Hidden costs associated with the universal application of risk management in maternity care

Abstract

This paper presents a critical analysis of risk management in maternity care and the hidden costs associated with the practice in healthy women. Issues of quality and safety are driving an increased emphasis by health services on risk management in maternity care. Medical risk in pregnancy is known to benefit 15% or less of all pregnancies. Risk management applied to the remaining 85% of healthy women results in the management of risk in the absence of risk. The health cost to mothers and babies and the economic burden on the overall health system of serious morbidity has been omitted from calculations comparing costs of uncomplicated caesarean birth and uncomplicated vaginal birth. The understanding that elective caesarean birth is cost-neutral when compared to a normal vaginal birth has misled practitioners and contributed to over use of the practice. For the purpose of informing the direction of maternity service policy it is necessary to expose the effect the overuse of medical intervention has on the overall capacity of the healthcare system to absorb the increasing demand for operating theatre resources in the absence of clinical need. What is known about this topic? Australia is experiencing an increase in unexplained caesarean section births in healthy populations of women at a time when risk management is an accepted practice in maternity care irrespective of clinical need. The effect of this increase on health services has been cushioned in the belief that caesarean section is cost neutral when compared with uncomplicated vaginal birth. What does this paper add? This article shows that caesarean section is not cost neutral when compared with uncomplicated vaginal birth. Hidden costs in terms of serious morbidity affecting women’s future health and fertility associated with caesarean delivery in the absence of medical risk need to be calculated into the overall cost burden. Practitioners have been misled in this regard, thereby contributing to overuse of the practice. What are the implications for practitioners? The importance of changing the index measurement of safety and quality of maternity care to include serious morbidity following unexplained caesarean section birth rates and normal births.