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Complete Health Indicator Report of Cesarean Deliveries among Low Risk Women

Definition

The low-risk cesarean delivery rate is the percentage of cesarean deliveries among '''n'''ulliparous (first birth), '''t'''erm (37 completed weeks or more, based on the obstetric estimate), '''s'''ingleton (one fetus), '''v'''ertex (head first) births, sometimes referred to as NTSV births.

Numerator

Number of cesarean deliveries among nulliparous, full-term, singleton, vertex presentation (NTSV) births

Denominator

Total number of nulliparous, full-term, singleton, vertex presentation (NTSV) births

Why Is This Important?

Compared to vaginal deliveries, cesareans carry an increased risk of infection, blood clots, longer recovery, and difficulty with future pregnancies.

Healthy People Objective: Reduce cesarean births among low-risk (full-term, singleton, vertex presentation) women: Women with no prior births

U.S. Target: 24.7 percent
State Target: 27.9 percent

Other Objectives

'''Healthy NJ 2020 Objective MCH-14''': Reduce cesarean births among low-risk (nulliparous, full-term, singleton, vertex presentation) women to 27.9% among the total population, 27.0% among Whites, 29.3% among Blacks, 27.6% among Hispanics, and 30.2% among Asians.

How Are We Doing?

The cesarean delivery rate among low risk (NTSV) births declined in 2010 for the first time since the mid-1990s and in 2020 stood at 26.2%. The rate is higher among Asian (30.2%) and Black (29.9%) mothers than among Hispanic (25.8%) and White (24.4%) mothers. The Healthy New Jersey 2020 target for all low-risk mothers and for Whites, Hispanics, and Asians were achieved. If the current trend continues, the target for Blacks will also be achieved within a year or two.

How Do We Compare With the U.S.?

The low-risk cesarean rate in New Jersey began to rise in 1995, two years ahead of the US rate, and rose more quickly than the national rate. Both rates peaked in 2009. 2020 was the first year in which New Jersey's rate was not statistically significantly higher than the US rate.

What Is Being Done?

In 2017, a team composed of DOH staff and external partners collaborated to develop a plan to reduce low risk c-sections in New Jersey hospitals. In 2018, DOH awarded [https://nj.gov/health/news/2018/approved/20180711a.shtml $4.7 million] to eight agencies to improve health outcomes among infants and mothers in New Jersey, including implementation of a doula pilot program to reduce the likelihood of certain birth and delivery/labor outcomes such as cesarean births. In 2021, the state [https://nj.gov/governor/news/news/562021/approved/20210202b.shtml Medicaid program began covering doula care], while also no longer paying for non-medical early elective deliveries. The same year, the [https://nurturenj.nj.gov/wp-content/uploads/2021/01/20210120-Nurture-NJ-Strategic-Plan.pdf Nurture NJ Strategic Plan] recommended that all NJ birthing hospitals meet or attain NTSV cesarean birth rates lower than the national target by instituting new, comprehensive informed consent processes for all maternity patients so that patients understand the short- and long-term risks of c-sections and the benefits of spontaneous labor for both parents and newborns. The Plan also recommended more aggressive action by state government agencies to ensure improvement, including limitations on participation in provider networks for hospitals who do not meet targets.[https://nurturenj.nj.gov/wp-content/uploads/2021/01/20210120-Nurture-NJ-Strategic-Plan.pdf#page=61 ^1^]

Available Services

See Programs and Resources on [https://nj.gov/governor/admin/fl/nurturenj.shtml]


Related Indicators

Related Health Care System Factors Indicators:



Data Tables


Low-Risk Cesarean Deliveries by Year, New Jersey and the United States, 1990-2020 (HNJ2020)

US/NJYearPercentage of Low-Risk BirthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 62
US199021.6%
US199121.4%
US199221.0%
US199320.2%
US199419.1%
US199518.8%
US199618.5%
US199718.4%
US199818.7%
US199919.5%
US200020.3%
US200121.6%
US200223.1%
US200324.3%
US200425.7%
US200526.6%
US200627.1%
US200727.5%
US200827.8%
US200928.1%
US201027.5%
US201127.2%
US201227.2%
US201326.8%
US201426.0%
US201525.8%
US201625.7%
US201726.0%
US201825.9%
US201925.6%
US202025.9%
NJ199023.5%23.0%23.9%8,88237,865
NJ199122.6%22.1%23.0%8,76338,847
NJ199222.4%22.0%22.8%8,53638,166
NJ199323.1%22.7%23.5%8,86438,397
NJ199422.0%21.6%22.4%8,48238,517
NJ199520.9%20.5%21.4%7,84237,465
NJ199621.4%21.0%21.8%8,10337,834
NJ199722.6%22.2%23.0%8,44337,394
NJ199823.2%22.8%23.6%8,65237,321
NJ199923.6%23.2%24.0%8,66236,688
NJ200025.1%24.6%25.5%9,55938,124
NJ200125.7%25.3%26.2%9,73537,866
NJ200227.9%27.4%28.3%10,43337,453
NJ200330.3%29.8%30.8%11,65338,468
NJ200432.3%31.8%32.8%12,16037,677
NJ200533.9%33.4%34.4%12,51336,919
NJ200634.6%34.1%35.1%12,88937,258
NJ200735.4%34.9%35.9%13,41537,903
NJ200835.3%34.8%35.8%13,13637,180
NJ200936.3%35.8%36.8%13,14436,163
NJ201034.9%34.4%35.4%12,27735,129
NJ201134.9%34.4%35.4%12,07234,586
NJ201235.1%34.6%35.6%11,91733,967
NJ201333.5%33.0%34.0%11,06933,066
NJ201432.4%31.9%32.9%10,64832,879
NJ201531.0%30.5%31.5%10,18032,828
NJ201630.4%30.0%30.9%10,52534,581
NJ201729.7%29.2%30.2%10,21034,399
NJ201828.0%27.6%28.5%9,59034,191
NJ201927.0%26.5%27.5%9,10733,747
NJ202026.2%25.8%26.7%8,75433,356

Data Notes

This is Healthy New Jersey 2020 (HNJ2020) Objective MCH-14. Confidence intervals are not available for U.S. data.

Data Sources

  • Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health
  • National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), [https://www.cdc.gov/nchs/index.htm]


Low-Risk Cesarean Deliveries by Year and Mother's Race/Ethnicity, New Jersey, 1990-2020 (HNJ2020)

Race/EthnicityYearPercentage of Low-Risk BirthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 124
White199024.1%23.6%24.7%5,83324,181
White199123.0%22.5%23.6%5,60724,330
White199222.7%22.2%23.2%5,33023,487
White199323.2%22.7%23.8%5,43823,439
White199422.3%21.7%22.8%5,15523,151
White199521.2%20.7%21.8%4,76122,414
White199621.6%21.0%22.1%4,78322,182
White199722.3%21.8%22.9%4,83221,668
White199822.8%22.2%23.4%4,82821,192
White199923.5%23.0%24.1%4,83520,544
White200024.8%24.2%25.4%5,17920,899
White200126.0%25.4%26.6%5,22520,107
White200228.9%28.3%29.5%5,66319,597
White200331.2%30.6%31.9%6,18619,797
White200433.0%32.3%33.7%6,23218,881
White200534.9%34.2%35.6%6,38418,290
White200635.7%35.0%36.4%6,38917,874
White200736.9%36.1%37.6%6,56017,801
White200835.8%35.1%36.6%6,13617,124
White200937.1%36.4%37.8%6,17016,625
White201034.8%34.1%35.6%5,70416,380
White201134.7%34.0%35.5%5,60416,137
White201234.9%34.2%35.7%5,40315,472
White201332.6%31.9%33.3%5,05515,509
White201431.4%30.7%32.2%4,81515,325
White201530.0%29.3%30.8%4,54715,133
White201629.3%28.6%30.0%4,64315,831
White201728.2%27.5%28.9%4,50715,970
White201826.6%25.9%27.3%4,15015,597
White201925.6%25.0%26.3%3,93515,349
White202024.4%23.7%25.0%3,76515,456
Black199021.2%20.2%22.2%1,3706,454
Black199120.8%19.8%21.8%1,4506,978
Black199220.3%19.4%21.3%1,3566,665
Black199321.9%20.9%22.9%1,4736,735
Black199422.1%21.1%23.1%1,4946,767
Black199520.3%19.3%21.3%1,2396,101
Black199621.7%20.7%22.8%1,2935,952
Black199723.5%22.4%24.7%1,3375,679
Black199824.9%23.8%26.0%1,4275,739
Black199924.0%22.9%25.2%1,3235,507
Black200027.4%26.3%28.6%1,5255,560
Black200126.7%25.5%27.9%1,4695,509
Black200229.3%28.0%30.5%1,5745,380
Black200332.1%30.8%33.4%1,6755,217
Black200433.8%32.5%35.1%1,7305,114
Black200535.3%34.0%36.6%1,8495,232
Black200634.8%33.6%36.1%1,8565,328
Black200735.1%33.8%36.4%1,9475,546
Black200836.5%35.2%37.8%2,0375,583
Black200936.3%35.0%37.6%1,9615,397
Black201036.0%34.7%37.3%1,8735,208
Black201136.0%34.7%37.3%1,8225,059
Black201236.4%35.1%37.7%1,8615,112
Black201334.9%33.5%36.2%1,6434,711
Black201434.1%32.7%35.5%1,5364,504
Black201532.5%31.1%33.9%1,4084,331
Black201632.6%31.2%34.0%1,4184,347
Black201731.9%30.6%33.4%1,3544,238
Black201831.5%30.1%32.9%1,3584,313
Black201931.5%30.1%32.9%1,2984,123
Black202029.9%28.5%31.4%1,1743,923
Hispanic199023.4%22.3%24.5%1,3095,599
Hispanic199122.6%21.5%23.7%1,3285,881
Hispanic199223.3%22.2%24.4%1,3945,988
Hispanic199323.7%22.6%24.8%1,4546,142
Hispanic199421.8%20.8%22.9%1,4026,422
Hispanic199520.4%19.5%21.4%1,3346,525
Hispanic199621.0%20.1%22.0%1,4206,755
Hispanic199722.2%21.2%23.2%1,5206,843
Hispanic199823.2%22.3%24.3%1,6236,982
Hispanic199923.4%22.4%24.4%1,6537,069
Hispanic200024.6%23.7%25.6%1,8957,695
Hispanic200124.7%23.7%25.6%1,9848,041
Hispanic200225.4%24.5%26.4%2,1158,322
Hispanic200327.9%27.0%28.8%2,5099,000
Hispanic200430.3%29.3%31.2%2,8069,269
Hispanic200531.4%30.4%32.4%2,8529,083
Hispanic200632.8%31.8%33.7%3,1439,595
Hispanic200732.8%31.8%33.7%3,1939,748
Hispanic200832.5%31.6%33.4%3,0729,450
Hispanic200933.6%32.6%34.5%3,0809,180
Hispanic201033.5%32.5%34.5%2,8938,645
Hispanic201133.1%32.1%34.1%2,8098,491
Hispanic201233.7%32.7%34.8%2,7848,249
Hispanic201333.1%32.1%34.1%2,6518,011
Hispanic201432.2%31.2%33.2%2,5467,913
Hispanic201530.7%29.7%31.7%2,4698,048
Hispanic201629.7%28.7%30.7%2,4128,121
Hispanic201730.0%29.0%31.0%2,4318,114
Hispanic201827.7%26.7%28.6%2,2778,231
Hispanic201926.0%25.1%27.0%2,1758,356
Hispanic202025.8%24.8%26.7%2,1838,472
Asian199023.8%21.6%26.2%3171,330
Asian199123.9%21.8%26.1%3641,525
Asian199222.3%20.4%24.2%4091,837
Asian199324.5%22.5%26.5%4461,824
Asian199420.4%18.6%22.3%3861,896
Asian199521.2%19.5%23.1%4472,105
Asian199621.1%19.6%22.7%5542,624
Asian199723.8%22.3%25.4%6902,897
Asian199822.7%21.2%24.2%6823,006
Asian199924.1%22.6%25.6%7683,191
Asian200024.4%23.0%25.8%9023,702
Asian200125.0%23.6%26.3%9873,955
Asian200226.0%24.6%27.4%1,0233,939
Asian200328.6%27.2%30.0%1,2134,243
Asian200431.1%29.7%32.5%1,3084,206
Asian200533.4%31.9%34.8%1,3724,113
Asian200633.8%32.4%35.2%1,4324,236
Asian200735.9%34.5%37.3%1,6084,480
Asian200837.7%36.3%39.1%1,7284,586
Asian200939.7%38.2%41.1%1,7404,384
Asian201037.4%36.0%38.9%1,6094,301
Asian201138.2%36.8%39.6%1,6704,373
Asian201236.8%35.4%38.2%1,6794,561
Asian201335.7%34.2%37.1%1,5064,223
Asian201434.3%32.9%35.7%1,4814,320
Asian201533.7%32.3%35.1%1,4274,235
Asian201633.4%32.0%34.7%1,6624,982
Asian201732.3%31.0%33.6%1,5564,813
Asian201830.3%28.9%31.6%1,4184,687
Asian201929.5%28.2%30.8%1,3474,571
Asian202030.2%28.8%31.6%1,2844,254

Data Notes

This is Healthy New Jersey 2020 (HNJ2020) Objective MCH-14. Data for White, Black, and Asian do not include Hispanics. Hispanic ethnicity includes persons of any race.

Data Source

Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health


Low-Risk Cesarean Deliveries by Race/Ethnicity, New Jersey 2020

Race/EthnicityPercentage of Low-Risk BirthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 6
White24.4%23.7%25.0%3,76515,456
Black29.9%28.5%31.4%1,1743,923
Hispanic25.8%24.8%26.7%2,1838,472
Asian30.2%28.8%31.6%1,2844,254
New Jersey26.2%25.8%26.7%8,75433,356
United States25.9%310,303

Data Notes

Data for White, Black, and Asian do not include Hispanics. Hispanic ethnicity includes persons of any race.

Data Source

Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health


Low-Risk Cesarean Deliveries by County, New Jersey, 2020

CountyPercentage of Low-Risk BirthsLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 23
Atlantic29.0%26.1%32.2%258889
Bergen28.3%26.8%29.9%8933,154
Burlington22.6%20.6%24.8%3431,517
Camden20.3%18.5%22.2%3871,909
Cape May29.4%24.0%35.6%73248
Cumberland18.9%15.6%22.6%97514
Essex27.2%25.6%28.8%8623,171
Gloucester21.1%18.6%23.9%195924
Hudson29.8%28.4%31.2%1,2164,086
Hunterdon26.3%21.8%31.4%90342
Mercer24.6%22.3%27.0%3321,351
Middlesex29.3%27.7%31.0%8793,002
Monmouth25.0%23.1%26.9%5122,050
Morris27.1%25.0%29.4%4501,659
Ocean18.5%16.9%20.2%4262,304
Passaic29.7%27.8%31.8%6052,036
Salem29.1%22.8%36.4%53182
Somerset27.1%24.5%29.9%2891,067
Sussex26.8%22.9%31.0%128478
Union26.8%25.0%28.7%5812,167
Warren27.8%22.9%33.2%85306
New Jersey26.2%25.8%26.7%8,75433,356
United States25.9%310,303

Data Source

Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health

References and Community Resources

1. [https://nurturenj.nj.gov/wp-content/uploads/2021/01/20210120-Nurture-NJ-Strategic-Plan.pdf#page=61 Nurture NJ 2021 Strategic Plan], pages 61-62. Curtin SC, Gregory KD, Korst LM, Uddin SFG. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: New data from the birth certificate, 2013. National vital statistics reports; vol 64 no 4. Hyattsville, MD: National Center for Health Statistics. 2015. [https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_04.pdf] Osterman MJK, Martin JA. Trends in low-risk cesarean delivery in the United States, 1990-2013. National vital statistics reports; vol 63 no 6. Hyattsville, MD: National Center for Health Statistics. 2014. [https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_06.pdf] C-section Rates for NJ Hospitals: [https://nj.gov/health/maternal/] National Center for Health Statistics Method of Delivery Fast Stats: [https://www.cdc.gov/nchs/fastats/delivery.htm]

Page Content Updated On 05/19/2022, Published on 05/19/2022
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