Why Is This Important?

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

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.

Data Sources

• Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health
  (https://www.nj.gov/health/vital/)
• National Vital Statistics Reports, National Center for Health Statistics, Centers for Disease Control and Prevention
  (https://www.cdc.gov/nchs/products/nvsr.htm)

How the Measure is Calculated

How Are We Doing?

The cesarean delivery rate among low risk (NTSV) births began declining in 2010 for the first time since the mid-1990s and in 2022 stood at 26.2%. The rate is higher among Black (30.7%) and Asian (29.7%) mothers than among White (25.1%) and Hispanic (24.7%) mothers. The Healthy New Jersey 2020 targets for all low-risk mothers and for Whites, Hispanics, and Asians were achieved by 2020 and the target for Blacks was achieved in 2021.

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 and 2021 was the first year New Jersey's rate was lower 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]

More Resources

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]

Footnote References

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.