I must have missed this back in February when the results on the Leapfrog group's analysis of early elective delivery between 2010 and 2014 were reported on NJ.com. Here's the info from the Leapfrog group, an organization that monitors hospital performance to enhance information and safety, while "highlighting the variation in quality of care across hospitals."
Leapfrog Maternity Care Fact Sheet
You can search the survey results HERE (search by state, then check out the maternity care results: the results are eyeopening)
So, the good news. Elective delivery rate statewide has dropped from 16% in 2010 to just 4% in 2014. This is largely due to a "hard stop" by many area hospitals where head of ob needs to review any case where induction/csection before 39 weeks is being called for. AND in those years we've seen the teeniest tiniest bit of a drop in the overall csection rate in NJ. Let's hope it's the start of a trend.
The big thing is this tells us CHANGE IS POSSIBLE. When a hospital wants to effect change, it can happen. Everyone got on board with this. Hospitals, obstetricians, March of Dimes. Something as simple as reviewing the reasons for elective early delivery has made a big change in outcome.
The not-so-great news: As usual the blame is shifted to the patient (wanting to fit into a bridesmaid dress), and not the cases of "I'll be going on vacation July 2nd, so we'll schedule your induction/csection for June 30..."
A couple of other things worth noting: Meadowlands Hospital, with an early elective delivery rate of 34.3% (close to ten times what the average for the other reporting hospitals is, with the exception of St. Barnabas) also has a 50% csection rate, one of the highest in the state (cesarean rates: NJ). OK, most of the hospitals nationwide chose not to provide their statistics to LeapFrog, but of those that did, the numbers are mostly in the single digits. Meadowlands' statistics of 34.3% are off the chart.
No reporting of whether the reasons for denying elective early delivery are discussed with the patient. Is it just a shift from "We won't let you go past 40 weeks" to "We won't let you go earlier than 39 weeks," or are the risks of early elective delivery (to the baby) actually discussed? Considering that the risks of elective repeat csection are often glossed over, I'm going to guess no.
Another interesting observation: While early elective delivery has decreased, as reported by the NJ.com article, "New Jersey remains one of 14 states where women are more likely to receive an episiotomy, or small incision, during labor. While the procedure used to be commonplace, it has since fallen out of medical favor because it carries increased risks. Roughly 17 percent of women still receive the incision in New Jersey hospitals - a rate topped only by Alabama, Mississippi and Utah among the states included in the study.
Episiotomy is a small incision made in the perineum, or birth canal, to facilitate delivery. It was once routine in childbirth, but today's medical guidelines recommend it only in a small percentage of cases. That's because it increases the risk of tears, loss of bladder or bowel control, and pelvic floor infections.
"Clearly we have more work to do on the episiotomy rate," said Kelly.
Leapfrog reported that hospitals vary tremendously in the rate of episiotomies, with some hospitals reporting fewer than 1 percent of mothers experience it, while others saying more than 40 percent have it during childbirth."
IN OTHER WORDS: While csections and episiotomies are sometimes absolutely medically warranted, some doctors don't know how to deliver a baby without cutting something. It's either abdominal incision or perineal.
Do your research.
Know your rights.
Sometimes the only people who really see the differences in hospital practices are DOULAS!!! We need to get this local information out there so women can make an informed decision about their health care. Please share!