As a longtime doula, childbirth and maternal health educator, I have been following New Jersey’s recent engagement on maternal health with great hope. Maternal mortality and infant health were a focus of the Fourth Annual Population Health Summit in Princeton last week. Just last week also, New Jersey-born Harvard obstetrician, Dr. Neel Shah commented on a special report in U.S. News & World Report in which New Jersey made the list as No. 4 of the ten worst states for the highest rates of cesarean sections.
This is not a new statistic and there are statewide initiatives that have been responding to the state’s unsafe and unsustainable rate of such births. In his commentary, Dr. Shah wrote, “For mothers, birth complications such as hemorrhage, infection and organ injury are three times more likely to occur with a cesarean compared with a vaginal delivery — risks that increase with each subsequent cesarean a mother has. Even in the absence of complications, taking care of a newborn infant is a much more difficult task when a mother has a 10-centimeter incision on her abdomen.” The U.S. News special report reminds us to maintain attention on the issue.
It’s hard to overstate the potential impacts of a C-section, both for the mother — as Dr. Shah underlined — but also for the baby: higher rates of infection, respiratory complications, and neonatal intensive care unit stays.
But, as the conversation continues over how to reduce the C-section rate, a question to keep in mind is, how can clinical facilities and providers partner with expectant parents to ensure access to high-value maternity care? Lamaze International has guidelines for safe and healthy birth practices based on research from the American College of Obstetricians and Gynecologists and the American College of Nurse Midwives. A high C-section rate can indicate a facility’s lack of evidence-based maternity care practices that could impact a woman’s future health.
We must acknowledge that consumers in New Jersey have no easy way to learn about facilities that use evidence-based care practices for labor and birth. Recent legislation has helped highlight the state’s high C-section rate. Expectant families can check a Department of Health online report card and map for the C-section rate in individual facilities. But the online tool is hard to use and could do with an upgrade. And it would be a big improvement if information on other indicators that contribute to a safe and healthy birth were added. For example, expectant families who want to ensure that women have freedom of movement in labor and are not exclusively in bed — a hallmark of a safe labor practice — have no access to transparent information about how different hospitals treat women in labor. Expectant parents often depend on friends and social media forums for word on facilities that use such practices as well as information on access to showers and tubs in labor; eating and drinking in labor, and letting labor begin on its own. So, even as we do the work of transforming maternity care in New Jersey, we are missing an important consumer tool that could give information on safe and healthy birth practices. California and New York City help consumers navigate quality maternity care with zip code databases; New Jersey should consider the same.
C-section birth rates have multiple etiologies and need multiple approaches to reduce those rates without shaming nor blaming women. While 14 of 48 New Jersey hospitals are accredited as BabyFriendly by a global program that documents where consumers will have optimal care after the birth, we need the same clarity of information on giving birth. As well as upgrading the Department of Health online tool, I’m hopeful that the state will embrace the International Childbirth Initiative; it encompasses the BabyFriendly model, but expands it for evidence-based maternity care in labor, not just after.
The initiative has 12 steps and begins by enshrining dignity and respect as central to a safe and healthy birth, recognizing that bias and racism can be part of what expectant families experience.
It’s too easy to place all the responsibility on expectant families to seek out the best facility for giving birth; that puts a lot of responsibility on families to navigate a system that currently doesn’t give them all the information they might want. It is too easy to suggest that people only take a childbirth education workshop; access to these workshops is often limited. The stakes are too high to continue with the status quo in New Jersey. I have great hope that expectant parents, as consumers of maternity care, soon will have different experiences and outcomes than previously — and much more information on their options.