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
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Article info
Publication history
Published online: December 23, 2021
Accepted:
December 7,
2021
Received in revised form:
November 23,
2021
Received:
September 13,
2021
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
