Impact of Pre-Labour Caesarean Delivery for a Low-Risk Indication on Hospital Length of Stay and Costs in Singleton, Nulliparous Women.

Abstract

Background: Understanding the costs to the healthcare system of caesarean delivery with a low-risk indication ('maternal request') is important for informing policies on its use. Numerous studies have examined hospital length of stay (LOS)-a key driver of hospital costs-by actual mode of delivery (vaginal vs. caesarean). This comparison, however, is misaligned with the information available at the time of antenatal decision-making, as a planned vaginal delivery could result in either an actual vaginal delivery or an emergency intrapartum caesarean.

Objectives: To compare maternal LOS in hospital and hospital costs for pre-labour caesarean delivery for a low-risk indication with planned vaginal delivery.

Methods: We conducted a population-based cohort study of all singleton births ≥ 37 weeks from nulliparous pregnancies in British Columbia, Canada, 2013-2023, using the British Columbia Perinatal Data Registry. We identified pre-labour caesarean deliveries for breech presentation (proxies for caesarean deliveries with no medical indication) as well as planned vaginal deliveries. We examined maternal total LOS in hospital, in days, and hospital costs. Differences were estimated using generalized linear models with a gamma distribution and a log link.

Results: The planned caesarean group comprised 5545 women, and the planned vaginal group comprised 146,270 women (29% emergency caesarean). The total length of hospital stay for the planned caesarean group was 2.9 days and 2.7 days for planned vaginal delivery (absolute difference 0.22 days; relative difference 8.3%, 95% considence interval [CI] -1.75, 19.4). Hospital delivery admission costs were CDN$981 higher (95% CI 886, 1076) for low-risk, pre-labour caesarean delivery than planned vaginal delivery.

Conclusion: Maternal hospital length of stay for pre-labour caesareans for a low-risk indication was similar to planned vaginal delivery, while hospital costs were 21% higher. These findings provide contemporary evidence to help inform policy development on the use of 'maternal request' caesareans, alongside other clinical, patient, and health system considerations.