Planned cesarean delivery less costly than planned vaginal birth for breech births

Toronto - A new study has found that the estimated mean cost of a planned cesarean delivery is $877 lower than that of a planned vaginal birth for breech births.

Published in the latest issue of Canadian Medical Association Journal, the study was based on the Term Breech Trial which compared the effectiveness of a policy of planned vaginal birth versus cesarean delivery. It used third party perspective, and took into account all costs for physician services and all hospital-related costs incurred by both the mother and the infant.

The mean cost for a policy of planned cesarean birth was $7165, compared to the mean cost of $8042 for a policy of planned vaginal birth, with a mean difference of $877. The estimated mean cost of a policy of planned cesarean was lower than that of a policy of planned vaginal birth for both women having a first birth ($7255 versus $8440) and women having had at least one prior birth ($7071 versus $7559).

"In this study we conducted a cost analysis of the two approaches to breech presentations at delivery," says Dr. Amiram Gafni, Department of Clinical Epidemiology and Biostatistics at McMaster University. "Length of stay in different departments in the hospital for both mother and newborn were taken into consideration, as well as physician services such as antenatal visits, induction of labour, epidural and anaesthetist services and support around the delivery and care in neonatal intensive care units."

The study was a follow-up to the Term Breech Trial, a randomized controlled trial conducted between January 1997 and April 2000 which determined that a policy of planned cesarean delivery, compared with a policy of planned vaginal birth, decreased the risk of adverse outcomes for infants.

"It would be a misinterpretation of the results of the Term Breech Trial to conclude that the option of planned vaginal birth should no longer be offered to Canadian women," says Dr. Hannah, professor of obstetrics and gynecology at the University of Toronto. "The immediate risks of adverse outcome for the mother are somewhat greater with a policy of planned cesarean, and some women may continue to prefer to plan a vaginal birth despite the higher risks to the infant. As well, the long term risks and costs of a policy of planned cesarean compared with planned vaginal birth, over a lifetime, are not known."