Safety and Quality in Maternity Care

The Department of Health statistically tracks many indicators of safety and quality care in maternity hospitals.

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Cesarean Delivery and Artificial Induction of Labor
New Jersey’s cesarean delivery rate is among the highest in the nation and has grown rapidly over the past decade— to nearly 40% of all births. Many hypotheses about women’s health are often discussed as causes of this trend, but subtle changes in medical practice are just as important.

For example, the graph here shows how labor induction and cesareans without labor have contributed to overall trends for first-time mothers. For more information:

Cesarean Delivery: Trends and Causes [pdf 119k]

Trends and Causes, Update 2009  [pdf 111k]

Women’s personal choices about cesarean delivery are also important, although we have little data to say whether those choices are changing rapidly, or are well supported by effective education.

National Institutes of Health: Cesarean Delivery by Maternal Request

The PRAMS survey of New Jersey mothers indicates that few women start pregnancy wishing for a cesarean, and almost half never discuss the possible need with their obstetric provider.

The PRAMS survey of New Jersey mothers indicates that few women start pregnancy wishing for a cesarean, and almost half never discuss the possible need with their obstetric provider.

PRAMS: Cesarean Delivery and Maternal Choice [pdf 322k]

Vaginal Birth After Previous Cesarean (VBAC)

VBAC has declined dramatically in the past decade in New Jersey and nationally.  A recent conference sponsored by NIH concluded that VBAC is still a safe and desirable option for many women, and challenged states and professional organizations to evaluate the capacities and barriers involved in reestablishing the practice of VBAC.

National Institutes of Health: Vaginal Birth After Cesarean, New Insights

The Department and the NJ Hospital Association have convened a VBAC Task Force to "envision" a path to that outcome—to determine what would be necessary to ensure statewide access to VBAC for women who want that option and are good obstetrical candidates.

Access to VBAC Vision Statement by the DHSS/NJHA VBAC Task Force

Rating New Jersey Hospitals

NJDOH publishes an annual report comparing New Jersey hospitals on their cesarean and related practices. The most important indicators are emergency cesareans for first-time mothers, repeat cesareans, and cesareans after a failed induction of labor. Statistics are adjusted for important differences in the populations that hospitals serve.

Cesarean Delivery: Comparing New Jersey Hospitals (2006-08) [pdf 109k]

2011 Comparisons by Region:

• North Jersey [pdf 90k]
• Northwest and Central Jersey [pdf 89k]
• South Jersey [pdf 87k]

Explanation of methods, tables [pdf 113k]

New Epidemiological Reports for New Jersey

The relative risks for various maternal peri-operative complications from cesarean delivery have not changed, in spite of the higher volume of procedures and some overall increases in safety.  Maternal Risks [pdf 174k]

Guidelines for optimal weight gain by obese mothers has not improved rates of cesarean. Obesity and Cesarean [pdf 475k]

The last decade has brought a significant increase in deliveries before 39 weeks gestation, and serious complications for the baby—many of these may be elective deliveries.  Neonatal Morbidity [pdf 119k]

Partnerships

NJDOH collaborates with the New Jersey Hospital Association in a Perinatal Collaborative, where hospitals, doctors, midwives, nurses and others share information on quality improvement in maternity care.

The March of Dimes is a national leader in the prevention of premature birth. NJDOH collaborates with the New Jersey chapter to improve practice of artificial induction of labor, particular insuring that no elective inductions are performed before the pregnancy has gone at least 39 weeks.

We Also Recommend

The Society of Obstetricians and Gynaecologists of Canada presents a comprehensive set of patient education materials with a different slant from Americans.  For example, one pamphlet is called Normal Birth

CDC Preconception Workgroup. Preconception care is recognized as a critical component of health care for women of reproductive age. The main goal of preconception care is to provide health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. 

New Jersey PRAMS (Pregnancy Risk Assessment Monitoring System) surveys new mothers each month about their experiences before, during and after pregnancy.