Objective. This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies.Methods. A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services.Results. The mean unadjusted cost for each woman and her baby (n = 134 910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) -32%, -4%); women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51).Conclusions. There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs.What is known about the topic? The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes. What does this paper add? This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors. What are the implications for practitioners? Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver.

BackgroundCritical evaluation of the cost-effectiveness and clinical effectiveness of continuity of midwifery care models for women experiencing complex pregnancy is an important consideration in the review and reform of maternity services. Most studies either focus on women who experience healthy pregnancy or mixed risk samples. These results may not be generalised across the childbearing continuum to women with risk factors. This review critically evaluates studies that measure the cost of care for women with complex pregnancies, with a focus on method and quality.Aims / objectivesTo critically appraise and summarise the evidence relating to the combined cost-effectiveness, resource use and clinical effectiveness of midwifery continuity models for women who experience complex pregnancies and their babies in developed countries.DesignStructured review of the literature utilising a matrix method to critique the methods and quality of studies.MethodA search of Medline, CINAHL, MIDIRS, DARE, EMBASE, OVID, PubMed, ProQuest, Informit, Science Direct, Cochrane Library, NHS Economic Evaluation Database (NHSEED) for the years 1994 – 2018 was conducted.ResultsNine articles met the inclusion criteria. The review identified four areas of economic evaluation that related to women who experienced complex pregnancy and continuity of midwifery care. (1) cost and clinical effectiveness comparisons between continuity of midwifery care versus obstetric-led units; (2) cost of continuity of midwifery care and/or team midwifery compared to Standard Care; (3) cost-effectiveness of continuity of midwifery care for Australian Aboriginal women versus standard care; (4) patterns of antenatal care for women of high obstetric risk and comparative provider cost.Cost savings specific to women from high risk samples who received continuity of midwifery care compared with obstetric-led standard care was stated for only one study in the review. Kenny et al. 1994 identified cost savings of AUS $29 in the antenatal period for women who received the midwifery team model from a stratified sub-set of high-risk pregnant woman within a mixed risk sample of 446 women. One systematic review relevant to the UK context, Ryan et al. (2013), applied sensitivity analysis to include women of all risk categories. Where risk ratio for overall fetal/neonatal death was systematically varied based on the 95% confidence interval of 0.79 to 1.09 from pooled studies, the aggregate annual net monetary benefit for continuity of midwifery care ranged extremely widely from an estimated gain of £472 million to a loss of £202 million. Net health benefit ranged from an annual gain of 15 723 QALYs to a loss of 6 738 QALYs. All other studies in this review reported cost savings narratively or within mixed risk samples where risk stratification was not clearly stated or related to the midwifery team model only.ConclusionsStudies that measure the cost of continuity of midwifery care for women with complex pregnancy across the childbearing continuum are limited and apply inconsis...

The findings suggest individualised postnatal lengths of stay may be beneficial for the initiation of breastfeeding. Five values were not impacted by early discharge, but rather individual midwives' practice. There is consensus in the literature that early discharge promoted a comfortable environment to support breastfeeding initiation. Wide variations in the definition of early postnatal discharge made it difficult to draw influential conclusions. Therefore, further research is required.

Background Ensuring women receive optimal breastfeeding support is of key importance to the health of mothers and their infants. Early discharge within 24 h of birth is increasingly common across Australia, and the practice of postnatal home visiting varies between settings. The reduction in length of stay without expansion of home visits reduces midwives’ ability to support breastfeeding. The impact of early discharge on first-time mothers establishing breastfeeding was unknown. The study aim was to understand the experiences of first-time Australian mothers establishing breastfeeding when discharged from the hospital within 24 h of a normal vaginal birth. Methods A qualitative interpretive method was used. Semi-structured interviews with 12 women following early discharge were conducted. Data were audio recorded, professionally transcribed, and subjected to a thematic analysis. Results Three interconnected themes of ‘self-efficacy’, ‘support’ and ‘sustainability’ were identified. Self-efficacy influenced the women’s readiness and motivation to be discharged home early and played a role in how some of the mothers overcame breastfeeding challenges. Social, semi-professional and professional breastfeeding supports were key in women’s experiences. Sustainability referred to and describes what women valued in relation to continuation of their breastfeeding journey. Conclusion This study found accessible people-based breastfeeding services in the community are valued following early discharge. Furthermore, there is demand for more evidence-based breastfeeding educational resources, potentially in the form of interactive applications or websites. Additionally, a focus on holistic and individualised breastfeeding assessment and care plans prior to discharge that link women with ongoing breastfeeding services is paramount.

This article examines the background and limitations of maternity care policy and provision in Australia using the Boundary Critique method from critical systems thinking. We argue that the historical legacy of funding maternity care within medically dominated fee-for-service structures and acute hospital budgets is seriously flawed. Furthermore, it cannot deliver the policy goals of healthy and socially equitable birth practices. Despite the 2009 national Maternity Services Review and progress of a National Maternity Services Plan (2011), most mainstream Australian maternity services remain out-of-step with both health service research and evidence-based 'best practice'.The present system drives unnecessary clinical interventions, increased expenditure, short-term adverse health outcomes and the potential for a larger, unacknowledged legacy of future chronic disease. By contrast, boundary critique analysis suggests that redesigning for good maternity service provision can act as a population-level preventative health strategy, offering better value, better health and improved equity in maternity care.