-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: VBAC From: Myer S. Bornstein (mborn@massmed.org) Tue Apr 19 15:08:39 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ainsron: "Re: VBAC" Previous message: Richard Chudacoff, MD: "Re: VBAC" In reply to: D. Ashley Hill: "Re: VBAC" Next in thread: R. Daniel Braun: "Re: VBAC" In 1999 this article appeared in NEJM , and the cost were noted as below: Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering the cesarean-delivery rate. N Engl J Med 1999;340:54-57 Cost of Childbirth The cost of childbirth includes both the professional fee and the cost of hospitalization. Many people assume that a cesarean delivery costs more than a vaginal delivery because of the charges for a longer hospital stay and use of an operating room. This may not be true from a hospital's perspective. Because a labor unit is similar to an intensive care unit with respect to costs, a prolonged and difficult labor, even when it results in a vaginal delivery, is more costly to an institution than a cesarean delivery. At the Beth Israel Deaconess Medical Center in Boston, an elective repeated cesarean delivery costs approximately $7,700 and a normal vaginal delivery costs approximately $6,800 - a difference of $900. A failed trial of labor and a cesarean delivery, however, cost $3,000 more than a normal vaginal delivery. Furthermore, if either mother or baby has a complication (e.g., a ruptured uterus in the mother or a disorder in the infant requiring admission to the neonatal intensive care unit), the cost increases by $4,000 for the mother and by $2,000 (on average) for the child. Ashley's comments are correct in regards to hospital costs, staffing etc. It doesn't take into account any complications for and elective primary or a repeat cesarean section/ Interesting points to ponder Regards Myer -- Myer S. Bornstein, MD, MMM, FACOG, FACPE -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D. Ashley Hill Sent: Tuesday, April 19, 2005 3:37 PM To: Multiple recipients of list OB-GYN-L Subject: Re: VBAC I thought cesareans would be more costly than attempted vaginal delivery, until I spoke with our hospital finance department, and read an interesting article in AJOG (see below). I was told that a policy of "100% c/section" would be advantageous for hospitals. Apparently it would allow accurate staffing (less nursing on call time, for example) and better bed management. Further, rather than 2 days undergoing induction, then a cesarean, followed by 3 days of in-hospital recovery, the 100% section policy would make things more efficient. According to an interesting paper in AJOG (see cut and paste from Medline below), there is no significant cost differences between attempted vaginal delivery and elective cesarean. However, elective cesarean is 10% less costly than attempted vaginal deliveries when oxytocin and epidural are used. In our area almost everyone gets oxytocin and an epidural, therefore it appears that elective cesareans (at least the first one) may be equally or less costly than when patients undergo labor. Ashley Am J Obstet Gynecol. 2003 Jun;188(6):1418-21. Cesarean delivery on demand: what will it cost? Bost BW. OBJECTIVE: The purpose of this study was to estimate the cost differences between elective cesarean delivery and the alternative of attempted vaginal delivery and to assess the economic impact of cesarean delivery on demand. STUDY DESIGN: Cost data were obtained over a 12-month period from a not-for-profit community hospital to calculate a per-patient cost for clinical alternatives. RESULTS: The average cost of an attempted vaginal delivery without oxytocin (Pitocin) or epidural anesthesia was 15.1% lower in nulliparous women and 20% lower in multiparous women than with elective cesarean delivery. However, in nulliparous women, the addition of Pitocin nullified any cost differences; if epidural anesthesia was also used, total costs exceeded the cost of elective cesarean delivery by almost 10%. The cost of a failed attempt at vaginal delivery was much higher than elective cesarean delivery for both groups. The average cost for all women who attempted vaginal delivery was only 0.2% less than the per-patient cost of elective cesarean delivery. CONCLUSION: The adoption of a policy of cesarean delivery on demand should have little impact on the overall cost of obstetric care. -- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency and Loch Haven Ob/Gyn Group Orlando, Florida Next message: ainsron: "Re: VBAC" Previous message: Richard Chudacoff, MD: "Re: VBAC" In reply to: D. Ashley Hill: "Re: VBAC" Next in thread: R. Daniel Braun: "Re: VBAC"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 04:48:13 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.