DefinitionThe 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.
NumeratorNumber of cesarean deliveries among nulliparous, full-term, singleton, vertex presentation (NTSV) births
DenominatorTotal 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. Reducing cesarean births among low-risk women is a goal of the Healthy People 2020 initiative.
Healthy People Objective: Reduce cesarean births among low-risk (full-term, singleton, vertex presentation) women: Women with no prior cesarean birthsU.S. Target: 23.9 percent
State Target: N/A - NJ objective is for women who have never given birth before. US objective is for women who have never had a c-section before.
Other Objectives'''Healthy NJ 2020 Objective MCH-14 (NEW)''': 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 New Jersey mothers declined in 2010 for the first time since the mid-1990s and in 2017 stood at 29.7% of births. The rate is slightly higher among Asian and Black (32%) mothers than among Hispanic (30%) and White (28%) mothers. It is also higher overall among foreign-born mothers than US-born mothers. Cesareans are performed more frequently among older mothers and among non-Medicaid recipients.
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. Currently, the New Jersey low-risk cesarean rate is about 14% higher than the national rate.
What Is Being Done?In 2017, a team composed of DOH staff and external partners [http://www.njha.com/njpqc/initiatives/collaborative-to-reduce-nulliparous-term-singleton-vertex-ntsv-cesarean-deliveries/ 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.