Value-based care in obstetrics: comparison between vaginal birth and caesarean section

BMC Pregnancy Childbirth. 2021 Apr 26;21(1):333. doi: 10.1186/s12884-021-03798-2.

Abstract

Background: Healthcare costs have substantially increased in recent years, threatening the population health. Obstetric care is a significant contributor to this scenario since it represents 20% of healthcare. The rate of cesarean sections (C-sections) has escalated worldwide. Evidence shows that cesarean delivery is not only more expensive, but it is also linked to poorer maternal and neonatal outcomes. This study assesses which type of delivery is associated with a higher healthcare value in low-risk pregnancies.

Results: A total of 9345 deliveries were analyzed. The C-section group had significantly worse rates of breastfeeding in the first hour after delivery (92.57% vs 88.43%, p < 0.001), a higher rate of intensive unit care (ICU) admission both for the mother and the newborn (0.8% vs 0.3%, p = 0.001; 6.7% vs 4.5%, p = 0.0078 respectively), and a higher average cost of hospitalization (BRL14,342.04 vs BRL12,230.03 considering mothers and babies).

Conclusion: Cesarean deliveries in low-risk pregnancies were associated with a lower value delivery because in addition to being more expensive, they had worse perinatal outcomes.

Keywords: Birth setting; Cesarean section; Delivery of healthcare; Healthcare cost; Obstetric delivery; Obstetrics; Quality of healthcare.

MeSH terms

  • Adult
  • Brazil / epidemiology
  • Breast Feeding / statistics & numerical data
  • Cesarean Section* / economics
  • Cesarean Section* / methods
  • Cesarean Section* / statistics & numerical data
  • Delivery of Health Care / organization & administration
  • Delivery of Health Care / trends
  • Delivery, Obstetric* / economics
  • Delivery, Obstetric* / methods
  • Delivery, Obstetric* / statistics & numerical data
  • Female
  • Health Care Costs* / statistics & numerical data
  • Health Care Costs* / trends
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Intensive Care Units / statistics & numerical data
  • Obstetrics / economics*
  • Outcome and Process Assessment, Health Care / economics
  • Outcome and Process Assessment, Health Care / statistics & numerical data
  • Pregnancy
  • Risk Assessment