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Addressing C-Section Rates in New Jersey

For a number of years, the rate of Caesarean sections (C-sections) performed in New Jersey has been among the highest in the country. Since 2010, the New Jersey Hospital Association’s (NJHA) Institute for Quality and Patient Safety has been working in collaboration with us and other stakeholders to help ensure the health and safety of women and children by analyzing why C-sections are performed so frequently and working to reduce the number of C-sections performed in the state.

Early Elective Deliveries

A primary initial focus of the Institute for Quality and Patient Safety was early elective deliveries (EED): vaginal deliveries/C-sections performed electively prior to week 39 of the pregnancy, with no medical indications.

The initial analysis of the Institute for Quality and Patient Safety revealed an EED rate of about eight percent, meaning that eight percent of pregnancies resulted in an elective delivery either vaginally, after induction, or by C-section. Through their efforts working with all providers in the state, a reduction in early elective deliveries to below one percent was realized statewide by 2014.

Nulliparous Term Singleton Vertex (NTSV) C-sections

In 2017, the Institute for Quality and Patient Safety received funding from the Center for Disease Control (CDC)and established the NJ Perinatal Quality Collaborative.

One of only thirteen Perinatal Quality Collaboratives in the country, the NJ Perinatal Quality Collaborative is currently working with the NJ Department of Health to reduce the incidence of C-sections performed on first-time mothers with a normal, uncomplicated, low risk pregnancy in an effort to minimize post-partum complications for both mothers and babies.

The of C-section performed on first-time mothers in New Jersey with a normal, uncomplicated, low risk pregnancy increased from 23.5 percent in 1990 to 36.3 percent in 2009. Although there has been a modest decrease in NTSV cesarean rates, current data shows that we are still far from meeting the Healthy People 2020 target of 23.9 percent.

Primary cesarean deliveries are a major contributor to the increase in total C-section delivery rates in the US over the past two decades. Moreover, approximately 90 percent of women who have a primary cesarean delivery are likely to deliver by cesarean again in subsequent pregnancies, which incurs higher costs and progressively higher morbidity risks with each additional cesarean delivery.

For this work the NJ Perinatal Quality Collaborative will be recommending the adoption of the following key practices to promote primary vaginal deliveries, including, but not limited to:

  • Improve access to and promote quality childbirth education, informed consent and shared decision making;
  • Improve the culture of safety, teamwork and communication in the obstetrical area;
  • Implement institutional policies that uphold best practices in obstetrics, safely reduce routine interventions in low-risk women and consistently support vaginal birth;
  • Educate staff on labor support skills that promote labor progress, labor support and pain management;
  • Increase access to non-pharmacological pain management/labor progression tools;
  • Track C-section rates and conduct case reviews to drive improvement.

The Institute for Quality and Patient Safety, the NJ Department of Health and all other stakeholders are excited about these opportunities to improve care delivered to NJ mothers and babies.

Horizon BCBSNJ will work to support the efforts of this collaborative by sharing information and resources and providing educational opportunities to employees at our network hospitals that provide obstetrical services and encourage them to join in this important effort.

Maternal Health Awareness Day

Horizon BCBSNJ is pleased with how well this effort has been received by New Jersey legislators. In January of this year, New Jersey observed the first Maternal Health Awareness Day to underscore the importance of healthy pregnancies and promote the use of evidence-based protocols to help ensure successful births for NJ mothers and babies. The event included public gatherings, educational outreach, academic seminars at Rutgers Medical School, and a social media presence with the hashtag #123forMOMS.


We encourage you to access the links below to review information that was shared as part of recent educational sessions held by Horizon BCBSNJ for staff of our network hospitals.

Ariadne Labs
Delivery Decisions Initiative

Harvard T.H. Chan School of Public Health
Hospital management practices may put women at risk for C-sections during childbirth

National Partnership for Women & Families
What Every Pregnant Woman Needs to Know About Cesarean Birth
Cesarean Prevention Recommendations from Obstetric Leaders: What Pregnant Women Need to Know
Why is the U.S. Cesarean Section Rate So High?
New Professional Recommendations to Limit Labor and Birth Interventions: What Pregnant Women Need to Know

Published on: April 26, 2018, 11:51 a.m. ET
Last updated on: April 26, 2018, 12:00 p.m. ET