A growing number of hospitals in New Jersey are embracing protocols shown to improve the birthing experience for mothers and could help reduce the state’s troublesome racial disparities in maternal and infant health outcomes.
By the end of this year, staff at more than a dozen birthing centers will have been trained in a shared decision-making tool called TeamBirth, according to the New Jersey Health Care Quality Institute, a nonprofit leading the initiative in the state. Nearly 90% of preventable medical errors are the result of gaps in communication and teamwork, according to Ariadne Labs, a partnership involving Massachusetts’ Brigham Health and Harvard’s school of public health that has introduced the model at more than 150 hospitals nationwide.
At least 9 out of 10 mothers who experienced a TeamBirth delivery said they felt involved in decisions, informed and educated about their options and that their choices were respected, according to a survey of nearly 2,000 people scheduled to be publicly shared Monday by the Quality Institute. Women who did not participate in the model were as much as 20% less satisfied with the experience, the survey found.
“Our survey results show that birthing people feel more informed and heard. More feel that their choices are respected,” said Adelisa Perez Hudgins, the institute’s director of quality. “That is considerable and a reason that more New Jersey hospitals are committing to TeamBirth.”
New Jersey has struggled to reduce its maternal mortality of nearly 26 fatalities per 100,000 births, based on the most recent federal analysis of data from 2018 through 2021. It also faces glaring racial disparities that leave Black women nearly seven times — and Hispanic women three times — more likely to die during pregnancy, childbirth or the postpartum period, when compared with white women.
The TeamBirth model was particularly powerful for Black women, with those involved 35% more likely to report feeling empowered, when compared to Black moms who were not in the program, the Quality Institute found.
The C-section gap
The institute’s announcement comes on the heels of a new study that found Black mothers who had not scheduled a surgical, or cesarean birth, are 25% more likely to deliver by C-section than white, non-Hispanic woman. The analysis, by the National Bureau of Economic Research, is based on New Jersey data covering nearly 1 million births from 2008 through 2017 and echoes previous research that showed racial disparities in birth practices.
“The findings in this study are wholly unacceptable and deeply disturbing,” first lady Tammy Murphy said in a news release last week. Murphy has championed efforts to improve maternal health and reduce racial disparities under the Nurture NJ campaign. The push includes a free nurse home-visit program available to all new moms regardless of income, insurance coverage or immigration status; the creation of a new maternal health authority to oversee the work, and programs to train culturally competent doulas, or birth coaches, to help women advocate for themselves before, during and after delivery.
“This research is critical to supporting the ongoing development of new initiatives that will continue to make a difference for families in New Jersey,” Murphy said.
While C-sections are an important option in some pregnancies, experts agree that surgical birth should be limited to critical cases. The procedure carries risks, including the potential for infection and blood clots for the mother, and can lead to breathing problems, allergies and other health challenges for the baby. C-sections also may involve longer recovery time, when compared to a vaginal birth, and can limit a woman’s delivery options in the future. The higher likelihood of surgical births among Black women likely contributes to overall maternal health disparities, experts suggest.
Changes in policy
New Jersey has worked to reduce its overall rate of cesarean births. That effort includes work by outside advocates like the Quality Institute and a dedicated focus on maternal care by the New Jersey Hospital Association, which represents the state’s 43 hospital birthing centers. It also includes policy changes at the state level. In 2017, 3 out of 4 New Jersey hospitals with labor and delivery practices failed to meet the target rate of 24% for medically unnecessary C-sections established by national experts, according to The Leapfrog Group, a nonprofit watchdog that monitors health care quality. In one facility, 60% of the babies were delivered surgically at that time.
By 2022, half of the birthing hospitals in New Jersey were below this recommended threshold and C-section rates ranged from 9.6% at Inspira Medical Center in Elmer to 37.7% at St. Mary’s General Hospital in Passaic, according to Leapfrog data distributed by the Quality Institute. A Hospital Association report from late 2022 shows that these changes in pregnancy care enabled an estimated 10,000 New Jersey women to avoid unnecessary surgical births over five years. Statewide, the rate for all C-sections was just under 28% by 2021, it showed.
The Hospital Association report — “Path to Progress,” created by maternal health providers working as the New Jersey Perinatal Collaborative — also showed the racial distortions in C-section deliveries continued. By 2020, Asian women comprised 29% of all surgical births in the state and Black women made up almost 29% more, with Hispanic women accounting for 25% and white mothers adding just over 23%, the data showed. (New Jersey’s population is roughly 54% white, 21% Hispanic, 15% Black and 11% Asian.)
Cathy Bennett, the Hospital Association’s president and CEO, said birthing hospitals’ intentional focus on racial disparities is “yielding results. Even in the midst of the unprecedented challenges of the pandemic, New Jersey’s C-section rate for Black persons declined 5.3% between 2018 and 2022.”
Hospitals have worked together under the banner of the Perinatal Collaborative to implement various strategies that involve both proven clinical standards “along with a strong focus on patient and family engagement and communication,” Bennett said, work that continues as part of the state’s Nurture NJ strategy.
Growing awareness
In New Jersey the decline in C-sections has been driven by a growing awareness about maternal health challenges and the racial disparities, better clinical training and improved communication among the birthing team and patient, experts note. The TeamBirth model builds on that, with structured huddles for the hospital’s care team that include the person giving birth. A whiteboard is used bedside to highlight the mother’s wishes and keep everyone on track. In the past, clinical decisions were traditionally dominated by a medical hierarchy that did not always involve the patient, the Quality Institute notes.
The TeamBirth model has also been shown to drive down unnecessary C-sections in at least one location, according to a report from Ariadne Labs. At a hospital in Oklahoma the rate of these surgical procedures dropped from 33% to 24% once the model was introduced, the group said, and the protocol is equally popular with mothers of different races, from varying economic backgrounds and geographic locations.
Linda Schwimmer, president and CEO of the Quality Institute and board chair for Leapfrog, said the shared-decision model is also impacting outcomes in New Jersey, in addition to improving the birth experience for moms. “We are seeing improvement on this front — especially for Black women. This work is essential to changing things for all pregnant people and families in New Jersey,” she said.
More NJ hospitals adopt team approach to improve birth outcomes
njspotlightnews.org
September 17, 2024 10:32 am
A growing number of hospitals in New Jersey are embracing protocols shown to improve the birthing experience for mothers and could help reduce the state’s troublesome racial disparities in maternal and infant health outcomes.
By the end of this year, staff at more than a dozen birthing centers will have been trained in a shared decision-making tool called TeamBirth, according to the New Jersey Health Care Quality Institute, a nonprofit leading the initiative in the state. Nearly 90% of preventable medical errors are the result of gaps in communication and teamwork, according to Ariadne Labs, a partnership involving Massachusetts’ Brigham Health and Harvard’s school of public health that has introduced the model at more than 150 hospitals nationwide.
At least 9 out of 10 mothers who experienced a TeamBirth delivery said they felt involved in decisions, informed and educated about their options and that their choices were respected, according to a survey of nearly 2,000 people scheduled to be publicly shared Monday by the Quality Institute. Women who did not participate in the model were as much as 20% less satisfied with the experience, the survey found.
“Our survey results show that birthing people feel more informed and heard. More feel that their choices are respected,” said Adelisa Perez Hudgins, the institute’s director of quality. “That is considerable and a reason that more New Jersey hospitals are committing to TeamBirth.”
New Jersey has struggled to reduce its maternal mortality of nearly 26 fatalities per 100,000 births, based on the most recent federal analysis of data from 2018 through 2021. It also faces glaring racial disparities that leave Black women nearly seven times — and Hispanic women three times — more likely to die during pregnancy, childbirth or the postpartum period, when compared with white women.
The TeamBirth model was particularly powerful for Black women, with those involved 35% more likely to report feeling empowered, when compared to Black moms who were not in the program, the Quality Institute found.
The C-section gap
The institute’s announcement comes on the heels of a new study that found Black mothers who had not scheduled a surgical, or cesarean birth, are 25% more likely to deliver by C-section than white, non-Hispanic woman. The analysis, by the National Bureau of Economic Research, is based on New Jersey data covering nearly 1 million births from 2008 through 2017 and echoes previous research that showed racial disparities in birth practices.
“The findings in this study are wholly unacceptable and deeply disturbing,” first lady Tammy Murphy said in a news release last week. Murphy has championed efforts to improve maternal health and reduce racial disparities under the Nurture NJ campaign. The push includes a free nurse home-visit program available to all new moms regardless of income, insurance coverage or immigration status; the creation of a new maternal health authority to oversee the work, and programs to train culturally competent doulas, or birth coaches, to help women advocate for themselves before, during and after delivery.
“This research is critical to supporting the ongoing development of new initiatives that will continue to make a difference for families in New Jersey,” Murphy said.
While C-sections are an important option in some pregnancies, experts agree that surgical birth should be limited to critical cases. The procedure carries risks, including the potential for infection and blood clots for the mother, and can lead to breathing problems, allergies and other health challenges for the baby. C-sections also may involve longer recovery time, when compared to a vaginal birth, and can limit a woman’s delivery options in the future. The higher likelihood of surgical births among Black women likely contributes to overall maternal health disparities, experts suggest.
Changes in policy
New Jersey has worked to reduce its overall rate of cesarean births. That effort includes work by outside advocates like the Quality Institute and a dedicated focus on maternal care by the New Jersey Hospital Association, which represents the state’s 43 hospital birthing centers. It also includes policy changes at the state level. In 2017, 3 out of 4 New Jersey hospitals with labor and delivery practices failed to meet the target rate of 24% for medically unnecessary C-sections established by national experts, according to The Leapfrog Group, a nonprofit watchdog that monitors health care quality. In one facility, 60% of the babies were delivered surgically at that time.
By 2022, half of the birthing hospitals in New Jersey were below this recommended threshold and C-section rates ranged from 9.6% at Inspira Medical Center in Elmer to 37.7% at St. Mary’s General Hospital in Passaic, according to Leapfrog data distributed by the Quality Institute. A Hospital Association report from late 2022 shows that these changes in pregnancy care enabled an estimated 10,000 New Jersey women to avoid unnecessary surgical births over five years. Statewide, the rate for all C-sections was just under 28% by 2021, it showed.
The Hospital Association report — “Path to Progress,” created by maternal health providers working as the New Jersey Perinatal Collaborative — also showed the racial distortions in C-section deliveries continued. By 2020, Asian women comprised 29% of all surgical births in the state and Black women made up almost 29% more, with Hispanic women accounting for 25% and white mothers adding just over 23%, the data showed. (New Jersey’s population is roughly 54% white, 21% Hispanic, 15% Black and 11% Asian.)
Cathy Bennett, the Hospital Association’s president and CEO, said birthing hospitals’ intentional focus on racial disparities is “yielding results. Even in the midst of the unprecedented challenges of the pandemic, New Jersey’s C-section rate for Black persons declined 5.3% between 2018 and 2022.”
Hospitals have worked together under the banner of the Perinatal Collaborative to implement various strategies that involve both proven clinical standards “along with a strong focus on patient and family engagement and communication,” Bennett said, work that continues as part of the state’s Nurture NJ strategy.
Growing awareness
In New Jersey the decline in C-sections has been driven by a growing awareness about maternal health challenges and the racial disparities, better clinical training and improved communication among the birthing team and patient, experts note. The TeamBirth model builds on that, with structured huddles for the hospital’s care team that include the person giving birth. A whiteboard is used bedside to highlight the mother’s wishes and keep everyone on track. In the past, clinical decisions were traditionally dominated by a medical hierarchy that did not always involve the patient, the Quality Institute notes.
The TeamBirth model has also been shown to drive down unnecessary C-sections in at least one location, according to a report from Ariadne Labs. At a hospital in Oklahoma the rate of these surgical procedures dropped from 33% to 24% once the model was introduced, the group said, and the protocol is equally popular with mothers of different races, from varying economic backgrounds and geographic locations.
Linda Schwimmer, president and CEO of the Quality Institute and board chair for Leapfrog, said the shared-decision model is also impacting outcomes in New Jersey, in addition to improving the birth experience for moms. “We are seeing improvement on this front — especially for Black women. This work is essential to changing things for all pregnant people and families in New Jersey,” she said.