C-sections can double birthing costs
Mark Simonelli, obstetrician and gynecologist, Harrington HealthCare System
An important new study by the Leapfrog Group shows that more than 60 percent of the reporting hospitals have excessive rates of Cesareans, or C-sections. According to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, Cesarean birth has increased greatly since it was first measured in the '60s, and today, one in three women have C-sections.
We, at Harrington HealthCare System, believe that too many of these women are undergoing major abdominal surgery without medical necessity, increasing medical risks as well as costs.
Leapfrog's study, which focused on first-time, low-risk pregnancies that reached the 37th week or later, included 1,222 nationwide hospitals that divulged their C-section rates. Among the reporting hospitals, only 39.1 percent met Leapfrog's recommended target rate of 23.9 percent, with surprising results among community hospitals and teaching hospitals. For example, in Massachusetts, some well-known medical centers reported rates of over 40 percent, while Harrington HealthCare System, based in Southbridge and serving 21 communities in South Central Massachusetts, had the lowest rate in the state at 14.3 percent.
At Harrington, we are pleased with our performance yet troubled by the statistics. We hope this information will be beneficial to patients, providers, employers and insurers in the future.
The fact is, while C-sections are sometimes preferable or necessary – especially when the baby is in distress – most often, vaginal birth is a better option. C-sections may be a more expedient means of delivery, but they have serious risks, including infection and blood clots as well as injuries to other organs, respiratory problems for babies, and potential complications for mothers with future pregnancies.
Ultimately, safety should be a hospital's first priority, and every baby should be delivered in the safest and least complicated manner. Lower C-section rates mean reduced risks — and less risk means less associated costs.
Calculating the Costs
Baby-delivery costs typically include the services of the obstetrician/gynecologist and anesthesiologist; an epidural, if used; the length of hospital stay; nursery time; laboratory services; medications and medical supplies; and postpartum recovery.
The biggest factors affecting the cost of a birth are vaginal vs. Cesarean, complications, length of stay and location (with community hospitals typically more cost effective than city medical centers).
Factors to consider:
• Costs – Looking at the uninsured costs – either billed to the insurance companies or directly to individuals who don't have insurance – vaginal deliveries range from $9,000 to $17,000, compared to $14,000 to $32,000 for C-sections.
• Length of stay – The average hospital stay for vaginal childbirth in Massachusetts is 48 hours compared to 96 hours for C-section procedures.
• Recovery – Full recovery after a vaginal delivery is one to two weeks compared to four to six weeks with C-sections.
• Additional costs – C-sections increase the chances for costly complications (including specialized care in the neonatal intensive care unit), additional medication, further costs for more out-patient visits after discharge, and the potential for various long-term health issues for mothers and babies.
Mark Simonelli, M.D., F.A.C.O.G., is a board-certified obstetrician and gynecologist at Harrington. He is a member of Harrington Physician Services and sees patients in Southbridge and Webster. Reach him through Harrington's web site, www.harringtonhospital.org.
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