{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:38:28Z","timestamp":1792654708905,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Understanding the costs to the healthcare system of caesarean delivery with a low\u2010risk indication (\u2018maternal request\u2019) is important for informing policies on its use. Numerous studies have examined hospital length of stay (LOS)\u2014a key driver of hospital costs\u2014by actual mode of delivery (vaginal vs. caesarean). This comparison, however, is misaligned with the information available at the time of antenatal decision\u2010making, as a planned vaginal delivery could result in either an actual vaginal delivery or an emergency intrapartum caesarean.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare maternal LOS in hospital and hospital costs for pre\u2010labour caesarean delivery for a low\u2010risk indication with planned vaginal delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based cohort study of all singleton births \u2265\u200937\u2009weeks from nulliparous pregnancies in British Columbia, Canada, 2013\u20132023, using the British Columbia Perinatal Data Registry. We identified pre\u2010labour caesarean deliveries for breech presentation (proxies for caesarean deliveries with no medical indication) as well as planned vaginal deliveries. We examined maternal total LOS in hospital, in days, and hospital costs. Differences were estimated using generalized linear models with a gamma distribution and a log link.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The planned caesarean group comprised 5545 women, and the planned vaginal group comprised 146,270 women (29% emergency caesarean). The total length of hospital stay for the planned caesarean group was 2.9\u2009days and 2.7\u2009days for planned vaginal delivery (absolute difference 0.22\u2009days; relative difference 8.3%, 95% considence interval [CI] \u22121.75, 19.4). Hospital delivery admission costs were CDN$981 higher (95% CI 886, 1076) for low\u2010risk, pre\u2010labour caesarean delivery than planned vaginal delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal hospital length of stay for pre\u2010labour caesareans for a low\u2010risk indication was similar to planned vaginal delivery, while hospital costs were 21% higher. These findings provide contemporary evidence to help inform policy development on the use of \u2018maternal request\u2019 caesareans, alongside other clinical, patient, and health system considerations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ppe.70188","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:51:13Z","timestamp":1792651873000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Pre\u2010Labour Caesarean Delivery for a Low\u2010Risk Indication on Hospital Length of Stay and Costs in Singleton, Nulliparous Women"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3315-6138","authenticated-orcid":false,"given":"Taylor","family":"Traaseth","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3128-913X","authenticated-orcid":false,"given":"Kirsten M.","family":"Niles","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Cordingley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7244-4258","authenticated-orcid":false,"given":"Hannah","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Giesbrecht","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver British Columbia Canada"},{"name":"Perinatal Services British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2242-7868","authenticated-orcid":false,"given":"Amy","family":"Hobbs","sequence":"additional","affiliation":[{"name":"Perinatal Services British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3536-0498","authenticated-orcid":false,"given":"Laura","family":"Schummers","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin C.","family":"Strumpf","sequence":"additional","affiliation":[{"name":"Departments of Economics and of Epidemiology, Biostatistics, and Occupational Health McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1573-5574","authenticated-orcid":false,"given":"Jessica","family":"Liauw","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6618-6018","authenticated-orcid":false,"given":"Jennifer A.","family":"Hutcheon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"2","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.bpobgyn.2012.09.006","article-title":"Caesarean Section on Maternal Request for Non\u2010Medical Reasons: Putting the UK National Institute of Health and Clinical Excellence Guidelines in Perspective","volume":"27","author":"D'Souza R.","year":"2013","journal-title":"Best Practice & Research Clinical Obstetrics & Gynaecology"},{"key":"e_1_2_10_3_1","volume-title":"WHO Statement on Caesarean Section Rates","author":"WHO","year":"2015"},{"issue":"1","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1097\/AOG.0000000000003013","article-title":"Prepregnancy Counseling","volume":"133","author":"ACOG Committee Opinion No. 762","year":"2019","journal-title":"Obstetrics and Gynecology"},{"issue":"1","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1515\/jpm-2012-0049","article-title":"To \u2018C\u2019 or Not to \u2018C\u2019?\/Caesarean Delivery Upon Maternal Request: A Review of Facts, Figures and Guidelines","volume":"41","author":"D'Souza R.","year":"2013","journal-title":"Journal of Perinatal Medicine"},{"issue":"1","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002494","article-title":"Long\u2010Term Risks and Benefits Associated With Cesarean Delivery for Mother, Baby, and Subsequent Pregnancies: Systematic Review and Meta\u2010Analysis","volume":"15","author":"Keag O. 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A.","year":"2011","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"1","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/s12884-020-2839-9","article-title":"Length of Stay After Childbirth in India: A Comparative Study of Public and Private Health Institutions","volume":"20","author":"Kumar P.","year":"2020","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"18","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"E634","DOI":"10.1503\/cmaj.202262","article-title":"Birth Outcomes Following Cesarean Delivery on Maternal Request: A Population\u2010Based Cohort Study","volume":"193","author":"Guo Y.","year":"2021","journal-title":"Canadian Medical Association Journal"},{"issue":"2","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/AOG.0b013e3182605b1a","article-title":"Maternal Preference for Cesarean Delivery: Do Women Get What They Want?","volume":"120","author":"Fuglenes D.","year":"2012","journal-title":"Obstetrics and Gynecology"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s12884-015-0563-7","article-title":"Validating the British Columbia Perinatal Data Registry: A Chart Re\u2010Abstraction Study","volume":"15","author":"Frosst G.","year":"2015","journal-title":"BMC Pregnancy and Childbirth"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1503\/cmaj.060870","article-title":"Maternal Mortality and Severe Morbidity Associated With Low\u2010Risk Planned Cesarean Delivery Versus Planned Vaginal Delivery at Term","volume":"176","author":"Liu S.","year":"2007","journal-title":"Canadian Medical Association Journal"},{"key":"e_1_2_10_15_1","unstructured":"Canadian Institute for Health Information \u201cCost of a Standard Hospital Stay\u2014Methodology Notes \u201dOttawa ON 2026."},{"key":"e_1_2_10_16_1","unstructured":"Canadian Institute for Health Information \u201cPatient Cost Estimator: Methodology Notes and Glossary \u201dOttawa ON 2023."},{"issue":"2","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"E35","DOI":"10.1542\/peds.108.2.e35","article-title":"A New and Improved Population\u2010Based Canadian Reference for Birth Weight for Gestational Age","volume":"108","author":"Kramer M. 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