Nearly one in three child births in the U.S. happens through cesarean section or C-section.

But as maternal and infant deaths hit alarming numbers in the U.S. and here in New Jersey over the last several years, there's been a major effort in the state to bring down the rate of C-sections.

And it seems to be working here in New Jersey.

Joining us now to explain what's working is lavoro Kiki, who led the analysis at the Rutgers School of Public health.

Slava, thanks so much for being with us today.

Now, I know that researchers at the Rutgers School of Public Health have been looking at the rates of caesarean section here in New Jersey first.

Just help us understand what you're looking at and how the rates have changed recently.

Yeah, thank you.

So we've been looking at the rate of low risk cesarean births, which is a measure of the quality of maternal care in general in the U.S..

The rate of cesarean births has been rising.

It's gone up from about 20% back in the nineties.

It's now at about a third of births are cesarean.

And the worry there is that many of these are unnecessary caesareans.

So when when you say low risk, you mean elective.

So in other words, someone choosing to have a C-section rather than a vaginal birth.

Right.

So not not necessarily.

It could be elective.

It could be that the provider decided during the process of labor to encourage the woman giving birth to to choose the cesarean delivery.

So by low risk, what I mean is what this measure called NTSC.

So it's NOLA Paris, meaning the first birth that a woman has.

It is singleton.

So not twins or multiple births, but a single baby.

It is full term and it's in the head position, down vertex position.

So that is kind of the measure that we look at to determine whether it's low risk or high risk.

Why is the increased risk of C-section a concern?

How about nationwide?

Yeah.

So when when women have a have cesarean deliveries, they are at higher risk of some poor outcomes.

Complications like infection or blood clots, complications of anesthesia and surgery.

They can result in also increased risk of neonatal respiratory issues, as well as difficulty breastfeeding.

There's also emotional toll from having unnecessary surgery.

So there's quite a few negative outcomes and no real benefits for these low risk cesarean delivery.

Cesarean can be, of course, an important tool that an obstetrician has in their toolkit for for maternal health.

But in cases where it's unnecessary, it's not, it's not a positive for maternal health.

We know that with the Nurture NJ initiative that was rolled out by at the beginning of the Murphy administration, there was a big push to reduce low risk cesarean C-section C-sections here in New Jersey.

What is the state doing right to bring those numbers down?

Yeah, so that's what we have been looking at in our policy briefs.

And we have found a good deal of progress that New Jersey has made in reducing their their low risk cesarean rate from 30% back in 2016 now to 27%, which is a 10% decrease.

And it is a substantial drop when compared to other states which over this period of time either increase because, you know, COVID happened during this period of time.

There's lots going on.

Many states saw their rates increase or stay the same while New Jersey saw a big decrease.

So something is going right in New Jersey.

And there's been a range of policies that nurture New Jersey has implemented.

So, for example, one of the ones is prohibiting coverage of elective caesareans in certain non medically indicated situations under Medicaid and under the state health benefits program.

And school employees health benefits program.

So that's been an important factor in in this drop.

There's been other policies as well.

So increasing access to do less and less have been found to to advocate for their for their patients, for their clients.

And in reducing cesarean delivery, there's increased access to midwives.

And again, midwives have are associated with lower or lower rates of cesarean delivery.

So there's been quite a few different policies that have come together to to result in a lower rate.

Now that that would have happened in the past.

Yeah, it certainly signals a move in the right direction, although we know that not all women have seen the same.

Women of color have not.

We'll have to leave that for another day.

We ran.

We are out of time.

But Slava Rickey with the Rutgers School of Public Health, thank you for that insight.

Thank you.

Thanks for having me.

Support for the medical report is provided by Horizon Blue Cross Blue Shield of New Jersey and independent licensee of the Blue Cross Blue Shield Association.