MATERNAL HOSPITAL CHARGES ASSOCIATED WITH TRIAL OF LABOR VERSUS ELECTIVE REPEAT CESAREAN-SECTION

Background: Although cesarean section is known to be associated with h igher hospital charges than vaginal delivery, cost comparisons require further investigation. This study compared maternal hospital charges of women with one previous cesarean section undergoing a trial of labo r with the charges of women who underwent an elective repeat cesarean section. Hospital charges for the trial of labor group were also compa red with charges of women with a previous vaginal delivery but no prev ious cesarean section. Methods: A retrospective analysis of three prim iparous privately insured patient groups who gave birth from July 1992 to October 1993 was conducted. Hospital charges for 50 primiparas wit h previous cesarean births who underwent a trial of labor were compare d with those of 50 contemporaneous primiparas who underwent elective r epeat cesarean section, and with those of 50 primiparas without a past history of cesarean birth. Results: Trial of labor was associated wit h a mean maternal hospital charge of $5820 +/- $1609 compared with $67 85 +/- $771 for elective repeat cesarean section (p < 0.001). Trial of labor was also associated with a decreased length of stay when compar ed with elective cesarean section (2.48 +/- 0.88 days vs 3.62 +/- 0.57 days, p < 0.001). The difference in charges between these two groups was primarily due to charges associated with length of stay and the op erating room, but was partly offset by charges associated with labor T he group of women without a past history of cesarean birth had a mean maternal hospital charge of $4685 +/- $966 and a mean length of stay o f 1.96 +/- 0.63 days. Conclusions: Trial of labor is associated with a n overall 14 percent reduction in maternal hospital charges and a 31 p ercent reduction in length of stay compared with elective repeat cesar ean section.