C-Section Rate in New Jersey Ranks Among Highest in the Nation

Colleen O'Dea | February 14, 2014 | Map of the Week, Maps
Percentage of babies delivered by cesarean – nearly 40 percent -- trails only Louisiana

Nearly 4 of every 10 births in New Jersey occurs by cesarean section, a rate that remains stubbornly higher than the national average, according to data from the National Center for Health Statistics.

New Jersey’s C-section percentage of 38.7 percent of all births in 2011 was the second-highest in the nation, trailing only Louisiana, where 39.9 percent of all babies were delivered by cesarean section. The state has consistently had one of the highest rates in the nation despite efforts to encourage more vaginal births whenever appropriate.

Nationally, the rate hit a high of 32.9 percent, just shy of a third of all births, in 2009 and has been virtually stagnant at 32.8 percent through 2012, according to a January 2014 report on cesarean rates from the NCHS.

The highest [link:http://www.icanofnj.com/hospitalcsectionrates.htm|
rates in New Jersey] were in the northeastern counties of Bergen, Hudson and Passaic, where many of the hospitals have some of the highest c-section rates in the state. At two of those facilities — Meadowlands Hospital in Secaucus and Jersey City Medical Center — more than half of all babies were born by cesarean in 2012, according to data from the International Cesarean Awareness Network of New Jersey. The c-section rate at Meadowlands Hospital was 54.8 percent.

The lowest rate by far was in Ocean County, where just about a quarter of all births were by c-section. Two of that county’s hospitals — Kimball Medical Center and Ocean Medical Center — had among the lowest rates in the state in 2012, the ICAN data show. The lowest rate in New Jersey was at nearby Monmouth Medical Center, where 22.1 percent of births were by cesarean.

While c-sections are common today, that was not the case just 40 years ago, when only 5 percent of babies were delivered by cesarean. In the 1970s and 1980s, the rate rose to about a quarter of births. After dropping slightly during the 1990s, the rate rose precipitously in the last 15 years.

One culprit often blamed is the increase in malpractice lawsuits. And there is great disagreement over whether the c-section is overused in some of the other cases that may prompt it being recommended — a woman’s age, obesity or other medical problems, a breech baby or induced labor.

Some non-medically necessary c-sections are scheduled in advance for the convenience of the mother or doctor. And the nonprofit Childbirth Connection states that there is a financial incentive for some doctors and hospitals to do more c-sections due to greater insurance reimbursement rates.

But a cesarean should not be undertaken lightly experts warn, noting that it is abdominal surgery and, as such, carries the risk of both short-term and long-term complications.

A 2012 report by Childbirth Connection found a potential of 25 adverse health outcomes from cesarean section, including infection, hysterectomy and death for the mother and respiratory problems, asthma and diabetes for the child.

“C-sections can be life-saving in a small proportion of emergency situations,” Maureen Corry, Executive Director of Childbirth Connection, said on releasing that report in December 2012. “But today, too many low-risk women who are the least likely to benefit from cesareans are having them. That means these women and their babies face unnecessary risks and avoidable harm.”

State and national health officials are trying to reduce the number of unnecessary cesareans and the American College of Obstetricians and Gynecologists has issued guidelines to try to reduce the number of c-sections and inductions of labor before 39 weeks of pregnancy.

After missing its 2010 goal, Healthy People 2020 is working to reduce the percentage of cesarean births among low-risk women with no prior c-section from 26.5 percent in 2007 to 23.9 percent. The National Priorities Partnership, a consortium of national organizations interested in healthcare improvement, would like to reduce that further, to 15 percent or less.

The Leapfrog Group, a hospital quality watchdog, is seeking to get hospitals to reduce the percentage of early elective deliveries to less than 5 percent of all births. Between 2011 and 2012, according to Leapfrog, the national average dropped from 14 percent to 11.2 percent.

Its data for New Jersey hospitals was mixed, with most meeting the 5 percent threshold, but others significantly higher: Underwood-Memorial Hospital in Woodbury reported a 100 percent rate and the rate at Christ Hospital in Jersey City was 61 percent.