June 25, 2018

How 49 New Jersey hospitals plan to rein in unnecessary C-sections

Daily Briefing

    The New Jersey Hospital Association (NJHA) recently announced all 49 of the hospitals in the state with labor and delivery services have joined an initiative to reduce the number of unnecessary cesarean sections (C-sections) to protect infants and mothers from risks associated with the procedure. 

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    The risks associated with C-section

    C-sections are necessary in certain cases, but experts warn against using the procedure for convenience, because it raises the risk of:

    • Asthma and diabetes in infants; and
    • Blood clots, cardiac complications, future pregnancy complications, infection, and pelvic pain for women.

    High use of C-section delivery in NJ

    While New Jersey in recent years has seen improvements in the use of C-sections, the use of C-sections is still higher in New Jersey than in other parts of the country, according to NJHA. Further, the C-section rate for all births in New Jersey was at 30.3%, which is higher than the 23% target HHS set as part of its Healthy People 2020 goals.

    NJHA, NJ Health Department seek to reduce C-sections

    NJHA and the New Jersey Department of Health (DOH) launched a joint initiative in April to reduce the number of C-sections in New Jersey. The effort, which will run through next year, focuses on first-time mothers with low-risk pregnancies who have a single fetus in the proper position for a vaginal birth. According to NJHA, this is because women who deliver their first child by C-section will typically use C-sections again.

    Under the initiative, NJHA in a release said participating hospitals agree to adopt "evidence-based best practices in supporting mothers in labor and avoiding unnecessary C-sections," including:

    • Implementing "policies for the intermittent monitoring of low-risk women to protect the safety of mother and baby while allowing the labor to progress;"
    • Increasing education for nurses and health care professionals on supportive techniques for women in labor, which involves improving pain assessments and keeping families informed;
    • Integrating doulas into the hospital's birth care team, which involves defining roles, setting expectations, and fostering teamwork between nurses and doulas; and
    • Using best-practice protocols for the use of regional anesthesia, such as epidurals.


    New Jersey's Health Commissioner Shereef Elnahal in a statement said, "As long-time partners with NJHA in the New Jersey Perinatal Quality Collaborative, we have seen success in reducing preterm births significantly in our state. This new effort will build on those gains by spreading the tools and best practices so all our birthing hospitals can improve quality of care and reduce the state's high maternal mortality rate."

    Separately, Linda Schwimmer, CEO and president of the New Jersey Health Care Quality Institute, said, "In our work, we've seen that physician and nurse leadership is the most important ingredient to improving the outcomes," adding that "early clear communication with patients about their birth plan and setting expectations is also important" (Knowles, Becker's Clinical Leadership & Infection Control, 6/21; Stainton, NJ Spotlight, 6/19; NJHA release, 6/4).

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