Report finds NJ hospitals are performing too many C-sections

BY Leah Mishkin, Correspondent |

A new Leapfrog report shows New Jersey hospitals are performing too many C-sections.

The state is in the bottom five in the country in terms of meeting recommended standards.

“For pregnant women, it’s hard because we want to listen to our health care providers and trust them, but we also need to, to the extent we can, arm ourselves with data like looking at the Leapfrog safety information,” said New Jersey Health Care Quality Institute President and CEO Linda Schwimmer.

The report looked at NTSV cesarean birth rates – meaning first time mothers with a single baby at term, in the head-down position, the population least likely to need a C-section delivery.

But the report shows only 9 out of 47 hospitals in New Jersey met the C-section standard rate of no more than 23.9 percent.

Christ Hospital in Jersey City reported the lowest NTSV C-section rate at 14 percent.

CentraState Medical Center in Freehold, on the other hand, performed the highest rate of C-sections in the state at 42.1 percent, far above the recommended standard.

In a statement, a spokesperson for CentraState said the hospital is, “Working with our physicians and clinicians on improving processes to lower the number of C-sections performed.”

“The hospitals that are doing well on this measure, they have weekly huddles. They go over every single C-section in the hospital and they discuss, was this appropriate, did this need to happen, was this avoidable? Sometimes it is the absolutely appropriate procedure to do, but often times it’s not,” said Schwimmer.

Leapfrog Director of Operations Erica Mobley also stressed while there are times when a C-section is necessary and critical to protect the health of both mother and child, in general it’s being used too often for non-medical related reasons, putting everyone at risk.

“Including potential risk of wound rupture, risk of infection and any number of things that can go wrong during a surgical procedure,” said Mobley. “And as for the baby, there are some studies that have shown some difficulty breathing, perhaps difficulty in beginning of breastfeeding and other challenges that can make it more difficult for the infant if a C-section is performed.”

But why is it happening? Sometimes it’s a patient’s choice either for scheduling purposes or for vanity reasons.

But Schwimmer says another reason is a doctor’s time limitations. That’s why she recommends hospitals have appropriate staffing to give women enough time to labor.

“So you’re not rushing to have a women do a C-section because somebody’s going off shift and nobody is coming on to help so we have to get it done now. Or having a C-section because the doctor wants to leave and he or she has been there for 10 hours and he or she wants to go home,” she explained.

Schwimmer says it also comes down to money. That’s why she says to improve C-section rates, hospitals have to change the payment system.

“Right now, there is a financial incentive to have higher C-section rates and to have more days of the infant being in the NICU, so it’s really taking away those financial incentives and putting in place financial incentives where hospitals and physicians are rewarded for having those better birth outcomes,” she said.

But there’s something else women planning to have a baby in the state should be aware of, according to the report — New Jersey has the highest episiotomy rates in the country.

“Which is also an intervention that is done during labor to widen the birth canal,” explained Mobley. “Many hospitals are significantly struggling with very high rates of this usually unnecessary procedure.”

Roughly three weeks after Leapfrog’s report was released, New Jersey hospitals, the New Jersey Department of Health and the New Jersey Hospital Association announced they would be collaborating on a statewide initiative to reduce non-medical C-section rates.

All 49 hospitals in the state that offer labor and delivery programs agreed to participate, and they hope to have a 10 percent reduction in NTSV C-sections by next summer.