Admission in Active Labor Could Decrease Cesareans & Maternal Deaths in Low-Risk Women

Using the obstetric research to develop their underlying assumptions, investigators created a decision-analytic model to compare outcomes in a theoretical population of 3.2 million healthy, low-risk women with no prior cesareans, this being the number of such women giving birth in the U.S. each year, based on whether they were admitted to the hospital at less than 4 cm dilation or at 4 or more cm dilation. Delaying admission until active labor would result in 67,200 fewer cesareans and 10 fewer maternal deaths while having no effect on fetal deaths. It would also reduce the use of epidurals by 670,000 and save $700,000,000. The cost savings would seem to add to the good news, but unfortunately, cost-effectiveness would be a disincentive to a policy of active labor admission as it is the opposite of revenue generating. For more on perverse economic incentives, check out this article in the Economist.