Vaginal birth after cesarean delivery: An historic cohort cost analysis

Objective: The purpose of this study was to evaluate the relative cost-effectiveness of attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery. Study Design: We performed an historic cohort analysis of women with a single prior cesarean delivery who were delivered at our institution during 1999. Inclusion criteria were ≥36 weeksʹ gestation and carrying a live, singleton fetus with no antenatally diagnosed anomalies. The primary outcome variable was mean cost of hospital care for mother-infant pairs, as obtained from the hospitalʹs Clinical Resources Department. Results: The cohort consisted of 204 mother-infant pairs, 65 in the elective repeat cesarean group and 139 in the attempted vaginal birth group. Mean cost of care was higher for mothers ($4155 vs $3675;P< .001), neonates ($1794 vs $1187; P = .03), and mother-infant pairs ($5949 vs $4863; P = .001) for the elective repeat cesarean group compared with the attempted vaginal delivery group. Conclusion: In women with a single prior cesarean delivery, a trial of labor is more cost-effective than an elective repeat cesarean delivery. (Am J Obstet Gynecol 2002;186:890-2)