Does a Cesarean section delivery always cost more than a vaginal delivery?

There is evidence that average total charges per episode of child birth depend on maternal plus child length of stay, neonatal intensive care unit (NICU) utilization, maternal race and mode of delivery. In particular, when maternal and child records are linked, this study suggests that when adjusted for maternal characteristics, the cost of vaginal deliveries followed by NICU utilization may be higher than the cost of Cesarean sections and NICU utilization.

Cesarean section, one of the most frequently performed surgical procedures on women, is rising globally and in the USA. Much of the current Cesarean section literature focuses on reporting geographic and hospital-specific variations, but little has been published about the clinical and demographic characteristics of the patients, and even less about the economic consequences of a Cesarean section delivery compared with a vaginal delivery [e.g. the total hospital charges and length of neonatal intensive care unit-NICU-stay] of a birth episode. To examine these relationships further, three urban Baltimore hospitals volunteered in 2004 to participate in a retrospective chart review that linked mother and child hospital records.

1172 mother-child records were randomly selected and data regarding maternal co-morbidities, age, infant weight along with transfer to neonatal intensive care units, and economic data were extracted from the mother and child charts.

Average total charges for vaginal deliveries [maternal plus total baby charges that includes NICU utilization (X=$17 624.38)] may be higher than average total charges for Cesarean sections [maternal plus total baby charges that includes NICU utilization (X=$13 805.47)]. Specifically, maternal race--being African American--was indirectly associated with overall charges through its association with mode of delivery and NICU utilization patterns. The presence of maternal co-morbidities--Herpes Simplex Virus, hypertension and diabetes--most probably influenced babies' hospital stay charges as well as NICU charges when transferred to NICU following both vaginal and Cesarean section deliveries. Thus, prenatal care targeting co-morbidities management may reduce the odds of a newborn's transfer to NICU thus avoiding greater lengths of stay, medical care and charges. Recommendations for obstetrical practices as well as health care policy on their charges should not assume that Cesarean section deliveries are always costlier than vaginal deliveries.