Published by Michael L. Diamond in the Asbury Park Press.
New Jersey hospitals will try to reduce their high C-section rates by 10 percent during the next year in part by educating nurses and adding non-medical childbirth experts known as doulas, health officials said Monday.
The project is designed to prevent unnecessary cesarean sections, which expose women to increased risks of hemorrhage, infection, uterine rupture and cardiac events, they said.
“Delivering a baby is one of the most important times in which more medical intervention isn’t always best,” Cathy Bennett, president and chief executive officer of the New Jersey Hospital Association, a trade group, said.
All of the state’s 49 hospitals that provide labor and delivery services will adopt new procedures, focusing on low-risk, first-time deliveries where a single fetus is in the proper position.
New Jersey’s C-section rate in 2016 was 36.2 percent, according to the Centers for Disease Control. It trailed only Mississippi, Louisiana and Florida. And it was well above the federal government’s target rate of 23 percent.
New Jersey mothers are twice as likely as the national average to die in the year after giving birth. And their deaths may be related to the unusually high rate of surgical deliveries, experts say.
C-sections cost more than vaginal childbirth. They result in longer hospital stays. And they carry health risks. See the video above about the cost of childbirth in the U.S.
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.
Mothers who deliver their first child through C-section often deliver subsequent babies through C-sections, even if they are good candidates for vaginal deliveries, officials said.
A recent report by the Leapfrog Group found C-section rates in New Jersey ranged from 14 percent at CarePoint Health-Christ Hospital in Jersey City to 42.1 percent at CentraState Medical Center in Freehold Township.
Linda Schwimmer, president of New Jersey Health Care Institute, an advocacy and research group, said the hospitals’ announcement was a sign that it recognized that the high C-section rate was a problem.
But she called on health care leaders to go further. Among the ideas: Change the payment system that currently rewards the status quo; and require by law that all hospitals publicly report their C-section rates.
The hospital group is working on the initiative with the New Jersey Department of Health. Among the steps they are taking:
- Increase education for nurses and other staff on supportive care techniques for mothers in labor. It includes better assessment for pain.
- Integrate doulas, non-medical experts who assist women throughout childbirth, into the medical team.
- Use best-practice protocols for regional anesthesia such as epidurals.
- Develop policies to monitor low-risk women while allowing labor to progress.
- Educate parents. Fewer expectant parents are taking part in childbirth classes.
“We must approach this challenge as a partnership — with well-trained hospital teams working with well-prepared women and their support teams to ensure that every mother and baby has the very best care without incurring any unnecessary risks,” Bennett said.