According to APP.com, New Jersey has the highest incidence of birth by Cesarean section in the nation. While medical research has shown that C-sections are absolutely necessary in about 15 percent of cases, 40 percent of all hospital births in New Jersey were by Cesarean section in 2009. The rates varied greatly - from the lowest rate of 20.8 percent C-section deliveries at Kimball Medical Center to CentraState Medical Center, among the highest in the state, at 48.9 percent. APP.com reports that the state Department of Health and Senior Services and the Institute for Quality and Patient Safety at the New Jersey Hospital Associates have launched a statewide quality improvement initiative to determine why New Jersey's rate of C-section births is the highest in the nation and why there is such variability from one hospital to another.
The primary focus of the two-year study is reportedly to reduce the number of deliveries before the 39-week, full-term benchmark. Aline Holmes, director of the institute, also stated that a parallel aim for the study is to reduce the overall volume of Cesarean deliveries. The Courier Post Online states that physicians, nurses, midwives and other health care professionals from 45 hospitals in the state are involved in the effort.
Unnecessary Risks
C-sections generally carry more risks for the mother, including risks of infection, other complications from surgery and longer recovery times. Various explanations exist for the rate of Cesarean births in New Jersey and the rising rate nationally including:
· Some obstetricians claim that unnecessary C-sections are the result of the fear of malpractice insurance and litigation. Dr. Eric Lehnes, president of the medical staff at Kimball notes the coincidence that New Jersey has both the highest per-capita number of C-sections in the country and the highest number of lawyers per capita, claiming that vaginal birth is safer for the mother but C-sections are slightly safer for the child and definitely safer for the doctor.
- Some mothers say their doctors prefer the ease of a scheduled birth, when compared to the potential for protracted labor
- Doctors may claim that the age, level of obesity and even career of the mother increasingly dictates delivery mode
In a study by the Division of Family Health Services of the New Jersey Department of Health and Senior Services, researchers Charles E. Denk, PhD, and Kathryn P. Aveni, RNC MPH, examined New Jersey Electronic Birth Certificate (EBC) files from 1997 through 2005. EBC files are linked to hospital billing records for delivery and for readmissions up to 60 days postpartum. Among other questions, the study sought to examine whether, amid the rise of Cesarean deliveries in the state and nationwide, C-section births are a safer choice now than in 1997. The study results indicate that while, on average, a woman has a lower risk of many complications, she still experiences the same relative increase in risk when undergoing a Cesarean, with or without trial of labor. The researchers saw a tenfold increase in systemic complications for C-section deliveries and in no case was the risk of complication lower for Cesarean in 2005 than for vaginal delivery ten years earlier.
Proactive Protection for Mother and Baby
There are ways for expecting mothers to protect themselves, including:
- Research: Mothers-to-be should feel free to inquire about rates of Cesarean delivery when selecting a hospital or doctor. Other areas of consideration may include how many delivery teams are on duty around the clock and what, if any, ongoing education, training and emergency drills are required of staff.
- Communication: Pregnant patients should be granted an open level of communication with their doctors, encouraging honesty regarding risk factors.
- Birth plan: A birth plan allows the expecting mother to offer her wishes and expectations clearly and in writing, prior to the rush of emotions in the delivery room. Terms of the birth plan may include the mother's requests regarding who may be present at the time of delivery, offers of anesthetics or analgesics, and avoidance of Cesarean absent imminent danger to the baby.
Mothers or babies who have suffered injury or unnecessary surgery during delivery should consult with an attorney. Although it may feel as though it is a trauma best addressed personally, an experienced personal injury attorney can protect the interests of the injured person.
