Historical cohort analysis: Trial of labor proves cost effective after C-section. (Obstetrics).

NEW ORLEANS -- A trial of labor was more cost effective than elective repeat cesarean delivery in a historical cohort analysis of 204 women presented by Dr. Heather DiMaio at the annual meeting of the Society for Maternal-Fetal Medicine.

The mean overall cost of care for the 65 women who had a repeat elective cesarean was [pounds]1,538 higher than that of the 104 women who had a successful vaginal birth after cesarean section (VBAC). Among the 35 women who failed VBAC, the mean cost was [pounds]323 more than that of the C-section group.

"Using these differences, attempting VBAC is cost effective as long as the success rate exceeds 18%," Dr. DiMaio of the University of Florida, Gainesville, said in a poster session. And although the costs incurred when women fail an attempted VBAC are higher than those associated with elective repeat cesarean delivery, "our data would suggest that this difference is small."

While hospital charges are higher for cesarean than for vaginal deliveries, hospital charges may not accurately reflect the overall costs incurred with an attempted trial of labor. More nursing care is required with labor, for example, and neonatal costs can also contribute, particularly if there are complications.

There were no maternal or neonatal deaths and no hysterectomies. Three women undergoing oxytocin induction experienced uterine scar separation and were delivered operatively because of nonreassuring fetal heart rate tracing. Their infants were not among those requiring admission to the neonatal intensive care unit, however, and ...