{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:18:27Z","timestamp":1784132307833,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,7,28]],"date-time":"2019-07-28T00:00:00Z","timestamp":1564272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Preventing a primary cesarean birth in nulliparous women with term, singleton, vertex pregnancies (NTSV) is recognized as an important strategy to reduce maternal morbidities and risks to the newborn. Multiple professional organizations are supporting approaches to safely reduce NTSV cesarean rates, including the American College of Obstetricians and Gynecologists; the Society for Maternal\u2010Fetal Medicine; and the Association of Women's Health, Obstetric and Neonatal Nurses. The American College of Nurse\u2010Midwives (ACNM) is leading one such effort as part of its Healthy Birth Initiative: the Reducing Primary Cesareans (RPC) Learning Collaborative. The objective of this study is to estimate the cost savings of a decrease in NTSV cesareans at one hospital participating in the RPC Learning Collaborative.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All women giving birth at Baystate Medical Center from October 1, 2016, to March 31, 2017, and their newborns were identified by Medicare Severity Diagnosis Related Group (N = 1747). Total hospital costs were calculated using a resource consumption profile for each of 6 groups: women who had vaginal birth, primary cesarean, and repeat cesarean and their linked newborns. A model was developed to estimate cost differences for the first and second births and overall cost savings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For the NTSV birth, total costs for primary cesarean and newborn care were $5989 higher compared with vaginal birth and newborn care. For the subsequent birth, repeat cesareans and newborn care were $4250 higher compared with vaginal birth. In 2016, 69 primary cesareans were prevented, for an actual cost savings of $413,241. Projecting the prevention of 66 subsequent repeat cesareans would result in additional savings of $280,500, for a total savings of $693,741. Apgar score at 5 minutes and length of stay remained unchanged.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Participation in ACNM's RPC Learning Collaborative led to significant savings in hospital costs during the first year without affecting quality metrics. This cost comparison model could be replicated by other hospitals involved in cesarean reduction endeavors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jmwh.13010","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T04:26:56Z","timestamp":1564374416000},"page":"56-63","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Estimating the Financial Impact of Reducing Primary Cesareans"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2095-3290","authenticated-orcid":false,"given":"Susan A.","family":"DeJoy","sequence":"first","affiliation":[{"name":"Division of Midwifery and Community Health, Department of Obstetrics and Gynecology Baystate Medical Center  Springfield Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew G.","family":"Bohl","sequence":"additional","affiliation":[{"name":"Clinical Financial Planning and Decision Support Baystate Health  Springfield Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Healthcare Quality Baystate Medical Center  Springfield Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"Blake","sequence":"additional","affiliation":[{"name":"Department of Nursing Baystate Medical Center  Springfield Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000444441.04111.1d"},{"key":"e_1_2_7_3_1","volume-title":"Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care","author":"Buckley SJ.","year":"2015"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1891\/1058-1243.22.1.14"},{"issue":"6","key":"e_1_2_7_5_1","first-page":"1","article-title":"Trends in low\u2010risk cesarean delivery in the United States, 1990\u20102013","volume":"63","author":"Osterman MJ","year":"2014","journal-title":"Natl Vital Stat Rep"},{"issue":"8","key":"e_1_2_7_6_1","first-page":"1","article-title":"Births: final data for 2017","volume":"67","author":"Martin JA","year":"2018","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_7_1","volume-title":"Cesarean Deliveries, Outcomes, and Opportunities for Change in California: Toward a Public Agenda for Maternity Care Safety and Quality","author":"Main EK","year":"2011"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.06.035"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1030"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002128"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002263"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12218"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2016.11.008"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003109"},{"key":"e_1_2_7_15_1","unstructured":"American College of Nurse\u2010Midwives.Reducing primary cesareans. 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