Choice of Maternity Care Provider

A new study in the journal, Birth (11/3/19), compares birth outcomes and maternity care costs for low risk, healthy pregnant women using midwives vs. physicians.  Research shows pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. Limited research has assessed cost implications in the United States. Using national data, this study assessed costs and resource use of midwife‐led care vs obstetrician‐led care. They developed a model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife‐led vs obstetrician‐led care.  Data were from the Listening to Mothers III national survey of women who gave birth in US hospitals in 2011‐2012 and cost estimates came from published or publicly available information on health insurance claims payments.  The costs of childbirth for low‐risk women with midwife‐led care were, on average, $2262 less than births to low‐risk women cared for by obstetricians. These cost differences come from lower rates of preterm birth and episiotomy among women with midwife‐led care, compared with obstetrician‐led care. Across the population of US women with low‐risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife‐led vs obstetrician‐led care) and fewer episiotomies (170 504 vs 415 686, for midwife‐led vs obstetrician‐led care).  The authors conclude that a shift from obstetrician‐led care to midwife‐led care for low‐risk/most pregnancies could be cost saving and support broad efforts to improve quality and value in the US.   (Midwife‐led care and obstetrician‐led care for low‐risk pregnancies: A cost comparison. Laura B. Attanasio PhD  Fernando Alarid‐Escudero PhD  Katy B. Kozhimannil PhD, MPA)

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