Tuesday, February 14, 2012

Two Really Big Flaws to Cost Studies on C-Section versus Vaginal Birth

Everyone knows that vaginal birth is a lot less expensive than a surgical birth...and that women who are demanding c-sections for nothing more than convenience are drains on the social resources of the health care system.

What everyone doesn't know is that most of the cost studies that compare the costs of c-section to vaginal birth are fundamentally flawed - so much so that the cost difference between the two planned methods of birth might even be negligible.

Flaw 1: Prospective versus Retrospective

Imagine you are driving a car - now imagine that you have your car in drive but are looking exclusively in the rear view mirror, now apply your foot to the accelerator and drive on the basis of this rear view mirror information. This is using retrospective information to make prospective decisions.

Most cost studies that compare the costs of vaginal birth to the cost of surgical birth use this approach. After the outcome of the birth is known (surgical or vaginal) the cost of the birth is estimated and all of the costs of the successful vaginal births are averaged and all of the costs of the surgical births are averaged - if it's a 'good' cost study, the costs of unplanned or emergent surgical births might be seperated out from the costs of planned surgical births. When advocates for natural childbirth cite a figure for the cost-savings of avoiding c-sections they will often do some simple math whereby the average cost difference between a vaginal birth and a surgical birth is applied to the number of c-sections that are proposed to be avoided. Unfortunately this ignores the reality that many planned vaginal births end in urgent/emergent c-sections and as such there is likely to be a large difference between the expected cost of a planned vaginal birth and the actual cost of a vaginal birth.

Flaw 2: A Tunnel Vision Approach to Cost

The second flaw that is endemic to cost studies comparing c-section to vaginal birth is a type of tunnel vision on which costs are included in the comparison and which costs are excluded in the comparison. Typically most cost studies take a very narrow view on the costs of labour and delivery. It is the resources used by the mother and baby while in the hospital for the specific birth event. Once mom and baby are discharged the meter stops. As mode of delivery can have an ongoing impact on the use of health resources this is disingenous. So what kind of costs are currently being excluded in cost analyses on mode of delivery: 1. Cost of ongoing care for birth injuries, 2. Cost of reconstructive surgery, 3. Cost of incontinence supplies 4. Cost of psychological counselling, 5. Cost of litigation, 6. Cost of stillbirth, 7. Cost of pelvic floor injuries.

No comments:

Post a Comment