Opinion: NJ must do more to improve maternity care

NorthJersey Published 12:13 p.m. ET June 8, 2018

Regarding the June 5 article “NJ hospitals look to reduce high C-section rate” (Page 3A) New Jersey’s history of maternity care mirrors the history of birth in our nation; the interwoven interplay of race, class and access to health care continues to define families and health outcomes. 

Our state’s history of childbirth holds uncomfortable truths of racial segregation and disrespect in maternity care. In Essex County, Kenney Memorial Hospital and Wright Maternity Hospital are among some of the facilities listed by historians who remind us that Brown v. Board of Education may have impacted classrooms, but clinical facilities remained separate and unequal.  

In 2018, our state is at the intersection of examining racial disparities, maternal morbidity and our unsustainable and unsafe high cesarean birth rate for low-risk women. I applaud the leadership of policymakers, elected officials and clinicians who recognize the time has come to improve birth in New Jersey.  Some of the steps include integrating doulas, non-medical experts who assist women in birth; educating parents in prenatal education; and increasing education for nurses and other staff on supportive care techniques for mothers in labor. 

My challenge is for New Jersey to do this work of improving outcomes in the framework of respectful maternity care. Obstetrical violence, which is shockingly common and amplifying amidst the #MeToo movement, can be addressed as we improve birth in New Jersey.

“Cruelty in Maternity Wards” was the title of a shocking article published just over 50 years ago in Ladies’ Home Journal. In that article, nurses and women told stories of inhumane treatment in labor and delivery wards during childbirth. When New Jersey families have been listened to about their experience giving birth, it is clear through data and direct language that cesarean births for low-risk birthing people have been overused and damaging. A cesarean birth for a low-risk childbearing person changes a family’s reproductive health future with escalating complications and damage in lack of access to vaginal birth after cesareans. Only 2 percent of families in northern New Jersey have a vaginal birth after cesarean. 

Overusing cesarean births for low-risk women and babies are fraught with the intersection of respectful maternity care. According to the Maternal Health Task Force, respectful maternity care is not only a crucial component of quality of care, it is a human right. Even the World Health Organization affirms that improving the quality of care of mothers and newborns includes an increased focus on respect and dignity. This can be hard to get in New Jersey, where patients may or may not have access to freedom of movement in labor, access to showers, birth in nonsupine positions and other evidence-based care practices for a safe and healthy birth. 

Our state also holds the history of training and investing in women as community health workers and perinatal health leaders. 

In 1927, the state of New Jersey offered a training to bring community care and maternal infant health education to local neighborhoods. As explained in the book “The American Midwife Debate,” some anecdotes included: “Mrs. M. James from Newark and had to get up at 5 am every day (she said it was worth the sacrifice); Mrs. A. Larsen of North Bergen said it was a splendid course; Mrs. H. Barthoeld of Vincentown, Burlington County came more than 75 miles to take the course; Miss E. Saggess from Newark said the course was most interesting and  learned a lot.” 

While this was a midwifery course and midwives are licensed clinicians, we can use our state’s history as a model for workforce development and community health engagement. We are at this seminal moment to improve birth and bring forth respectful maternity care as a quality indicator. We can make this two-generation impact to improve outcomes, reduce costs and make meaningful changes for respectful maternity care in New Jersey

Jill Wodnick is a national speaker on improving maternal infant health. A doula and childbirth educator working in public health, she currently leads a “Giving Birth and Being Born” initiative at Montclair State University. 

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