General Obstetrics and Gynecology: Obstetrics
Economic implications of method of delivery

https://doi.org/10.1016/j.ajog.2004.10.635Get rights and content

Objective

This study was undertaken to examine the costs of hospital care associated with different methods of delivery.

Study design

An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared outcomes in nulliparous women at term undergoing spontaneous or induced labor for planned vaginal delivery, or undergoing cesarean delivery without labor. Costs that were assessed included physician fees, nursing hours in the labor and delivery, postpartum and neonatal intensive care units, epidural use, induction of labor agents, and consumables.

Results

A total of 27,614 pregnancies satisfied inclusion and exclusion criteria, 5233 of which had labor induced. A comparison of mean costs per mother/infant pair demonstrated that cesarean delivery in labor ($2137) was increased compared with spontaneous vaginal delivery ($1340, P = .01), assisted vaginal delivery ($1594, P = .01), and cesarean delivery without labor ($1532, P = .01). The cost of delivery after induction of labor ($1715) was increased compared with spontaneous onset of labor ($1474, P < .001).

Conclusion

Cesarean delivery in labor occurs more frequently with labor induction and is associated with increased costs compared with other methods of delivery.

Section snippets

Materials and methods

We conducted a population-based, cohort analysis using data from the Nova Scotia Atlee Perinatal Database from 1985 to 2002 (18 years). The Nova Scotia Atlee Perinatal Database is a provincial, population-based, clinically oriented computerized database, which codes information on pregnancy outcomes. It was used to collect data on variables that included spontaneous or induced labor, maternal length of stay in labor and delivery, epidural use, method of delivery, and maternal and neonatal

Results

A total of 27,613 pregnancies satisfied inclusion and exclusion criteria, 5233 of which were induced labors. There were no maternal deaths, transfers for intensive care, or maternal re-admissions. The number of blood transfusions in all groups was low (<1%) and was not considered in the assessment of costs. Table I summarizes maternal and neonatal characteristics for women undergoing induction of labor, women having spontaneous onset of labor, and women undergoing cesarean delivery without

Comment

This study considered the costs of health service resources by using a population-based database for deliveries to nulliparous women undergoing induction of labor, entering labor spontaneously, and having no labor, as well as the costs for nulliparous women by method of delivery, including delivery by cesarean in labor, cesarean without labor, and assisted vaginal and spontaneous vaginal delivery. When type of labor was considered, deliveries to women in the group undergoing induction of labor

References (33)

Cited by (0)

Supported by a Clinical Scholar award from the Dalhousie University Faculty of Medicine (S.A.F.).

View full text