Women are more likely to experience an unexpected outcome during delivery and it's adding to hospital costs, according to a new analysis from Premier.
The rate of women with a severe maternal morbidity factor, which are complications during labor such as sepsis, shock or eclampsia, rose by 36% from 2008 to 2018, Premier found. And those vaginal births cost nearly 80% more on average than those without complications. Additionally, cesarean deliveries for women with a severe maternal morbidity factor cost almost twice as much as uncomplicated C-sections on average.
The findings should be a signal to hospitals that they can do more to prevent complications, said Deb Kilday, leader of Premier's Women, Infant and Children's Service Line. Screening women when they present to the hospital for conditions that make them vulnerable to complications such as substance abuse disorder or obesity could avoid issues during labor, especially for women who don't get the appropriate care throughout their pregnancy, she said.
"Some of these women haven't had great access to care, and they haven't had some of their pre-existing conditions and comorbidities followed" during pregnancy, she said. "That puts pressure on the hospital to have a very standardized screening process in place."
While screening women during their pregnancy for potential complications is common, not all hospitals follow the practice when women present for labor, according to Kilday. "That is something we are working on as a nation. There are a lot of organizations working to get hospitals to implement these standards of care," she said.
Premier used its own database for the analysis, and it includes the cost of delivery for 8.9 million women, which represents about 25% of births nationally, from 2008 to 2018. Data from about 2.7 million discharges at 613 hospitals from 2015 to 2018 were used to identify cost variations by complications.
The priciest severe maternal morbidity factors are cardiac arrest, heart attack, acute renal failure, shock and acute respiratory distress syndrome, which is when fluid collects in the lungs. These five complications add $13,600 on average to vaginal deliveries, which cost $5,681 on average without complications.
In addition to the rising costs associated with complicated births, the cost of labor and delivery in general is on the rise. From 2015 to 2018, the average cost for a hospital to perform an uncomplicated vaginal delivery rose by almost 13% while the cost to perform an uncomplicated C-section increased by more than 17%.
Kilday said the rise in costs reflects national trends in healthcare spending.
The analysis also found women with pre-existing conditions had more expensive deliveries. Pregnant women with chronic pain, diabetes or obesity added on average $1,006 to the cost of an uncomplicated vaginal delivery and $2,264 on average to the cost of an uncomplicated C-section.
"We have a much older population (of pregnant women) that have pre-existing conditions that really don't present as complications until the time of delivery," Kilday said. "We have these ever-rising complications and costs associated with delivery, and so we have to ask ourselves why and what can we be doing differently."