The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications

Abstract

Objective To compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital.Design Micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes Setting The Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007 Participants Maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre Of these, 167 women started their intrapartum care at the Birth Centre and 166 attended the Royal London Hospital for intrapartum care.Measurements and findings Women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who booked for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. Key conclusions and implications for practice The study showed that intrapartum throughput in the BirthCentre could be considered cost-minimising when compared to hospital. Taken together with the findings of the Birthplace Programme, it adds further weight to the evidence in support of freestanding midwifery unit care for women without obstetric complications. Modelling the financial viability of midwifery units at a local level is important however, because it can inform the appropriate provision of these services.

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

“…In addition, an English study found that FMUs were cost-effective. 54 Chapter 2 Research approach and methods T his chapter details the research design and rationale for the methods of the three stages of the research. It describes the individual components of each stage, including a discussion of the theoretical underpinning for the analyses of the case studies.…”

“…These rationales for closure were common, despite the extant scientific evidence that FMUs are as safe as hospital for babies and safer for mothers, 3 and that FMUs are the most cost-effective birthplace for low-risk women, even when occupancy is at an average rate of 30%. 46,54 They also failed to acknowledge the evidence that women are offered limited information 138 and that the choice to plan birth out of hospital is highly constrained by social norms. 158 One way of understanding the rationale for closures is that decision-making often takes place within managerial utilitarian frameworks, 156 which consider the directly observable local costs of buildings and staffing of FMUs, without including reference to corresponding savings in the acute service of, for example, theatre time or medical staffing.…”

“…This is because health economists factored in the savings they generate in less maternal morbidity. 46,54 FMU facilities could also be used for other outpatient services and could arguably operate as part of a community hub as envisaged by the Better Births 115,173 policy document. Wirral University Teaching Hospital NHS Foundation Trust has opened a 'pop-up' FMU within Seacombe Children's Centre in an innovative response to the government's call for more women to birth in MUs.…”

“…The stagnation in the numbers of FMUs is concerning, given their marginally better evidence base, both in clinical effectiveness and in cost-effectiveness, compared with AMUs. 25,46,54 One can extrapolate from these results that many low-risk women continue to birth in OUs where the risk of caesarean and other birth interventions is increased, maternal satisfaction is decreased and care is more expensive. Potentially, this could represent around 45,000 low-risk women per year in England who could birth in a MU but currently have no access to one or are not using existing ones.…”

‘Keeping birth normal’: Exploratory evaluation of a training package for midwives in an inner-city, alongside midwifery unit

“…Midwifery units (commonly referred to as birth centres) have demonstrated improvements in maternal outcomes, transition to parenthood and satisfaction, and lower rates of intervention while maintaining neonatal outcomes equivalent to those on obstetric-led labour wards (Birthplace in England Collaborative Group, 2011;Macfarlane et al, 2014aMacfarlane et al, , 2014bOvergaard et al, 2012). They are also cost-effective (Schroeder et al, 2011(Schroeder et al, , 2017. For staff, midwifery units offer opportunities for midwives and doctors to become familiar with the physiological processes of birth, due to the high concentration of normal births which occur in these settings (Hodnett et al, 2012;Stone, 2012;Walsh and Devane, 2012).…”