Reducing Nulliparous Term Singleton Vertex (NTSV) Cesarean Deliveries


The rate of cesarean sections for first-time moms is too high. C-sections are associated with greater risks for complication, and having a c-section for the first birth increases the likelihood of subsequent surgical deliveries to 90 percent.


Every hospital that provides labor and delivery services in the state has signed on to reduce the number of cesarean section births for low-risk, first-time mothers carrying a single baby – referred to as Nulliparous Term Singleton Vertex (NTSV).

As part of the collaborative, hospitals and their community partners are teaching soon-to-be moms what a normal progression of labor looks and feels like as part of the prenatal care routine.

Hospitals are also adopting policies and strategies for encouraging vaginal deliveries for NTSV moms. This includes educating staff on fetal monitoring and labor support skills; establishing criteria for inducing labor; and tracking data on C-sections to use in case reviews with delivery teams.


New Jersey’s labor and delivery hospitals focused on improving care for mothers and babies since the formation of the New Jersey Perinatal Collaborative in 2009. The main focus of this iteration of the collaborative was to reduce the number of elective births prior to 39 weeks, called early elective deliveries.

By November 2013, all but one hospital stopped scheduling elective deliveries before the 39th week. As of 2018, every delivery hospital achieved the national target of 5 percent or fewer early elective deliveries, according to the Leapfrog Hospital Safety Grade.

NTSV C-sections peaked in New Jersey in 2009 at 36.3 percent of all live births. The goal for the NJPQC is to reduce NTSV C-sections by at least 10 percent.