Cheaper, yet better

It may sound paradoxical, but ‘boutique’ continuity of care through midwives costs public hospitals less. 

Women who see the same midwife through the course of their pregnancy not only encounter fewer interventions at birth but cost less to the public hospital system, recent research shows.

University of Sydney researchers studied women who were evenly matched in terms of risk factors to look at the clinical outcomes whilst examining the cost of producing the results.

Lead author, professor Sally Tracy, said by looking at three models of care – caseload midwifery care, standard hospital care and care by a private obstetrician in a public hospital – researchers found that having the same midwife throughout pregnancy labour, birth and postnatal care cost about $1400 per woman, less than the other options.

On top of this, women under this model were also more likely to have spontaneous onset of labour and about 58 per cent had an unassisted vaginal birth, compared with about 48 per cent who had standard hospital care and under a third who had private obstetric care.

Continuity of care models resulted in only 1.6 per cent of women having an elective caesarean section, compared with 5.3 per cent of women receiving standard care and 17 per cent of women who had private obstetric care.

“It’s pretty intuitive that higher costs will [come from] having a caesarean section rather than a vaginal birth,” Tracy said.

She said there were other reasons behind the reduced cost as well. Caseload midwifery care is less interventionist and women have a shorter stay in hospital after giving birth, as they are visited at home.

“It’s a whole composite of outcomes that is actually pointing to the fact that it costs less to provide this care,” Tracy said. “What is hard for people to accept is that what looks like a boutique expensive service, in women being able to have just one midwife to follow them through, doesn’t in fact cost more in the public system.

“When you consider the amount of money that goes towards private obstetric care out of the public purse, including Medicare payments that are taxpayer funded, private obstetric care is quite a lot more costly to the public purse than having caseload midwifery care.

“There is an urgent need to look at restructuring the way midwifery care is offered in the hospital.”

Besides the positive outcomes in terms of public cost, there are also personal benefits for the woman, Tracy said: “Women experience a closer relationship and more personal control through their birth experience through a caseload midwifery model.

“They’ve got someone they can communicate with 24 hours a day because they know who their midwife is.”

Clinical co-ordinator of the Rural Private Midwifery Education Project at My Midwives, Karen McDonald Smith, said many women want their own midwives, and that the professional relationship formed with the women and their families is unique and important in supporting the individual throughout the event.

“As more women experience the care of a known midwife the consumer push to have this care option is rising,” McDonald Smith said, adding that even more women will want their own midwife following the recent studies demonstrating the cost-effectiveness and consumer satisfaction mothers to be are encountering under this care model.

Despite this, she said, the 2009 National Review of Maternity Services revealed that there were few opportunities for women to engage with this type of model.

“Since [that] time the National Maternity Plan has been developed and this established a national plan to increase options for continuity of midwifery care for all Australian women,” McDonald Smith said. However, she added, “Ultimately continuity of care needs to be available to all women who are having a baby.

“We are currently undertaking a rural and private midwifery education project, where future midwives have the opportunity to do most of their clinical requirements through private practising midwives and Midwifery Group Practice.”

This has enabled students to learn the benefits of continuity of care firsthand and the hope is that it will help create a future workforce passionate about this type of model becoming mainstream.

Furthermore, she said, “Victoria is now examining options for private practice midwives to have admitting rights and recently WA has distributed a directive to require all hospitals to have a process to credential and provide access for private practice midwives.”

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