title: Cumulative economic implications of initial method of delivery.
abstract: OBJECTIVE
  To examine the cumulative costs of hospital care in the first and subsequent pregnancies associated with different methods in the initial delivery of nulliparous women.
  
  
  METHODS
  An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared cumulative delivery costs in the first and subsequent pregnancies. Women were identified by initial method of delivery for nulliparous women with singleton cephalic presentation at term undergoing spontaneous or induced labor for planned vaginal delivery, and for nulliparous women undergoing cesarean delivery without labor. Costs that were assessed included nursing hours in antepartum, labor and delivery, postpartum and neonatal intensive care units, physician costs, labor induction agents, consumables, and costs for postpartum hysterectomy, tubal ligation, and dilatation and curettage.
  
  
  RESULTS
  A total of 27,613 pregnancies satisfied inclusion and exclusion criteria. When cumulative costs by type of labor at first delivery were considered, induction of labor (7,220 dollars) was more costly than spontaneous onset of labor (6,919 dollars, P = .006). The cumulative costs of assisted vaginal delivery at first delivery (7,288 dollars) and cesarean delivery in labor at first delivery (9,524 dollars) were similar in magnitude and were higher than spontaneous vaginal delivery at first delivery (P < .001). Cesarean delivery in labor in the first delivery was the most costly type of delivery (9,524 dollars), and the differences in cost increased with increasing number of deliveries (P < .05).
  
  
  CONCLUSIONS
  Cesarean delivery in labor in the first delivery is associated with increased cumulative costs compared with other methods of delivery, regardless of the number or type of subsequent deliveries.
authors.affiliation: Department of Obstetrics and Gynaecology, Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada. victoria.allen@dal.ca
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Allen
authors.forename: Colleen M
authors.initials: CM
authors.lastname: O'Connell
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Baskett
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics* / Q000401:mortality; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007745:Labor Onset; D007751:Labor, Induced / Q000191:economics; D007743:Labor, Obstetric; D009674:Nova Scotia; D010298:Parity; D010564:Personnel, Hospital / Q000191:economics*; D011247:Pregnancy