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Cumulative Economic Implications of Initial Method of Delivery

From the ¹Department of Obstetrics and Gynaecology, ²Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada.

OBJECTIVE: To examine the cumulative costs of hospital care in the first and subsequent pregnancies associated with different methods in the initial delivery of nulliparous women.

METHODS: An 18-year population-based cohort study (1985–2002) using the Nova Scotia Atlee Perinatal Database compared cumulative delivery costs in the first and subsequent pregnancies. Women were identified by initial method of delivery for nulliparous women with singleton cephalic presentation at term undergoing spontaneous or induced labor for planned vaginal delivery, and for nulliparous women undergoing cesarean delivery without labor. Costs that were assessed included nursing hours in antepartum, labor and delivery, postpartum and neonatal intensive care units, physician costs, labor induction agents, consumables, and costs for postpartum hysterectomy, tubal ligation, and dilatation and curettage.

RESULTS: A total of 27,613 pregnancies satisfied inclusion and exclusion criteria. When cumulative costs by type of labor at first delivery were considered, induction of labor ($7,220) was more costly than spontaneous onset of labor ($6,919, P=.006). The cumulative costs of assisted vaginal delivery at first delivery ($7,288) and cesarean delivery in labor at first delivery ($9,524) were similar in magnitude and were higher than spontaneous vaginal delivery at first delivery (P<.001). Cesarean delivery in labor in the first delivery was the most costly type of delivery ($9,524), and the differences in cost increased with increasing number of deliveries (P<.05).

CONCLUSION: Cesarean delivery in labor in the first delivery is associated with increased cumulative costs compared with other methods of delivery, regardless of the number or type of subsequent deliveries.

LEVEL OF EVIDENCE: II-3

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