Once again in May, New Jersey was under scrutiny for our rates of cesarean births for low-risk healthy women — rates of surgery that increase complications, increase morbidity, and impact future reproductive-health outcomes. We have rates of cesarean births that are neither safe nor sustainable. Leapfrog, a national center that collects data for quality indicators, found ongoing issues with what New Jerseyans navigate: a murky, lack-of-transparent path to get high-quality maternity care. In fact, according to Leapfrog, “New Jersey hospitals performed worse — not better — in lowering the rate of cesarean deliveries for newborns in the most recent report on the quality of maternity care.”
What does this mean for the 115,000 births that occur in New Jersey each year?
As a longtime childbirth educator, I focus on the six evidence-based practices for a safe and healthy birth published by Lamaze International, recommendations that are in alignment with the American College of Obstetricians and Gynecologists and the American College of Nurse Midwives. The six care practices give childbearing families the confidence and evidence as consumers to seek out the interventions and experiences in labor that lead to either vaginal or surgical outcomes. Consumers need a mechanism to confirm if hospitals have access to hydrotherapy, birth in nonsupine positions, comfort measures and labor support. Most important, women in my childbirth class report back to me that they still in 2018 cannot consistently get out of bed or have freedom of movement, depending on the hospital or the provider. Respectful maternity care is an indicator of quality that has been underutilized in New Jersey, and I would urge our state to listen to the voices of childbearing people and families.
Last summer, I had the honor to listen to women in New Jersey share their experiences of giving birth through two small focus groups. Participants who had recently given birth shared harrowing issues:
kept in bed without being allowed to move around in labor, even when they asked;
comfort measures like peanut balls and birth balls not available or shared with all but one participant in the focus group;
positions for laboring out of bed not discussed prenatally;
access to showers and baths in the maternity hospitals not consistently available.
While this was a very small sample of voices of New Jersey families, it is an untapped opportunity for patient engagement. To me, this is an invitation for hospitals to actively align quality indicators of a safe and healthy birth by listening to the voices of childbearing families.
When California made transforming maternity care a priority, we now see it is working. Amid rising maternal mortality and morbidity in the United States, a recent news report notes that California is defying the trends. In fact, in California, due to this commitment to link reducing racial disparities and reducing low-risk cesarean births along with other quality improvement and consumer engagement measures, “the maternal mortality rate in the state of CA is one-third of what we have in the (rest of the) United States.” California continues to generate programs that link improving maternity care to all sectors: from childcare and early-learning entities to faith-based to clinical facilities. They offer resources and research that New Jersey desperately needs to integrate, not just in one sector, but in a statewide vision. Part of how California focused on reducing disparities and reducing the risks of cesarean births is by making both clinical toolkits and consumer ratings through Yelp publicly available, focusing on quality indicators that occur during labor.
When I speak to policymakers, I have a commitment to speak with compassion as much as advocacy. We honor the two-generation impact of giving birth: a place for wonder and warmth about becoming a parent. Giving birth is part of the spectrum of human sexuality; therefore, our sensitivity and kindness to foster trust, inclusion, and optimal care for all families. Robin Wall Kimmerer — mother, scientist, and writer — explains, “Birds have the gift of song, stars the gift of shining. But with each gift comes a responsibility to use it in the service of life. Birds have a responsibility to greet the day with music, stars to guide night travelers. What gifts do humans have, and what responsibilities?” We have the gift and responsibility of transforming maternity care in New Jersey, moving it from worst to first. Let’s begin.