Comparison of healthcare costs associated with vaginal births versus cesarean sections

Dritsakou Kalliopi, Tzortzi Alexandra, Dafnos Georgios, Nousia Konstantina, Dalainas Ilias, Farmakides George

Elena Venizelou hospital, Athens, Greece

Correspondence: Dritsakou Kalliopi, Elena Venizelou hospital, Athens, Greece

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Keywords: healthcare cost; vaginal birth, cesarian section



Over the last years, there has been a large increase in the rates of cesarian section and nowadays tend to exceed the proportion of 60% of annual births in some developing and developed countries1-9. Several studies, despite the fact that highlight the maternal and perinatal advantages of elective cesarian sections, indicate that cesarian sections generally tend to be more costly than vaginal deliveries10-13. Cesarian sections are generally found to be associated with longer maternal hospitalization and increased postpartum healthcare utilization, that also increase healthcare associated costs14-18. On average, in the United States, cesarian sections tend to be more costly than vaginal births: $4,700 versus $2,900 without complications, and $6,500 versus $3,800 with complications, respectively2. However, other researchers have found that cesarean section deliveries are not always costlier than vaginal deliveries19.

We performed an observational study of women who gave birth with cesarean section or vaginal delivery from September 1st, 2014 to January 1st, 2015. The objective of the study was to evaluate the hospitalization costs per each mode of delivery. Data on the costs of hospitalization were derived from the hospital economic department while data on women’s and neonates’ demographic and perinatal characteristics were derived from medical records. The study was approved by the scientific hospital board and informed written consent was obtained from all participants. Women who gave birth to preterm neonates and neonates with major congenital malformations, operative vaginal deliveries and labors with serious complications, were excluded from the study. Variables were first tested for normality using the Kolmogorov-Smirnov criterion. Normal distributed variables were expressed as mean (± standard deviation, SD) and variables with skewed distribution were expressed as median (interquartile range). Student’s t test, Wilcoxon test, chi - square test and Fisher’s exact test were performed and all reported p values were two - tailed.

During the study period, 211 women gave birth with vaginal labor and 428 women delivered their neonates with cesarian section. Mean maternal age did not differ between the two study groups. The proportion of male neonates born with vaginal delivery was higher than double compared with those born with cesarean section (83.4% vs 41.1%), whereas the proportion of female neonates born with cesarean section was more than threefold higher than among vaginally delivered neonates (58.9% vs 16.6%). Parity, gestational age and neonatal birth weight were higher in the vaginal birth group. Women of Greek nationality were more likely to deliver with cesarian section, compared with those of foreign nationality (72.4% vs 43.8%). Most public employees underwent cesarean section, whereas all healthcare professionals delivered vaginally. The most common method of anesthesia in cesarean sections was general anesthesia (70.8%), followed by spinal anesthesia (25%) (Table 1). Women who underwent a cesarean section remained in the hospital longer than those who had a vaginal birth (4.4 vs 4.0 days). The mean cost of hospitalization per woman who gave birth with cesarean section was higher compared with those with vaginal birth. Moreover, the proportion of neonates admitted in the neonatal intensive care unit (NICU) was significantly lower among vaginal births and the cost per admitted neonate in the NICU was significantly lower among neonates delivered vaginally (Table 2).


Comparison of healthcare table1 2


General anesthesia was mainly used in urgent cesarian sections, while epidural and spinal anesthesia were generally used in planned cesarian sections. The high incidence of general anesthesia in our study is probably attributed to the high rates of urgent cesarian sections and women’s personal choice. We found that female neonates were more likely to be born with cesarean section, a finding that needs further evaluation in future studies. Furthermore, healthcare professionals are probably better informed, which is probably the reason they choose to give birth vaginally. Differences between Greek and non - Greek mothers were found statistically significant, probably due to different attitudes towards birth.

As concluded in our study, costs were higher when cesarian sections were performed while in the case of a cesarian section, more infants were hospitalized in NICU, inducing higher NICU hospitalization costs. Our results indicate that it is important to consider the promotion of vaginal births as potentially cost-effective healthcare policy method to decrease childbirths’ hospitalization costs.


Conflict of interest

All authors declare no conflict of interest.



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