Originally posted by Lindy Washburn at NorthJersey.com

New Jersey hospitals have drastically reduced the practice of delivering babies early as a convenience for the mother or doctor, saving mothers and infants from potential health problems. But too many expectant mothers still deliver via Cesarean section, according to new 2016 data from a nonprofit group that promotes transparency in health care.

Early elective deliveries – when babies are born before 39 weeks of gestation, via C-section or an induced labor – have plummeted since 2010. Half of the 48 hospitals in New Jersey with obstetrics departments in the report from Leapfrog have put a complete stop to the practice: They had no early elective deliveries at all last year.

“Early elective deliveries have been cut in half since 2011,” said Donna Leusner, a spokeswoman for the state Health Department, crediting the work of the department and the New Jersey Hospital Association, among others. “Babies born just a few weeks early can have more health problems than full-term babies, so every week matters,” she said. 

The rate has fallen from 17 percent of births in 2010 to 1.9 percent nationwide, according to the Leapfrog Group – a dramatic reversal brought about by strict new hospital protocols, focused attention from a variety of advocates, and public reporting of the data. The Washington, D.C., nonprofit was founded in 2000 by employers and large purchasers of health care.

About 100,000 babies a year are born in New Jersey, with some 40,000 of those covered by Medicaid, the state and federal insurance program for low-income residents. Additional expenses for longer hospital stays for mothers and babies, or future health problems for either, contribute to higher costs for employer-sponsored insurance, as well as Medicaid.

But one New Jersey hospital – Meadowlands Hospital Medical Center in Secaucus – is an exception to the trend. It has the highest rate of early elective deliveries in the nation, at 61.4 percent. The hospital confirmed the rate, a Leapfrog spokeswoman said, noting that only two hospitals in the country had rates higher than 40 percent. A hospital spokesman did not respond to a request for comment.  An attorney for Meadowlands, Anthony K. Modafferi III, said in an email Monday evening that the report was “part of a coordinated effort … to disparage and financially harm Meadowlands and its owners.”

Only 229 babies were born at the Secaucus hospital in 2016, according to preliminary state data – fewer than one a day. But a company based at the hospital advertised online to pregnant Russian citizens, urging them to travel to the hospital to give birth, to ensure that their babies automatically qualified to be American citizens, according to an investigation published last August by NJ Spotlight, a nonprofit online news service. The Facebook page for the agency, AmeriMama, is no longer available.

State health officials “met with Meadowlands officials last summer and urged them to improve maternal and child health outcomes,” Leusner said. They “also reviewed the hospitals’ OB/GYN hospital practice protocols.”

C-section rate high

The Leapfrog report found that the C-section rate remains stubbornly high. In New Jersey, the rate of surgical births for low-risk mothers – those with a single baby at full term in the head-down position — averaged 28.3 percent. That was among the worst rates nationwide, behind Louisiana, Florida, Texas, New York, Virginia and Nevada.

Where a mother chooses to have her baby can make a big difference in whether she will have a C-section, according to Linda Schwimmer, president of the New Jersey Health Care Quality Institute, which works with Leapfrog to promote hospital transparency in the state.

Fifteen of 54 New Jersey hospitals meet or beat the target C-section rate of 23.9 percent, set by the federal Health and Human Services Department. “Those hospitals are proof that this is very achievable,” said Schwimmer. “What we hope to do is see those hospitals disseminate their best practices and experience to other hospitals across the state.”

Whether the hospital is small or large, teaching or nonteaching, urban or rural, doesn’t affect the C-section rate or other measures of maternity care, according to Leapfrog data.

Hackensack University Medical Center, the busiest maternity hospital in the state with more than 6,400 births last year, had the highest C-section rate — 42.8 percent, according to Leapfrog. Just a few miles away, Holy Name Medical Center in Teaneck had a C-section rate of 18.5 percent. University Hospital in Newark had the lowest rate in the state, 14.9 percent.

Among local hospitals, St. Joseph’s Regional Medical Center in Paterson and Chilton Medical Center in Pompton Plains showed improvement over last year in their rates of Cesarean births, with 34.3 percent and 26.0 percent, respectively.

This year’s report included data from HackensackUMC at Pascack Valley for the first time. The Westwood hospital, with 957 births in 2016, according to preliminary state data, had a C-section rate of 27.5 percent.

Episiotomies vary

The practice of widening the birth canal during childbirth with a small incision, known as an episiotomy, also varied considerably among hospitals, Leapfrog found. This can cause subsequent bladder or bowel problems for the mother, or pelvic-floor defects. They were performed in less than 10 percent of deliveries last year, a decline, but still far from the goal of less than 5 percent, Leapfrog said.

Northern New Jersey hospitals had some of the highest episiotomy rates in the state, with 32.7 percent at Holy Name; 29.5 percent at Hackensack; 23.1 percent at HackensackUMC at Pascack Valley; and 23 percent at HackensackUMC Palisades. The lowest rate in the state was at St. Mary’s General Hospital in Passaic, with episiotomies used in 0.4 percent of births.

Only four hospitals in New Jersey declined to report their data to Leapfrog.

http://www.northjersey.com/story/news/health/2017/02/28/nj-cuts-down-number-planned-early-childbirths/98492176/