Cesarean delivery on demand: What will it cost?

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. (Am J Obstet Gynecol 2003;188:1418-23.)