New Jersey’s birthing hospitals have reduced birth complications and C-section rates under a statewide patient safety initiative led by the New Jersey Hospital Association. Their collaborative efforts have reduced maternal morbidity and averted more than 10,000 C-sections over a five-year period.

Those are among the key accomplishments of the New Jersey Perinatal Quality Collaborative, a network of clinical teams, healthcare stakeholders, patients and families and other partners that work together to improve pregnancy and infant outcomes. NJHA has convened these partners under the NJPQC banner since 2017 with funding from the Centers for Disease Control and Prevention. In September, the CDC renewed the collaborative for another five years with an annual allocation of $275,000 to continue its patient safety efforts.

The NJPQC focused its work on Caesarean sections, hypertensive disorders and maternal hemorrhage, three critical areas that present risks in pregnancy, labor and delivery and the post-partum period. For each area, birthing hospitals adopted “bundles” of best practices spanning provider education, protocols, standardized plans and checklists, screening and more. Compared with 2016 baseline data, the NJPQC hospitals achieved the following improvements for healthier mothers and babies:

• The overall C-section rate declined 14 percent, from 32.31 in 2016 to 27.77 in 2021. In addition, the C-section rate for first-time, uncomplicated pregnancies – formally identified by the medical term “nulliparous, term, singleton, vertex,” or NTSV – declined by 18.6 percent, from 29.91 in 2016 to a preliminary figure of 24.36 in 2021. Although C-sections are a valid and medically necessary procedure in many births, they are a more invasive procedure than vaginal delivery and can pose added risks including surgical site infections. Because of that, helping individuals deliver safely without a C-section is an important patient safety goal.
• The rate of hypertensive disorders in pregnancy per 100 cases fell by 29.4 percent, from 8.5 in 2016 to 6.0 in 2021. This measure encompasses illnesses commonly called high-blood pressure, or hypertension. It also includes preeclampsia, a serious condition of persistent hypertension during pregnancy that can impact the function of various organs.
• The rate of obstetric hemorrhage declined from 8.25 per 100 cases in 2016 to 6.98 in 2021, a 15.4 percent decline. Obstetric hemorrhage, or rapid blood loss, is one of the most common birth complications. It can arise at any time during pregnancy and delivery, including the days and weeks post-birth.

“New Jersey’s birthing hospitals are delivering on their goal of ensuring that mothers and babies have every opportunity for a safe, successful birth experience,” said NJHA President and CEO Cathy Bennett. “This reflects a statewide commitment in our hospitals from the bedside to the Board room to the executive offices. And now, like any quality improvement journey, the work continues for even greater improvement.”

 Bennett also acknowledged the work of First Lady Tammy Murphy in championing maternal and child health issues and elevating them on the state and national stage through the Nurture NJ campaign. The First Lady thanked the hospital community for its partnership and lauded the state’s birthing hospitals.

“The progress continues towards our goal of making New Jersey the gold standard for maternal and infant health,” said First Lady Tammy Murphy. “Since launching my Nurture NJ initiative in 2019, we have made headway on over half of the recommendations in the Nurture NJ Maternal and Infant Health Strategic Plan, and that is in thanks to some of our many partners, including the New Jersey Hospital Association’s New Jersey Perinatal Quality Collaborative. Their efforts demonstrate that our focus on maternal and infant health can make a real impact on lives saved, continuing our mission to make New Jersey the safest and most equitable place in the nation to deliver and raise a baby.”

“New Jersey’s birthing hospitals are important partners with the N.J. Department of Health to achieve our shared objective: reducing maternal mortality and disparities,” said Health Commissioner Judith Persichilli. “Improving the health of New Jersey begins with maternal health.”

With NJHA’s support, the NJPQC provides a statewide infrastructure and sharing space for collaborative learning, data collection and benchmarking and quality improvement science support. The effort is guided by two co-chairs, Suzanne Spernal, DNP, APN-BC, RN, vice president of women’s services at RWJBarnabas Health, and Robyn D’Oria, APN, RN, chief executive officer of the Central Jersey Family Health Consortium. The NJPQC utilizes proven standardized bundles from the Alliance for Innovation on Maternal Health (AIM).

“The bundles are built on evidence-based practices,” said Spernal. “They provide the guidance, while also educating staff and empowering mothers and families to work together for the best patient outcomes.”

Added D’Oria, “These maternal and infant health processes, when performed collectively and reliably, are moving the needle on reducing maternal morbidity and mortality.”

NJHA is one of 27 CDC grantees leading these quality improvements at the state level. The federal commitment supports a population-based focus that is then implemented at the facility level.

U.S. Sen. Bob Menendez (D-N.J.), senior member of the Senate Finance Committee that sets national health policy, has been an active supporter for maternal health issues, including closing the gap in racial and ethnic disparities.

“When it comes to supporting healthy mothers and babies, it truly does take a village,” said Sen. Menendez. “I commend NJHA and the state’s hospitals for their collaboration to improve birth outcomes. I’ll continue my efforts to ensure that New Jersey receives the critical resources needed to give all families, in all communities, a healthy start in life.”

The full report can be found at /media/719541/path-to-progress-nj-perinatal-quality-collaborative-2017-2022.pdf. Visit www.njha.com/maternal-child-health for more information on efforts by NJHA and the state’s birthing hospitals to support safe, successful deliveries.