“New Jersey has begun turning the corner on some of its maternal and child health challenges, including the state’s historically high C-section rates. We’ve had a 10 percent decline in our overall C-section rate since the creation of the New Jersey Perinatal Quality Collaborative in 2009, along with improvements in early elective deliveries and episiotomies as noted in today’s latest report from Leapfrog. But we’re committed to doing more to protect moms and babies in our state by focusing on NTSV C-sections. NTSVs are first-time, low-risk pregnancies with a single fetus in the proper position. We know that approximately 90 percent of women who have a C-section for their first delivery are likely to deliver by C-section again with any subsequent pregnancies. That’s why this is an important focus area – ensuring a safe vaginal delivery without the risks that can be associated with a C-section.

“Hospitals’ efforts in this area include: establishing evidence-based criteria for inducing labor; ongoing education with clinical leaders on topics such as labor support skills and fetal monitoring; and using rapid-cycle data analysis to drive improvement. The 2016 data provided by DOH yesterday will help us measure our improvement in the months to come.

“Other key focus areas in our quality improvement efforts include:

• Racial disparities in outcomes. According to data from NJHA’s Center for Health Analytics, Research and Transformation, all patient groups in New Jersey, regardless of race or ethnicity, have experienced reductions in C-section rates. However, the data show that white mothers achieved the highest rate of reduction since 2009 at 16.2 percent. Black and Asian mothers experienced more modest reductions of 6.1 percent and 3.0 percent, respectively.
• Age disparities. While all age groups experienced a reduction in C-section rates, mothers ages 20-24 experienced the most significant reduction of 23 percent. Deliveries in the largest birthing age group, ages 30-39, essentially mirrored the statewide drop, with a 10.4 percent reduction. Mothers ages 45-plus were outliers. In this high-risk age group, babies were born by C-section approximately two-thirds of the time.
• Patient engagement. Keeping the voice of the expectant mother at the forefront of care is critical to the success of any effort to improve quality. The NJPQC hospitals are working to engage and empower mothers in their birth plans; to help them understand that there are risks associated with unnecessary C-sections; and also to know that C-sections are valid medical procedures when medically indicated. The decision to perform a C-section should be shared by the mother and her care team.
• Pre-natal and perinatal care. Because reduction of C-sections is multifaceted and quality improvement efforts need to span the entire pregnancy, it’s also important to focus on what happens before and after the birth of the child. Influencing factors such as access to prenatal care; optimizing patient and family engagement; informed consent and shared decision-making about labor and birth plans; and timely postnatal care are also important factors in shifting the trajectory of outcomes.