Presentation (CTI)

OBJECTIVES: Cesarean deliveries incur higher facility, professional, and postpartum recovery costs than vaginal deliveries. This analysis evaluated the association between engagement with a multidisciplinary virtual maternity program and cesarean delivery rates and delivery costs in a commercially insured population.
METHODS: This retrospective cohort analysis used medical claims to identify deliveries and measure outcomes for episodes between January 2023 and December 2025. The primary exposure was audio or video prenatal engagement with a virtual maternity program care team that provides risk identification and management, birth planning support, and 24/7 access to medical and behavioral health care. We evaluated two exposure thresholds, ≥1 visit (n=475) and ≥2 visits (n=309). Outcomes included cesarean delivery and standardized delivery costs. We applied inverse probability weighting to address baseline imbalances in demographics, chronic conditions, and prior healthcare utilization, and used doubly robust regressions to estimate adjusted differences in outcomes.
RESULTS: Prior to weighting, members engaged with the program had higher baseline emergency department use and diabetes prevalence, while unengaged members had higher nicotine use. All covariates achieved balance after weighting (standard mean difference < 0.1). One or more visits was associated with a directional 13.4% reduction in adjusted odds of cesarean delivery. Two or more visits were associated with a 28.5% reduction in adjusted odds of cesarean delivery, corresponding to a 6.7 percentage-point adjusted reduction in cesarean rate (p < 0.05). Two or more visits were also associated with a significant 1.98% reduction in standardized delivery costs (p < 0.05), consistent with lower cesarean delivery rates.
CONCLUSIONS: Engagement with a multidisciplinary virtual maternity program was associated with significant reductions in cesarean delivery and delivery costs in a commercially insured population, with stronger effects observed at higher levels of engagement. These findings suggest virtual maternity care may offer a scalable pathway for reducing avoidable cesarean deliveries and the associated cost burden.