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Vaginal birth after cesarean delivery: an historic cohort cost analysis
Heather DiMaio1, Rodney K Edwards, Tammy Y Euliano
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Shands Hospital, University of Florida, Gainesville, USA.
Objective:
The purpose of this study was to evaluate the relative cost-effectiveness of attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery.
Study Design:
We performed an historic cohort analysis of women with a single prior cesarean delivery who were delivered at our institution during 1999. Inclusion criteria were > or =36 weeks' gestation and carrying a live, singleton fetus with no antenatally diagnosed anomalies. The primary outcome variable was mean cost of hospital care for mother-infant pairs, as obtained from the hospital's Clinical Resources Department.
Results:
The cohort consisted of 204 mother-infant pairs, 65 in the elective repeat cesarean group and 139 in the attempted vaginal birth group. Mean cost of care was higher for mothers ($4155 vs $3675;P <.001), neonates ($1794 vs $1187; P =.03), and mother-infant pairs ($5949 vs $4863; P =.001) for the elective repeat cesarean group compared with the attempted vaginal delivery group.
Conclusion:
In women with a single prior cesarean delivery, a trial of labor is more cost-effective than an elective repeat cesarean delivery.