Scheduled Induced-Labor Deliveries Continue to Decline at NJ Hospitals

Andrew Kitchenman | February 23, 2015 | Health Care
Number of episiotomies performed also diminishes, but still ranks among highest in the nation, report indicates

baby birth delivery
The practice of scheduling baby deliveries at a time most convenient for doctors and mothers by inducing labor is on the wane in New Jersey; a hospital-ratings group says the practice has dropped to only 4 percent in the past two years.

New Jersey once had a much worse record for scheduling birth deliveries, which can cause medical complications for mother and child. In 2010, 15.7 percent of babies were delivered that way, according to the Leapfrog Group’s annual maternity hospital survey.

Reducing early-elective deliveries has been a priority for the Leapfrog Group — a nonprofit that tracks hospital safety measures –the March of Dimes, and the New Jersey Hospital Association through a quality improvement program funded by the 2010 Affordable Care Act. There was a sharp national increase in these deliveries between 1990 and 2006, followed by a sharp decline in the past five years.

The report found that New Jersey also has room for improvement when it comes to the rate of episiotomies — surgical incisions used to widen the opening during births — and the share of hospitals set up to deal with babies with very-low birth weights.

While the improvement in induced-labor deliveries has been broad-based, some New Jersey hospitals are well above the Leapfrog Group standard of 5 percent: Meadowlands Hospital Medical Center, 34.3 percent; Saint Barnabas Medical Center, 20 percent; and Englewood Hospital and Medical Center, 12.3 percent. Twelve of the 57 New Jersey hospital included in the survey reported 0.0 percent early-elective procedures, while 10 hospitals declined to participate.

“We’ve seem a lot of progress both nationally and in the state of New Jersey with reducing early-elective deliveries,” said Erica Mobley, a Leapfrog Group spokeswoman.

New Jersey Health Care Quality Institute Vice President Linda Schwimmer said hospitals are learning from one another how to improve. In addition, some doctors and patients still must learn more about the benefits of avoiding induced labor.

“It’s a matter of having the conversation with the patient as to why it’s better to wait and as to why it’s better to go full term,” Schwimmer said. “Most patients would want to do what’s best for them and their baby … It’s a matter of fostering that cultural change and conversation — making it a priority.”

New Jersey hospitals averaged 17.5 percent for births with episiotomies, down 1 percent from 2013. It was the fourth-highest rate of the 33 states with at least five hospitals reporting results, after Alabama, Mississippi and Utah. “That’s definitely something to be concerned about,” Mobley.

Mobley noted that there has been national progress in reducing episiotomies, which are associated with some complications, since the organization began reporting on the procedures in 2012. But the decline hasn’t been as steep as for induced labor.

Most likely that’s because hospitals can exert control over the scheduling of procedures, but they have less control over the techniques that physicians think are appropriate.

Schwimmer said that while the episiotomy rate was important to measure, she expects that New Jersey’s will continue to improve as medical practices change. She noted that states with lower rates also tend to have more deliveries by midwives, where episiotomies are less likely.

“It’s important to look at it in context and it’s important to look at it as an evolution,” Schwimmer said. She noted that the American Congress of Obstetricians and Gynecologists has recommended against using episiotomies, which has contributed to steady national decline in their use.

The report also focused on how prepared hospitals are to deliver very-low-weight babies, which requires an on-site neonatal intensive-care units (NICU). It measured the percentage of hospitals in each state that deliver at least 50 very-low-weight babies per year or that have lower-than-average rates of these babies becoming sick or dying.

Only 29 percent of New Jersey hospitals fully met the Leapfrog Group standards, but that rate was slightly higher than what was typical of hospitals across the country. Tennessee was the only state with more than five hospitals reporting results where more than half of the hospitals met the report standards.

“It’s still indicating that there are too many babies being born at hospitals that aren’t adequately equipped to care for these very-high-risk infants,” Mobley said.

Employers looking for more information about hospital quality established the Leapfrog Group. Mobley said maternity care is a focus of the organization because of its importance to both costs and employee satisfaction and retention, as well as because of the importance of the information to consumers.

Mobley noted that childbirth is also one of the major healthcare services that enable consumers to shop around. “Women really do have a significant amount of time in most cases to do research on” maternity care, she said.