Midwifery-led maternity care homes, perinatal quality and return on investment

Background While the term “maternity care home” is relatively new, its description closely mirrors the midwifery model of care which emphasize access to continuous, coordinated, enhanced care for women. Since 1925, midwife-led services have grown in medically underserved areas in the U.S. characterized by poverty and social factors associated with poor perinatal outcomes. Methods Secondary analysis of 19 Midwifery-led maternity care homes (MLMCH) represented within in a professional benchmarking project from 2009-2010 is conducted to evaluate the models performance with preterm birth and cesarean section. Publicly reported county and state risk data, state birth certificate data and state health care data are used as the matched comparison group. Results The 19 MLMCHs are located within seven of ten public health regions, including two with the highest preterm birth rates in the nation. The MLMCH cohort attended 8,818 births during between 2009-2010. Of these, 520 (6%) occurred prior to 37 weeks gestation, compared to the 12% preterm birth rate of the regional comparison group. The MLMCH cohort attended 1,506 (17%) cesarean births, compared to 32% in the comparison group. The MLMCHs in this analysis demonstrate high value outcomes with an estimated annual savings to Medicaid of $4,206,904 related to prevention of cesarean section. An additional $13,401,028 in costs related to prevention of late preterm delivery were demonstrated. Conclusion The midwife-led maternity care home is an innovative work force solution that should be considered by policy makers, researchers and third party payers.