Ms. Hersh and her coinvestigators found that in the theoretical cohort, “laboring upright led to 64,890 fewer cesarean deliveries, 15 fewer maternal deaths, 113 fewer uterine ruptures, and 30 fewer hysterectomies.”
These reductions were associated with a savings for this cohort of $785 million, and an increase in QALYs of 2,142.
Using Monte Carlo simulation techniques to ascertain the effect of varying cesarean rates and other components of the model, Ms. Hersh and her colleagues found that the model remained cost-effective even with variation in all of the inputs.
“Laboring upright is a no-cost intervention that leads to improved outcomes, decreased costs, and increased QALYs during a woman’s first and second deliveries,” wrote Ms. Hersh and her associates. “This model argues for increasing systems factors that support women to be upright and mobile during labor, and in doing so, promoting improved health for our patients.”
Said Ms. Hersh, “This is an easy way for hospitals to adopt policies that can enable women to have improved outcomes.”
Ms. Hersh and her colleagues had no relevant financial disclosures.
SOURCE: Hersh A et al. ACOG 2018. Abstract 34C.