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Could ‘Maternity Report Card’ Help Reduce NJ’s High C-section Rate?

Information about birth procedures and maternal health — tailored to pregnant women and new moms — could help boost health of mothers and children

Suzanne Christian and son Rafael Bane, participants in the Strong Start program to improve maternal-child health at St. Peter's University Hospital, New Brunswick

New Jersey has worked diligently to bring down its stubbornly high rates of cesarean section deliveries, but they remain at least 10 points higher than the national average, and the numbers vary significantly among hospitals across the state.

Now one lawmaker is hoping to harness that data to empower women to take more control of their healthcare decisions.

Assemblywoman Valerie Vainieri Huttle, (D-Bergen), is championing legislation that would require state officials to collect specific information about birth procedures and maternal health and publish that data as a Report Card on Maternal Care, which would be updated annually. While much of this information is already collected by state agencies, it is not compiled in a format specifically for mothers to be.

First introduced in 2014, Vainieri Huttle’s proposal was approved by the Assembly Woman and Children’s Committee Monday. It would require each hospital licensed for maternal-infant care to report the number of deliveries, number of C-sections, rates of complications, and possibly other factors, based on recommendations by the American Congress of Obstetricians and Gynecologists.

Major surgery with ‘serious risks’

C-sections involve major surgery and carry “serious risks of infection or blood clots” and may result in longer recovery time and difficult pregnancies in the future, according to the Leapfrog Group, a nonprofit hospital watchdog that issues regular reports on hospital performance, including maternal-child health. The procedure can also cause breathing difficulties for infants, which sometimes require costly care in a neo-natal intensive care unit (NICU), and leave children at higher risk for chronic conditions like asthma and diabetes.

The legislative proposal reflects a growing awareness of the importance of key maternal health indicators, not just to protect the mothers and their infants, but also to hold down the cost of unnecessary care. In some aspects — like the percentage of breastfeeding mothers — New Jersey has seen positive gains, but in other areas, like C-sections, experts say more needs to be done.

The Medicaid 2.0 Blueprint, a long-term plan for the public health insurance that covers 1.8 million poor and low-income state residents, unveiled Monday by the New Jersey Health Care Quality Institute and the Nicholson Foundation, also addresses these maternal health goals. The plan calls for payment reforms and other programs designed to improve delivery outcomes and control hospital costs. Medicaid spent nearly $700 million on Garden State births in 2014, the report found, and C-sections are a significant contributor to these costs.

According to Leapfrog’s latest report, released in late February, hospitals have seen significant success nationwide in reducing the numbers of early-elective deliveries — chemically induced births that provide convenience, but can lead to lower health outcomes for mom and baby. This also is true for episiotomies — a surgical procedure to widen the birth canal, but that may also cause long-term problems. (However Meadowlands Hospital Medical Center, in Secaucus, reported delivering more than 60 percent of the babies born there by early-elected delivery, a national record.)

Stubborn trends

But C-section trends have been more stubborn, Leapfrog found. Focusing on low-risk, first-time mothers for whom the procedure was not deemed medically necessary, the group found 25.8 percent of births were done surgically at the hospitals reporting. While this is down from 26.4 percent in 2015, it is still above the Leapfrog target of less than 24 percent.

According to data collected by the state Department of Health, the rate of all C-sections in New Jersey (including those required by a doctor) has hovered between 36 percent and 37 percent of all births in recent years. This is down from more than 38 percent in 2009, due in part to efforts by the DOH, March of Dimes, and officials at the New Jersey Hospital Association to help hospitals better understand the risks involved with these unnecessary maternal-child surgeries.

The state has also invested $13.5 million to help community health providers educate new moms on the downsides of the procedure, officials said. (Some 90 percent of mothers who have their first baby by C-section also deliver later children in this way.)

The Leapfrog reports shows how C-section numbers vary greatly among New Jersey facilities, from a low of 14.9 percent at University Hospital, in Newark, and 17.5 percent at Inspira Medical Center, in Elmer, to 42.4 percent at CentraState Medical Center, in Freehold, and 42.8 percent at Hackensack University Medical Center. And that spread is a big factor in Vainieri Huttle’s push to make the data more publicly accessible.

Rates vary significantly by hospital

“Hospital to hospital, the C-section rate can vary significantly. Families should have this information at hand when deciding which hospital is right for them,” Vainieri Huttle said.

“This critical information, once compiled, will be crucial to expecting moms and families,” she continued “With this legislation, families will be able to use information on a hospital’s maternity care as part of their decision-making process when selecting the best hospital to suit their needs.”

Donna Leusner, communications director for the DOH, said the state already collects much of this data and it is available through several sources and databases, including the State Health Assessment Data (SHAD), which allows people to search by county and maternal-health indicators, and the Hospital Performance Report, which includes metrics from all state facilities. Resources include a current SHAD report related to maternity care and data on maternity hospitalizations per county.

“The department also collects data on C-sections and monitors trends so we can bring care trends to the attention of hospitals,” Leusner said, noting they share their findings with NJHA through its Perinatal Collaborative program.

These education programs appear to be having the desired effect. One developed by the Centers for Medicare and Medicaid Services, called Strong Start for Mothers and Newborns, is underway at dozens of hospitals nationwide, including eight in New Jersey. Highlighted as part of the Medicaid 2.0 blueprint, the program is designed to reduce-C-section rates, improve breastfeeding numbers, and encourage other healthy practices.

St. Peter's University Hospital, New Brunswick launched the program in late 2013 and, while additional data analysis is still pending, officials said it has involved some 1,200 women and that the impact has been largely positive. While 31 percent of all moms covered by Medicaid leave the hospital breastfeeding, the rate jumps to 71 percent for participants in Strong Start, explained Celeste Wood, with the Central Jersey Family Health Consortium, which helps run the program.

New mom Suzanne Christian, whose son Rafael Bane was born at St. Peter's on February 3, praised the Strong Start program for the practical tips and emotional support it provided. Christian said she was a bit leery at first, but when she joined her first support group meeting with other young moms scheduled to deliver around the same time, she soon recognized how much they had in common. Now the new moms stay in touch on social media.

“We just started laughing,” Christian said, recalling the first peer-group session. “We talked soup to nuts about pregnancy.”

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