Advertisement

Using epidemiological and health economic measures to inform maternity staffing decisions: A guide

Published:December 23, 2021DOI:https://doi.org/10.1016/j.wombi.2021.12.001

      Abstract

      Background

      There is growing concern around unnecessary intervention (particularly caesarean section) at birth in high-income countries. Caseload midwifery care aims to offset this, but is perceived to be costly to health services.

      Aim

      To use epidemiological and health economic techniques to estimate health outcomes and cost-savings of different levels of equivalent full time (EFT) midwives working in caseload midwifery care.

      Methods

      Two simulations were conducted — one assuming 10 EFT midwives working in a caseload model, with 35 women per caseload, and one assuming 50 EFT midwives working in a caseload model, with 45 women per caseload. Both were based on a sample of 5000 women. The main model inputs included rates of health outcomes for women (caesarean section, epidural anaesthesia, and episiotomy) and infants (low birthweight and admissions to special care nursery (SCN) or neonatal intensive care unit (NICU)), and the cost savings associated with health outcome avoidance.

      Findings

      The first simulation estimated 27 fewer caesarean sections, 12 fewer epidurals, 12 fewer episiotomies, 10 fewer low birthweight births, and 23 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$1,874,715. The second simulation estimated 173 fewer caesarean sections, 76 fewer epidurals, 76 fewer episiotomies, 65 fewer low birthweight births, and 150 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$12,051,741.

      Conclusion

      This study provides local-level decision-makers with a decision-tool to calculate the potentially avoidable health outcomes and cost savings associated with implementing caseload midwifery care in their own service.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Boerma T.
        • Ronsmans C.
        • Melesse D.
        • et al.
        Global epidemiology of use of and disparities in caesarean sections.
        Lancet. 2018; 392: 1341-1348
        • Australian Institute of Health and Welfare
        Australia’s Mothers and Babies.
        2021 (June 2021 https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/method-of-birth. (Accessed August 2021))
        • Scarf V.L.
        • Rossiter C.
        • Vedam S.
        • et al.
        Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis.
        Midwifery. 2018; 62: 240-255
        • Neu J.
        • Rushing J.
        Cesarean versus vaginal delivery: Long-term infant outcomes and the hygiene hypothesis.
        Clin. Perinatol. 2011; 38: 321-331
        • Zhang T.
        • Sidorchuk A.
        • Sevilla-Cermeño L.
        • et al.
        Association of cesarean delivery with risk of neurodevelopmental and psychiatric disorders in the offspring.
        JAMA Netw. Open. 2019; 2e1910236
        • Sandall J.
        • Tribe R.
        • Avery L.
        • et al.
        Short-term and long-term effects of caesarean section on the health of women and children.
        Lancet. 2018; 392: 1349-1357
        • Gamble J.
        • Creedy D.
        Psychological trauma symptoms of operative birth.
        Br. J. Midwifery. 2005; 13: 218-224
        • Australian Commission on Safety and Quality in Health Care
        • Australian Institute of Health and Welfare
        The Fourth Australian Atlas of Healthcare Variation.
        ACSQHC, Sydney2021
        • Hansen A.
        • Wisborg K.
        • Uldbjerg N.
        • Henriksen T.
        Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study.
        BMJ. 2008; 336: 85-87
        • Tita A.
        • Landon M.
        • Spong C.
        • et al.
        Timing of elective repeat cesarean delivery at term and neonatal outcomes.
        N. Engl. J. Med. 2009; 360: 111-120
        • Sullivan M.
        • Msall M.
        • Miller R.
        17-year outcome of preterm infants with diverse neonatal morbidities: part 1—impact on physical, neurological, and psychological health status.
        J. Spec. Pediatr. Nurs. 2012; 17: 226-241
        • Bentley J.
        • Roberts C.
        • Bowen J.
        • Martin A.
        • Morris J.
        • Nassar N.
        Planned birth before 39 weeks and child development.
        Pediatrics. 2016; 138e20162002
        • Dong Y.
        • Chen S.-J.
        • Yu J.-L.
        A systematic review and meta-analysis of long-term development of early term infants.
        Neonatology. 2012; 102: 212-221
        • Noble K.
        • Fifer W.
        • Rauh V.
        • Nomura Y.
        • Andrews H.
        Academic achievement varies with gestational age among children born at term.
        Pediatrics. 2012; 130: e257-e264
        • MacKay D.
        • Smith G.
        • Dobbie R.
        • Pell J.P.
        Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren.
        PLoS Med. 2010; 7e1000289
        • Betrán A.
        • Temmerman M.
        • Kingdon C.
        • et al.
        Interventions to reduce unnecessary caesarean sections in healthy women and babies.
        Lancet. 2018; 392: 1358-1368
        • McLachlan H.L.
        • Forster D.A.
        • Davey M.-A.
        • et al.
        Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial.
        BJOG. 2012; 119: 1483-1492
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016; : 4
        • Callander E.J.
        • Creedy D.K.
        • Gamble J.
        • et al.
        Reducing caesarean delivery: an economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women.
        Paediatr. Perinat. Epidemiol. 2020; 34: 3-11
        • Tracy S.K.
        • Welsh A.W.
        • Hall B.
        • et al.
        Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.
        BMC Pregnancy Childbirth. 2014; 14
        • Homer C.S.
        • Matha D.V.
        • Jordan L.G.
        • Wills J.
        • Davis G.K.
        Community-based continuity of midwifery care versus standard hospital care: a cost analysis.
        Aust. Health Rev. 2001; 24: 85-93
        • Toohill J.
        • Turkstra E.
        • Gamble J.
        • Scuffham P.A.
        A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital.
        Midwifery. 2012; 28: e874-e879
        • Gao Y.
        • Gold L.
        • Josif C.
        • et al.
        A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the top end of the Northern Territory, Australia.
        Midwifery. 2014; 30: 447-455
        • Callander E.J.
        • Slavin V.
        • Gamble J.
        • Creedy D.K.
        • Brittain H.
        Cost-effectiveness of public caseload midwifery compared to standard care in an Australian setting: a pragmatic analysis to inform service delivery.
        Int. J. Qual. Health Care. 2021; 33
        • Homer C.
        Getting evidence into practice—managing hares and tortoises.
        Women Birth. 2018; 31: 431-432
        • Dawson K.
        • McLachlan H.
        • Newton M.S.
        • Forster D.
        Implementing caseload midwifery: exploring the views of maternity managers in Australia—a national cross-sectional survey.
        Women Birth. 2016; 29: 214-222
        • Dawson K.
        • Forster D.A.
        • McLachlan H.L.
        • Newton M.S.
        Operationalising caseload midwifery in the Australian public maternity system: findings from a national cross-sectional survey of maternity managers.
        Women Birth. 2018; 31: 194-201
        • Heller R.F.
        • Buchan I.
        • Edwards R.
        • Lyratzopoulos G.
        • McElduff P.
        • St Leger S.
        Communicating risks at the population level: application of population impact numbers.
        BMJ. 2003; 327: 1162-1165
        • Callander Ej
        • Fox H.
        What are the costs associated with child and maternal healthcare within Australia? A study protocol for the use of data linkage to identify health service use, and health system and patient costs.
        BMJ Open. 2018; 8
        • Forster D.A.
        • McLachlan H.L.
        • Davey M.-A.
        • et al.
        Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.
        BMC Pregnancy Childbirth. 2016; 16: 1-13
        • Allen J.
        • Kildea S.
        • Tracy M.B.
        • Hartz D.L.
        • Welsh A.W.
        • Tracy S.K.
        The impact of caseload midwifery, compared with standard care, on women’s perceptions of antenatal care quality: survey results from the [email protected] randomized controlled trial for women of any risk.
        Birth. 2019; 46: 439-449
        • McInnes R.J.
        • Aitken-Arbuckle A.
        • Lake S.
        • Hollins Martin C.
        • MacArthur J.
        Implementing continuity of midwife carer—just a friendly face? A realist evaluation.
        BMC Health Serv. Res. 2020; 20: 1-15
        • Hewitt L.
        • Dahlen H.G.
        • Hartz D.L.
        • Dadich A.
        Leadership and management in midwifery-led continuity of care models: a thematic and lexical analysis of a scoping review.
        Midwifery. 2021; 98102986
        • Styles C.
        • Kearney L.
        • George K.
        Implementation and upscaling of midwifery continuity of care: the experience of midwives and obstetricians.
        Women Birth. 2020; 33: 343-351
        • Fox H.
        • Callander E.J.
        • Lindsay D.
        • Topp S.
        Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers.
        BMC Pregnancy Childbirth. 2019; 19: 1-8
        • Callander E.J.
        • Fenwick J.
        • Donnellan-Fernandez R.
        • et al.
        Cost of maternity care to public hospitals: a first 1000-days perspective from Queensland.
        Aust. Health Rev. 2019; 43: 556-564