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Complications & Common Chronic Conditions Increase Hospitals’ Childbirth Costs by 20 Percent or More

Serious complications during childbirth increase mothers’ hospital stays by 70 percent, in part due to pre-existing conditions and avoidable harm.

CHARLOTTE, N.C. – U.S. hospitals could save upwards of 20 percent in costs for complicated childbirths, according to a nationally representative analysis by Premier Inc. (NASDAQ: PINC). The increased costs associated with childbirth are in part due to potentially preventable complications and pre-existing chronic conditions.

In aggregate, complications, including severe maternal morbidity (SMM) factors and chronic conditions, add on average 20 percent to the cost to hospitals to perform a vaginal delivery and 25 percent to the cost to perform a cesarean delivery. This analysis shines light on the opportunity to improve outcomes and avoid excess costs and longer lengths of stay by working across provider networks to ensure appropriate care prior to childbirth, and standardizing processes to identify and prevent labor and delivery complications.

Premier’s analysis examined the cost to hospitals to provide labor and delivery care for women from 2008 through 2018, and specifically how the cost to hospitals varied by complication for 2.7 million maternal patients from 2015-2018. The cost to provide childbirth care for women who experienced complications or had pre-existing chronic conditions was compared to hospitals’ average base cost for an uncomplicated vaginal delivery (about $5,700) and cesarean delivery (about $8,500), per Premier’s analysis.

SMM factors – the most serious type of childbirth complication such as heart failure, heart attacks and shock – offer the greatest opportunity area for hospitals to standardize care and save significant costs. Premier found that a vaginal delivery with SMM costs hospitals 88 percent more to perform compared to an uncomplicated vaginal delivery, and a cesarean with SMM costs hospitals 111 percent more than an uncomplicated cesarean delivery, on average. These serious, lifelong complications are often preventable, and women who experience SMM factors stay in the hospital 70 to 75 percent longer than those with uncomplicated deliveries.

“Mothers and their babies are arguably our most important population. When providers are armed with the tools to identify pre-existing conditions and early warning signs, and commit to providing highly reliable care, they raise the quality of care for mothers and babies,” says Deb Kilday, MSN, who leads Premier's Women, Infants and Children Service Line. “This analysis clearly demonstrates a need to approach labor and delivery with standardized, coordinated care practices in order to better identify and manage potential complications, reduce costs and, most importantly, help mothers recover faster. This is why Premier is working across its alliance of hospitals and health systems to improve maternal outcomes and overall healthcare quality – and subsequently bring down the ever-rising cost of having a baby.”

Premier data shows that as of 2018, the maternal population has more pre-existing chronic conditions than previous generations, and these also contribute to higher risk factors for a complicated and more costly delivery. Premier’s analysis found that four common chronic conditions – obesity, behavioral health disorders, diabetes and chronic pain – add between 11 to 36 percent to the hospital’s cost of otherwise uncomplicated vaginal and cesarean deliveries, on average.

“Today’s maternal patient population has more complex conditions than previous years. By identifying cases that are at higher risk of complications during delivery and ensuring evidence-based practices are in place to prevent them, we can make a real impact on maternal harm and mortality,” Kilday says. “Both providers and patients stand to benefit, not only in terms of outcomes, but also cost, efficiency and experience.”

This is Premier’s first analysis on the cost to hospitals to provide maternal healthcare, and its second in its series on maternal and infant health trends, conducted as part of its Bundle of Joy™ campaign. The campaign is designed to test and scale measurable improvement in the quality, safety and cost of care for mothers and babies in the U.S. Premier’s analyses on the key drivers of maternal and infant mortality and morbidity, as well as the costs associated with these trends, serve as a baseline for measuring improvement.

View the full cost analysis.


Findings were derived from the Premier Healthcare Database, which Premier used to analyze the hospitals' cost of delivery for 8.9 million women (approximately 25 percent of births nationally) from 2008 through 2018. Premier specifically examined the hospital discharges of 2.7 million maternal patients treated at 613 hospitals across 42 states from 2015-2018 to drill into cost variation by complications.

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