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Inside the economics of the delivery room

A 4-day-old newborn baby

Sarah Beth Mathews just can't seem to get comfortable these days. She gets up in the middle of the night to go the bathroom. She's lugging extra weight around. Normal stuff when you're 38 weeks pregnant.

She's come in for a checkup with Sarah Aultman, an obstetrician at Brookwood Medical Center in Birmingham, Ala. When it comes time to deliver this baby, Aultman has no plans to rush to do a C-section.

"Now we recognize that it's safe to let a woman continue to try and labor," she says. "And the conversation I have with my patients is as long as mom is safe and baby is safe, I'm happy to continue trying for a vaginal delivery."

That falls right in line with guidelines issued last month by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. They essentially say wait, give moms a chance to deliver vaginally.

"This document is about being patient," says Aaron Caughey, an obstetrician who helped draft the new guidelines.

But experts say that's easier said than done. And for those in the business of delivering babies, the change is going to affect the bottom line.  

Caughey says that recently, hospitals have pushed to cut C-section rates. Hospitals charge more for C-sections, but they also cost more.

"Women stay longer after C-sections. They require more intensive nursing care. They require more intensive O.R. care," he says, referring to the operating room.

So what about obstetricians, who feel pressure to deliver as many babies as they can?

"It does lead to us being patient and waiting for longer periods of time," Caughey says. "So if it's Friday at 8 p.m. and, you know, I could be at home, instead I'm going to hang out and see if someone's cervix will change."

So they might lose a little more sleep, but they're not likely to make much more money, says Neel Shah, a Harvard Medical School obstetrician based at Beth Israel Deaconess Medical Center, who has studied the cost of labor.

"The hospital might make more money on a C-section, but the person who decides to do the C-section doesn't necessarily make more money," Shah says.

In fact, one report says out of the private insurance payout on a vaginal birth, doctors get a 25 percent slice of the pie. That's slightly more than the 21 percent they get for a C-section birth.

Still, Shah says, C-sections are faster than vaginal deliveries. So if an obstetrician is paid per delivery, more is better for the bottom line.

"The longer that labor lasts, the more attractive it might be or the stronger the incentive might be to offset your workload by just getting her delivered," he says.

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