What about economic concerns?

When it comes to the economics of maternity care, everyone’s concerned. People often say things like:

“Continuity of care for every woman sounds great, but wouldn’t it cost way too much?”

“Sure, in an ideal world, everyone would have their own midwife, but there’s just no room in the budget for more expenditure.”

Let’s talk about the economics of maternity care services

It seems that it would cost more money for every woman to have her own midwife, doesn’t it? This kind of care sounds great, but surely struggling health systems can’t possibly afford that? For this reason, one of the most commonly cited barriers to implementing a midwifery continuity of care model is economic. People argue that with so many competing maternity health priorities, the focus needs to go on cost-effective, life-saving measures. Here’s what’s amazing:

Midwifery continuity of care models – where each woman has her own midwife, supported by specialists as needed – costs less than standard, fragmented care. Quite a bit less!

• Research in Australia found $927 direct cost savings per woman in the midwifery group practice (MGP) model, where each woman had her own midwife, back-up midwives, and an obstetric and neonatal team where required (Tracy, Hartz et al., 2005).
• One to One Midwifery UK found decreased overall costs, with a reduction in resources of 75% (Page, McCourt et al. 1999). The study was repeated in 2001 with the same results – MGP was no more expensive, used less resources, and had improved outcomes – with the associated potential for cost-saving long term benefits (Page, Beake et al 2001).
• In Canada – midwifery-led continuity of care vs publicly funded care. Savings: $1172 per woman (O’Brien, 2010).
• Toohill and colleagues (2010) completed a cost comparison in Australia for women accessing a Birth Centre MGP model versus standard hospital care – matched for risk and demographics. Women in the MGP had fewer interventions, more postnatal care, and cost almost $1000 less per woman/baby pair.
• In 2016, Roslyn Donnellan-Fernandez examined the cost-effectiveness of a midwifery continuity of care model versus standard fragmented care amongst women with complex pregnancies (moderate to high-risk births). She found a cost saving of around $863.92/woman with the midwifery continuity of care model, along with:
  • improved clinical outcomes for women and babies
  • improved resource use.

Amazing isn’t it? Relationship-based care that’s supported by an abundance of solid research – care that women, their families, and health care providers are more satisfied with and that provides better outcomes – is no more expensive (and probably cheaper) than standard fragmented care. It’s clear that whatever barriers come up: they’re worth overcoming.

Over to you

Now that you’ve learned a bit more about the common barriers to change, and how you can overcome them, think back to your answer to the poll.

Do you still feel like the barrier exists? If so, do you feel better prepared to deal with it?

How will you overcome the resistance to change you may face? Share in the comments, and make suggestions to others that may help them move forward with their goals.

References

1. Tracy, S., Hartz, D., 2006. The Quality Review of Ryde Midwifery Group Practice, September 2004 to October 2005: Final Report. Sydney, Northern Sydney
2. Page, L., C. McCourt, et al. (1999). “Clinical interventions and outcomes of one-to-one midwifery practice.” Journal of Public Health Medicine 21(4): 243-48.
3. Page, L., S. Beake, et al. (2001). “A comparative cohort study of clinical outcomes and maternal satisfaction with One-to-One Midwifery Practice.” British Journal of Midwifery 9(11): 700-706.
4. O’Brien B, Harvey S, Sommerfeldt S, Beischel S, Newburn-Cook C, Schopflocher D. (2010). “Comparison of Costs and Associated Outcomes Between Women Choosing Newly Integrated Autonomous Midwifery Care and Matched Controls: A Pilot Study.” Journal of Obstetrics & Gynaecology Canada. 32(7) 650-656.
5. Toohill, J., Turkstra, E., Gamble, J., & Scuffham, P. (2012). “A non-randomised trial investigating the cost-effectiveness of midwifery group practice compared with standard maternity care arrangements in one australian hospital.” Midwifery, 28(6), E874-E879. doi:10.1016/j.midw.2011.10.012
6. Donnellan-Fernandez, R. (2016). Midwifery Group Practice And Standard Hospital Care: A Cost And Resource Study Of Women With Complex Pregnancy (doctoral thesis), Flinders University, School of Nursing & Midwifery.
7. Callander EJ, Creedy DK, Gamble J, et al. (2020) “Reducing caesarean delivery: An economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women”. Paediatric and Perinatal Epidemiology. 2020;00:1–9. https://doi.org/10.1111/ppe.12621