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Main Category: Pregnancy / Obstetrics
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Article Date: 23 Apr 2012 - 10:00 PDT
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Healthcare Prof: According to a study published in BMJ (British Medical Journal),giving birth at home or in a midwifery unit may be a safer and more cost effective option for women with low-risk pregnancies who already have children.
Researchers from the University of Oxford examined 64,000 births in England between 2008 and 2010 and enrolled both nulliparous women (those who had never given birth) and multiparous women (those who have given birth before), in order to estimate the cost-effectiveness of alternative planned places of birth.
Estimating the cost-effectiveness of alternative places of birth should be a priority area for research according to the National Institute for Clinical Excellence (NICE).
The researchers examined the costs and cost-effectiveness of planned births in different settings:
- Free-standing midwifery units
- Midwifery units located in the same hospital and an obstetric unit
- Obstetric units
- Home
Although the team took into account costs for treatment and interventions that the women and babies received if they were transferred into hospital during labor at home or in a midwifery unit after the birth, they did not evaluate any longer-term costs, including the life-long cost of caring for babies who suffer with serious birth injuries.
In order to assess cost-effectiveness, the researchers examined the relative costs of healthy births in different settings.
The researchers found that the most cost-effective and safest planned place of birth for low-risk multiparous was at home. For this group of women, giving birth at home saved the NHS money and also resulted in less expensive obstetric interventions.
In addition, giving birth in a midwifery unit was also found to be safe and cost-effective. The researchers found that a planned birth in an obstetric unit was the most expensive option for mothers who already have children, with a mean cost of £1,142 per woman, whilst giving birth at home was the cheapest, at £780 per woman.
For women who have not had children before, a planned birth in midwifery unit, or at home, was also cost-effective, but was associated with poorer outcomes for the baby.
According to the researchers, giving birth at home is the most cost-effective place for multiparous women to give birth. Furthermore, although giving birth at home is also the most cost effective place for nulliparous women to give birth, there is a higher risk of a poor outcome for the baby.
Limitations of the study included no evaluation of the financial impact on the NHS of changing the configuration of services and not taking into account women's preferences or longer-term costs and as a result, further economic evaluations may still be needed.
Liz Schroder, co-author of the study, explained:
"At the time of the study, only half of the NHS Trusts in England provided women with access to a midwifery unit, and occupancy levels were often low. The findings of the Birthplace study may encourage women - particularly women having a second or subsequent baby - to request and 'out of hospital' birth. And the potential for cost savings could make offering women more choice an attractive option for the NHS."
Written By Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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