Nursing ETDs

Publication Date



Every year, one-third of the 4 million child-bearing women in the United States have a cesarean delivery. Of these, 91% have a repeat cesarean delivery with the birth of subsequent children. Cesarean deliveries account for more than half of childbirth-related hospitalization expenses totaling approximately $8 billion every year. A repeat cesarean delivery has a 40% greater hospital cost than a vaginal delivery. Yet, the cost of the delivery for the health-care payer is rarely addressed in the published peer-reviewed literature. The purpose of this research was to determine the cost-effectiveness of elective repeat cesarean deliveries (ERCD) compared with trials of labor (TOL) in low-risk women who had a cesarean delivery with their first pregnancy and are now in their second pregnancy. The study compared the cost-effectiveness of ERCD versus TOL from the perspective of the health-care payer (defined as private insurance, self-pay, Medicaid, and Medicare). Cost-effectiveness was calculated on the difference of costs to the health-care payer for a delivery-related hospital stay and the possible complications incurred by the mother and baby divided by the difference of length of stay in the hospital for mother and baby for the two interventions, ERCD and TOL. Sources of data for the study were the Agency for Healthcare Research and Qualitys (AHRQ's) Healthcare Cost and Utilization Project (HCUPnet) for the year 2010, and the peer-reviewed literature. The study's findings reveal that a TOL is more cost-effective than an ERCD, with a possibility of cutting the health-care payers' costs overall by $225 million per year. Limitations of the study pertain to HCUP data, cost-effectiveness analysis assumptions, physician idiosyncratic coding practices, and the effectiveness measure (LOS). The findings have implications for practice, research, and policy. In particular, the findings could be of interest to health-care providers counseling women about their choice for mode of delivery, policymakers interested in creating new systems that reduce health-care costs and increase patient engagement, and for researchers studying health-care payment reform.

Degree Name


Level of Degree


Department Name

College of Nursing

First Committee Member (Chair)

Albers, Leah

Second Committee Member

Borrego, Matthew

Third Committee Member

Tinkle, Melinda


Robert Wood John Foundation, American College of Nurse-Midwives Colorado Affiliate


Cost-effectiveness, elective repeat cesarean, trial of labor, shared decision-making, decision model, bundled payments



Document Type