Economic implications of method of delivery

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.