Costs of intrapartum care in a midwife-managed delivery unit and a consultant-led labour ward

Hundley, Vanora; Donaldson, Cam; Lang, G; Cruickshank, F M; Glazener, Cathryn; Milne, Joan; Mollison, Jill

doi:10.1016/0266-6138(95)90024-1

Cited by 39 publications

(34 citation statements)

References 3 publications

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“…Furthermore, the methodology applied in these other studies does not always correspond with the methodology used in our study. As was explained in the introduction, these studies did not follow the same period (16 weeks of pregnancy until six weeks after delivery) [17] and costs were not calculated from a societal perspective [16,17]. Another difference is that this cost analysis is based on intention-to-treat, i.e.…”

Section: Discussionmentioning

confidence: 99%

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Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

Hendrix

Evers

Basten

et al. 2009

BMC Health Serv Res

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BackgroundIn the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting.MethodsThis study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis.ResultsIn the group of home births, the total societal costs associated with giving birth at home were €3,695 (per birth), compared with €3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (€138.38 vs. €87.94, -50 (2.5-97.5 percentile range (PR)-76;-25), p < 0.05), 'cost of maternity care at home' (€1,551.69 vs. €1,240.69, -311 (PR -485; -150), p < 0.05) and 'cost of hospitalisation mother' (€707.77 vs. 959.06, 251 (PR 69;433), p < 0.05). The highest costs are for hospitalisation (41% of all costs). Because there is a relatively high amount of (partly) missing data, a sensitivity analysis was performed, in which all missing data were included in the analysis by means of general mean substitution. In the sensitivity analysis, the total costs associated with home birth are €4,364 per birth, and €4,541 per birth for short-stay hospital births.ConclusionThe total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.

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Section: Discussionmentioning

confidence: 99%

“…whether to give birth at home or in a short-stay hospital setting, while some of the other studies were based on the actual place of birth. Finally, the other studies compared home births and births in a short-stay hospital setting with hospital births [16,17,20,22] but made no comparisons between home births and short-stay hospital births.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

Hendrix

Evers

Basten

et al. 2009

BMC Health Serv Res

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“…15 The results of other studies on costs and health outcomes of midwifery-attended births in England, the USA and Australia were comparable to the British study. [16][17][18][19][20][21] However, the outcomes of these studies cannot easily be generalised to the Netherlands, since the Dutch system is different, with a relatively high rate of home births and a low rate of medical interventions compared with other high-income countries. 7 We therefore studied the costs and health outcomes of Dutch birth-centre care as part of the Dutch Birth Centre study, a national project evaluating the outcomes of Dutch birth centres on aspects such as client and professional experiences, effectiveness and costs.…”

Section: Open Accessmentioning

confidence: 99%

Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

et al. 2017

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ObjectivesTo estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres.DesignEconomic evaluation based on a prospective cohort study.Setting21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible.Participants3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013.Main outcome measuresCosts and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score.ResultsThe total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI).ConclusionsWe found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre.

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“…Hundley et al (1995) concluded that even if the differences in costs of intrapartum care in a midwife-managed unit and consultant-led labour ward were small, the impact of establishing a separate midwife-managed delivery unit could be significant. A randomised controlled trial (RCT) from Australia comparing birth centre care with delivery suite care for low-risk women found no differences related to clinical outcomes or costs (Byrne et al, 2000).…”

Section: Introductionmentioning

confidence: 96%

Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial

2012

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Costs of intrapartum care in a midwife-managed delivery unit and a consultant-led labour ward

Cited by 39 publications

References 3 publications

Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial

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