more breathing problems and asthma, and can spend more time in a critical-care unit.

The need for the initiative is apparent. C-sections were used in 30 percent of low-risk, first-time pregnancies in New Jersey in 2016, the third highest rate in the nation, according to the U.S. National Center for Health Statistics. That’s well above the target of 23 percent.

The hospital initiative announced in June will focus on first-time, low-risk pregnancies in which the baby is properly positioned for vaginal delivery.

It will include additional training for nurses and staff in supportive care for mothers in labor; new clinical protocols and patient monitoring practices developed by the N.J. Hospital Association and state Department of Health; and embracing the work of doulas, who are trained to provide comprehensive birthing assistance.

C-section is sometimes the best delivery method for high-risk, complicated pregnancies and multiple babies. The president of the New Jersey Health Quality Care Institute, Linda Schwimmer, said it’s important that hospital birth teams communicate early with patients about their birth plan and expectations, and then discuss each potential C-section to determine if it is truly necessary.

AtlantiCare’s experience with reducing its C-section rate shows the quick progress that is possible. Such deliveries accounted for 45 percent to 50 percent of births in 2016. After creating a special advisory and review committee and identifying ways to reduce unnecessary C-sections, the rate declined to 25 percent.

Schwimmer said health insurance plans and other funding sources for care could play a role in reducing the rate as well — by not reimbursing providers for C-sections considered early elective deliveries, or done for other than medical reasons before 39 weeks of pregnancy.

That seems unnecessarily severe for now.

The initiative by New Jersey hospitals seems sound and well thought out. Let’s see what it can accomplish in the next couple of years before looking for additional incentives to improve birthing practices and outcomes in the state.

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