Comparison of Costs and Associated Outcomes Between Women Choosing Newly Integrated Autonomous Midwifery Care and Matched Controls: A Pilot Study |
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| Authors: | Beverley O’Brien Sheila Harvey Susan Sommerfeldt Susan Beischel Christine Newburn-Cook Don Schopflocher |
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| Affiliation: | 1. Faculty of Nursing, University of Alberta, Edmonton AB;2. Nursing and Midwifery, Thames Valley University, London, UK;3. Advanced Specialty Health Studies, Mount Royal College, Calgary AB;1. Midwifery Education Program, McMaster University, Hamilton ON;2. Department of Obstetrics and Gynecology, McMaster University, Hamilton ON;3. South Community Birth Program, Vancouver BC;4. Midwifery Program, Fort Smith Health and Social Services Authority, Fort Smith NT;5. Guysborough Antigonish Strait Health Authority District Collaborative Care Maternity Program, Guysborough NS;6. Midwifery Regulatory Council of Nova Scotia, Halifax NS;7. College of Midwives of British Columbia, Vancouver BC;1. McMaster Midwifery Research Centre, Hamilton, ON;2. Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON;3. Midwifery Education Program, McMaster University, Hamilton, ON |
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| Abstract: | ObjectiveIn response to consumer demand and a critical shortage of Canadian maternity care providers, provinces have integrated or are in the process of integrating midwives into their health care systems. We compared the costs and outcomes of newly integrated, autonomous midwifery care with existing health care services in the province of Alberta.MethodsAlberta Health and Wellness cost data from (1) physician fee-for-service, (2) outpatient, and (3) inpatient records, as well as outcome data from vital statistics records, were compared between participants in a midwifery integration project and individually matched women who received standard perinatal care during the same time period. Records of births occurring within the same time frame were matched according to risk score, maternal age, parity, and postal code.ResultsFor women who chose midwifery care, an average saving of $1172 per course of care was realized without adversely affecting maternal or neonatal outcomes. Cost reductions are partially realized through provision of out-of-hospital health services. Women who chose midwifery care had more prenatal visits (P < 0.01) and fewer inductions of labour (P < 0.01); their babies had greater gestational ages (P < 0.05) and higher birth weights (P < 0.05) than controls. The sample size was insufficient to compare events associated with extremely high costs, or rare or catastrophic outcomes.ConclusionRegulated and publicly funded midwifery care appears to be an effective intervention for low-risk women who make this choice. When compared with existing care, autonomous care by newly integrated midwives does not increase health care costs. |
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