Vaginal birth is more lucrative

I’m on vacation, but I thought I would take a moment to relay a conversation I had with a good friend of mine who is an OB.  A few weeks ago, we were lounging in a whirlpool at a downtown spa (hard life I know, thank you daddy for sitting with the baby!) and I asked her if she preferred to do vaginal or cesarean deliveries.

Without even hesitating, she said, “vaginal.”

Her reasons, even though she loves helping babes into the world, had little to do with the sanctity of birth or anything woo, but rather with money.  She considers vaginal and C/S births to be roughly equivalent, reasonable ways of birthing.

She said that, when on-call, the pay difference for managing a labour that ends with a vaginal delivery vs one that ends with a C/S is about $60.  That fee includes post-natal care (1-14 days in hospital).  Since patients go home a day after a vaginal delivery (and some go after 12 hours!) but 3 days after a C/S, the C/S patients are more work.

Hmmm…more work for basically equivalent money.

I can’t speak for renumeration in other countries, but in Canada, the concept of evil OB’s pushing women into C/S in order to increase their billings needs to die.  It just isn’t true.  Clearly, the public health insurers (in Canada the provincial governments) have set the fee schedule in order to incentivize doctors to chose vaginal deliveries over C/S.  For the healthcare system overall, vaginal deliveries are either probably cheaper or the government thinks they are.  I bet they have an actuary somewhere in the health ministry calculating the cost of vaginal versus C/S.

When you work in a public health care system, this is the kind of stuff that happens.  The benefits of being able to provide the same level of care to every citizen regardless of ability to pay is a beautiful thing.   However, women deserve informed choice, and we, as physicians, must always be cognizant of how factors (like how much we get paid to do a certain task) might bias us when we discuss care options with them.

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3 comments

  1. I completely agree – for instance, I hear a lot about nurses pushing pit to speed up the “assembly line”. Well, if pit increases the chance of c-section (which I’m not sure it really does, but I’ve heard that as well) as a nurse, I’d just be increasing the amount of days a bed is tied up – not exactly rushing women out! Also, c-sections are way more work, charting, meds, etc.

  2. Note: as an economist, who ironically works for a Canadian province’s ministry of health, this is a very interesting question. The answer to which is not entirely clear (from either the Dr.’s perspective or that to the health system as a whole). You’d be surprised at how little this question has actually been examined to the degree that would be needed to come up with a conclusive quality answer as to what is actually the more ‘cost-effective’ method of birth and whether or not the pay structure actually aligns the interests of the OB’s with the interests of the patient, the interests of the hospital, and the interests of the broader health system. After looking into this question in a little more depth, personally, I’m inclined to think that somewhere along the line somebody seriously messed up the math on this particular question…

  3. This is true for c/s after labour but a repeat c/s in ontario pays double that of a vaginal birth and it takes thirty minutes vs 14 hours. I wonder why our vac rates are so low

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