Maternal and Child Health Epidemiology
Program, N.J. Department of
increased steadily nationally and statewide, regardless of
previously delivered her child by Cesarean delivery. Specifically,
Dr. Denk said, data show an increase in the rate of Cesarean delivery
in many categories, which include:
2011
natural delivery during the subsequent delivery, from 52 percent in
2000 to 83 percent in 2011
delivery, from 7 percent in 2000 to 11 percent in 2011
tion of these high overall rates. New Jersey, with an overall rate of
highest nationally--second only to Louisiana. New Jersey is still above
the national average of 32.8 percent, according to the most recent
statistics from the Centers for Disease Control and Prevention.
some maternal complications, the state's Maternal and Child Health
Epidemiology Program explored whether the incidence of maternal
complications has been rising in conjunction with the increased rate
of Cesarean delivery.
on short-term, physical, and acute conditions for such risks as
of postpartum complications may have the same underlying
cause, the study tried to minimize that factor by looking only at
low-risk deliveries--that is, ones that were not typically associated
with requiring Cesarean delivery:
preeclampsia/eclampsia, uterine tissue abnormality, or
fetal macrosomia
infections and major systemic complications have declined overall.
A rather significant reduction in the rate of major infection that
was first noted between 1997 and 1998 is most likely a result
of the adoption of prophylactic antibiotic protocols that year,
Dr. Denk explained. However, the highest rate of major infections
in low-risk deliveries was seen among C-sections after a trial of
labor. As well, the rate of systemic complications was higher for
women who have delivered by Cesarean delivery either without or
after trial of labor, rather than by vaginal delivery.
mix of these types of complications by type of delivery, with a larger
proportion of negative outcomes being seen among women who
had a Cesarean delivery without trial of vaginal delivery. The rate
of transfusions also has been on the rise--again, with a higher
deliveries have been increasingly
performed to manage women with low-
risk profiles. In the past, these same
women would probably have delivered
their babies non-surgically. The relative
risks associated with Cesarean delivery
have not changed and are higher than a
vaginal delivery. As a result of the high
surgical delivery rate, recent improvements
in the area of maternal health and safety
appear to be less significant than
they could have been if more women
were delivering vaginally.