A cost effectiveness analysis of midwife psycho-education for fearful pregnant women – a health system perspective for the antenatal period

Abstract

BackgroundPsycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth.MethodOne thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups.ResultOf 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145.ConclusionCosts of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers.Trial registrationAustralian New Zealand Controlled Trials Registry ACTRN12612000526875, 17th May 2012 (retrospectively registered one week after enrolment of first participant).

The effect of midwifery led counseling based on Gamble’s approach on childbirth fear and self-efficacy in nulligravida women

“…Another study on women with high childbirth fear indicated that the overall caesarean section rates decrease after undergoing BELIEF clinically [21]. In addition, BELIEF seems to be a cost-effective approach [22].…”

​Effectiveness of a Psychoeducation Intervention by Midwives on Childbirth Fear and Childbirth Self-efficacy in Fearful First Time Pregnant Women: A Randomized Controlled Trial

“…Another study on women with high level of childbirth fear indicated that after implementing BELIEF, fearful women show clinically signi cant reduction in overall caesarean section rates than control group women (21). In addition, costeffectiveness of the BELIEF has been established (22). However, we do not aware of any published study that explore effectiveness of psychoeducational intervention on childbirth fear among Iranian women.…”

A Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) for first-time families: study protocol of a three-arm randomised controlled trial

“…As reviewed, midwife-led continuity care starting from pregnancy until early parenting period with home services, has been associated with positive maternal outcomes and parents' satisfaction [28]. Importantly, the resulted positive maternal outcomes had contributed to reduced health care cost [29]. Unfortunately, in Singapore, there is no midwife-led continuity care service to help rst-time parents in gaining positive parenting experience and building PSE.…”