Which is cheaper? Elective or Emergency C-section?

That was a recent search term someone used to find my blog.

An elective C-section ought to be cheaper than an emergency C-section. The only exception might be if an elective C-section ends up having complications while an emergency C-section does not.

First, a clarification of terms — some people, including most doctors performing studies, call any unplanned C-section an “emergency”. Most lay people would probably assume that an “emergency C-section” would mean a surgery that was not just unplanned, but actually was an emergency, such as if the fetal heartbeat were absent.

In doctor parlance, however, the following conditions would be considered “emergency”:

  • after going into labor, it was discovered that the baby was breech (although the baby was in no danger)
  • mom takes too long to dilate (according to the doctor’s strict time rules)
  • mom takes too long to push the baby out (according to the doctor’s strict time rules)
  • maternal exhaustion
  • mom decides she’s tired of labor in the middle of it, so opts for a C-section instead
  • baby’s heartbeat zigs when it should have zagged, and the doctors are afraid of a lawsuit

Studies have shown that emergency C-sections (that is, unplanned C-sections that were performed after labor began) have a higher rate of complications, including things like maternal hemorrhage, need for hysterectomy, maternal infection, etc. Should these complications occur — which are more likely in unplanned than planned C-sections — then it is obvious that hospital costs rise. There is cost involved in blood transfusions, antibiotics, longer hospital stay, additional surgery, longer surgery, etc. But I haven’t seen a study which looks at true emergency C-sections (like, immediately running the mom on the gurney into the OR and topping up her epidural or putting her completely out) and just unplanned non-emergency C-sections (you know the kind — the ones that start up to an hour or so after the decision to perform a C-section has been made)

However, the cost of an uncomplicated vaginal birth is less than a C-section, complicated or not. And if you attempt a vaginal birth, you are likely to succeed (as high as the C-section rate is, it’s still much less than half of all planned vaginal births). So, if you’re looking at this from a cost-benefit angle, where best is cheapest, a planned and successful vaginal birth is best, followed by an elective C-section, with an emergency C-section bringing up the rear.

It’s hard enough getting data on actual costs of births divided by vaginal and C-section without having them also divided into planned and unplanned. However, we can assume that more unplanned C-sections ended up having complications than planned ones, and that they therefore would be more expensive, on average, than planned C-sections (which should have a lower rate of complications). But looking at successful vaginal births — even those with complications — show them to be much cheaper than even uncomplicated C-sections.

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