An Opportunity for Birthing Quality and Cost Improvement

The Los Angeles Times ran an article on May 15, 2009, regarding Cesarean births.  (LA Times article)  Birth services are a microcosm of the problems in the broader health system.  Childbirth is the leading reason for hospital admissions and those hospital charges amount to $79 billion a year.  Cesareans, once a rare alternative to normal vaginal births have grown to become the method for 31% of all births.  An uncomplicated Cesarean costs about twice as much as a normal birth.  But as is often the case, utilizing a more complex, more expensive health service doesn’t necessarily result in better outcomes.  Cesareans can lead to serious complications, such as infections and blood clots, which increase costs even further and cause anxiety and discomfort at what should be a joyful time for parents.  There is also wide variation in Cesarean rates across physicians and hospitals, which suggests lack of good information about the benefits, risks and costs of the procedure and/or poor dissemination of the information that is available.

The reasons for the growth in use of the Cesarean procedure may be partly due to hospital and physician attempts to increase revenue and may be partly due to patient preference, as some women believe the procedure is a very safe and more convenient method of childbirth.  It also undoubtedly due to physician malpractice suit fears, as lawyers like John Edwards made a fortune suing doctors for supposed negligence in deliveries.  Whatever the cause, this looks like a relatively large bucket of health expense that could be significantly reduced, while improving outcomes.  What may be needed is clearer guidelines on when Cesareans are really necessary and liability protection for physicians who adhere to those guidelines; couple with more rigorous information sharing with patients about the risks.