Surprises in new OB practice trends:
Episiotomy rate drops 60%,
repeat cesareans almost double

Senior Editor

Use of episiotomy fell by 60% between 1997 and 2008, according to the latest statistical brief on childbirth-related hospitalizations from the Agency for Healthcare Research and Quality (AHRQ).¹ Other significant changes were noted, as well. For example, the use of forceps to aid delivery declined by 32%, from 14% to 10%.

In addition:

• The number of hospital stays for childbirth fell by 300,000 between 2007 and 2008—from 4.5 million to 4.2 million. (The annual number of childbirth stays had previously been increasing by about 2% a year, starting in 1999.) Nevertheless, childbirth remained the most common reason for hospitalization, accounting for 11% of all hospital stays and $18.9 billion in hospital costs—5% of all inpatient hospital costs.

• An increase in repeat cesarean delivery, from 8% to 14% of all childbirths, was accompanied by a decrease in the rate of vaginal birth after cesarean (VBAC), which fell to 1% of all deliveries in 2008

• The rate of cesarean delivery varied by insurance coverage, with uninsured women less likely to undergo it (28%), compared with privately insured women (34%) and those on Medicaid (31%)

• The average childbirth hospital stay involving cesarean delivery with no complications cost hospitals an average of $5,700; when complications occurred, the cost rose to $7,600. In contrast, a vaginal childbirth stay without complications cost hospitals an average of $3,400, and it cost $4,400 when complications occurred. Although it was uncommon, vaginal delivery that involved an operating room procedure (such as operative forceps or vacuum delivery) had the highest average cost: $9,400.

• Forty percent of all childbirth stays were billed to Medicaid; 53% to private insurers; 4% were uninsured; and the rest were charged to “other payers.”

• Roughly 36% of all childbirth hospital stays in 2008 occurred in the South, 16% in the Northeast, 26% in the West, and 23% in the Midwest.

To read the full report, visit the AHRQ Web site at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb110.jsp.

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