A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital

Toohill, Jocelyn; Turkstra, Erika; Gamble, Jenny; Scuffham, Paul Anthony

doi:10.1016/j.midw.2011.10.012

Cited by 34 publications

(26 citation statements)

References 11 publications

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“…Across Australia, similar clinical and cost outcomes have been reported from non‐randomised studies of midwifery continuity of carer in South Australia, 28 Queensland 29 and NSW 30 . A review of 22 international non‐randomised studies has also shown that low risk women in midwife‐led, birth centre or homebirth services in the care of midwives experienced fewer obstetric interventions and were more likely to have a normal birth without complications than low risk women receiving standard hospital or obstetric care 31 .…”

Section: Midwifery Continuity Of Care Models: the Evidence For Benefitmentioning

confidence: 70%

Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

157

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There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

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Section: Midwifery Continuity Of Care Models: the Evidence For Benefitmentioning

confidence: 70%

Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

157

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“…Additionally, combining psycho-education for women with childbirth fear and cost effective midwifery caseload care is likely to produce even higher benefits for maternity service organisations and for women with childbirth fear [31–34]. To assist screening of women with childbirth fear the validated two item Fear of Birth scale (FOBs) could also be used, as it is time-efficient for clinicians, and aligns to the widely used and accepted W-DEQ A tool [35].…”

Section: Discussionmentioning

confidence: 99%

A cost effectiveness analysis of midwife psycho-education for fearful pregnant women – a health system perspective for the antenatal period

Toohill

Callander

Gamble

et al. 2017

BMC Pregnancy Childbirth

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BackgroundPsycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth.MethodOne thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups.ResultOf 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145.ConclusionCosts of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers.Trial registrationAustralian New Zealand Controlled Trials Registry ACTRN12612000526875, 17th May 2012 (retrospectively registered one week after enrolment of first participant).

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“…, Toohill et al . ); better maternal/neonatal outcomes and lower use of medical procedures without associated risks (Hodnett et al . , Sutcliffe et al .…”

Section: Introductionmentioning

confidence: 99%

First‐time mothers’ choice of birthplace: influencing factors, expectations of the midwife's role and perceived safety

Borrelli

Walsh

Spiby

2017

Journal of Advanced Nursing

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Aim. To explore first-time pregnant women's expectations and factors influencing their choice of birthplace.Background. Although outcomes and advantages for low-risk childbearing women giving birth in midwifery-led units and home compared with obstetric units have been investigated previously, there is little information on the factors that influence women's choice of place of birth. Design.A qualitative Straussian grounded theory methodology was adopted. Fourteen women expecting their first baby were recruited from three large National Health Service organisations that provided maternity services free at the point of care. The three organisations offered the following birthplace options: home, freestanding midwifery unit and obstetric unit. Ethical approvals were obtained and informed consent was gained from each participant.Methods. Data collection was undertaken in 2013-2014. One tape-recorded face-to-face semistructured interview was conducted with each woman in the third trimester of pregnancy.Findings. Findings are presented as three main themes: a) influencing factors on the choice of birthplace; b) expectations on the midwife's 'being' and 'doing' roles; c) perceptions of safety. Conclusion. Midwives should consider each woman's expectations and approach to birthbeyond the planned birthplace, as these are often influenced by the intersection of various influencing factors. Several birthplace options should be made available to women in each maternity service and the alternatives should be shared with women by healthcare professionals during pregnancy to allow an informed choice. Virtual tours or visits to the birth units could also be offered to women to help them familiarise with the chosen setting.3 Keywords: midwifery; women's health; childbearing; choice; birthplace; place of birth; obstetric unit; homebirth; freestanding midwifery unit; pregnancy. 4 SUMMARY STATEMENT Why is this research needed? Although outcomes and advantages for women giving birth in different settings are demonstrated, there is little information on the factors that influence women's choice of birthplace. By understanding factors influencing women's choice of birthplace, healthcare professionals may be better able to facilitate informed choice; this is highlighted as a key factor in moving maternity provision forward. What are the key findings? This paper contributes novel evidence on women's expectations around choice of birthplace, increasing understanding of the factors that are important to them when choosing a preferred birth setting, including proximity; normality of childbirth; environment; model of care; TV programmes; recommendations from family and friends. Participants specified that the midwife's role should include both spheres of 'being' and 'doing'. Some participants planning to give birth in an obstetric unit confined the midwife's role to 'doing checks'.  Women's perceptions of birthplace safety varied, including having medical backup available in obstetric units, one-to-one dedicated midwifery care...

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A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital

Cited by 34 publications

References 11 publications

Models of maternity care: evidence for midwifery continuity of care

Models of maternity care: evidence for midwifery continuity of care

A cost effectiveness analysis of midwife psycho-education for fearful pregnant women – a health system perspective for the antenatal period

First‐time mothers’ choice of birthplace: influencing factors, expectations of the midwife's role and perceived safety

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