240936 Economic case for midwifery care and home birth: Large savings from lower prematurity and cesarean rates

Monday, October 31, 2011: 4:50 PM

Kenneth C. Johnson, PhD , Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
Betty-Anne Daviss, MSc, RM , Women's Studies, Carleton University, Ottawa, ON, Canada
Background: Increasing U.S. prematurity and caesarean section rates are central to rapidly increasing maternity care costs. Epidemiologic research on planned home births with midwives has demonstrated safety for low-risk women, reduced caesarean section rates, and lower prematurity rates. Methods: We examined the rates and trends in preterm, low birth weight, and caesarean section births associated with standard U.S. maternity care and in recently published home birth studies. We searched for financial data on the relative costs of standard U.S. maternity care and maternity care with midwives in the U.S. We explored the cost implications of lower rates of preterm, low birth weight, and caesarean section births associated with midwifery-based maternity care and planned home births. Results: Recent studies of planned home births with midwives demonstrated caesarean section rates for low-risk women which ranged from 3 to 8%, while comparable low-risk populations having hospital births had rates 3 to 5 times higher. The average cost of an uncomplicated birth with a midwife in the U.S. was estimated at $2,400, while hospital maternity care for an uncomplicated birth was more than $8,500. A caesarean adds about $5,300 to the cost; low birth weight adds an average of $15,100. If an additional 5% of U.S. women used midwives for maternity care and planned home births, the estimated cost savings would be $1.3 billion annually. Conclusions: Increasing access to midwifery care and promotion of home birth provides an important opportunity to improve maternity care in the United States and simultaneously reduce costs.

Learning Areas:
Provision of health care to the public

Learning Objectives:
Describe the cost implications for declines in vaginal deliveries. Describe the two important epidemiologic differences in outcomes associated with midwife-attended home birth that impact on cost of care.

Keywords: Maternal and Child Health, Cost-Effectiveness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to presnet because I have done perinatal epidemiology studies for more than two decades.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.