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Bączek G, Tataj-Puzyna U, Sys D, Baranowska B. Freestanding Midwife-Led Units: A Narrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:181-188. [PMID: 32724762 PMCID: PMC7299417 DOI: 10.4103/ijnmr.ijnmr_209_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/04/2020] [Accepted: 03/09/2020] [Indexed: 11/04/2022]
Abstract
Background Strengthening of midwives' position and support for freestanding birth centers, frequently referred to as Freestanding Midwife-led Units (FMUs), raise hopes for a return to humanized labor. Our study aimed to review published evidence regarding FMUs to systematize the knowledge of their functioning and to identify potential gaps in this matter. Materials and Methods A structured integrative review of theoretical papers and empirical studies was conducted. The literature search included MEDLINE, Cochrane, Scopus, and Embase databases. The analysis included papers published in 1977-2017. Relevant documents were identified using various combinations of search terms and standard Boolean operators. The search included titles, abstracts, and keywords. Additional records were found through a manual search of reference lists from extracted papers. Results Overall, 56 out of 107 originally found articles were identified as eligible for the review. Based on the critical analysis of published data, six groups of research problems were identified and discussed, namely, 1) specifics of FMUs, 2) costs of perinatal care at FMUs, 3) FMUs as a place for midwife education, 4) FMUs from midwives' perspective, 5) perinatal, maternal, and neonatal outcomes, and 6) FMUs from the perspective of a pregnant woman. Conclusions FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.
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Affiliation(s)
- Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warszawa, Poland
| | - Urszula Tataj-Puzyna
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warszawa, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Roots Community Birth Center: A culturally-centered care model for improving value and equity in childbirth. Healthcare (Basel) 2020; 8:100367. [DOI: 10.1016/j.hjdsi.2019.100367] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/21/2022] Open
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Isaline G, Marie-Christine C, Rudy VT, Caroline D, Yvon E. An exploratory cost-effectiveness analysis: Comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Belgium. Midwifery 2019; 75:117-126. [DOI: 10.1016/j.midw.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/18/2018] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Hitzert M, Hermus MMAA, Boesveld IIC, Franx A, van der Pal-de Bruin KKM, Steegers EEAP, van den Akker-van Marle EIME. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study. BMJ Open 2017; 7:e016960. [PMID: 28893750 PMCID: PMC5595203 DOI: 10.1136/bmjopen-2017-016960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. DESIGN Economic evaluation based on a prospective cohort study. SETTING 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible. PARTICIPANTS 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013. MAIN OUTCOME MEASURES Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score. RESULTS The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI). CONCLUSIONS We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Arie Franx
- Department of Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Eric, EAP Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Alliman J, Phillippi JC. Maternal Outcomes in Birth Centers: An Integrative Review of the Literature. J Midwifery Womens Health 2016; 61:21-51. [DOI: 10.1111/jmwh.12356] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Friedman HS, Liang M, Banks JL. Measuring the cost-effectiveness of midwife-led versus physician-led intrapartum teams in developing countries. ACTA ACUST UNITED AC 2015; 11:553-64. [PMID: 26258663 DOI: 10.2217/whe.15.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
International agencies have advocated scaling-up of midwifery resources as an important method for improving maternal health and reducing maternal mortality rates (MMR). The cost-effectiveness of midwife-led versus physician-led intrapartum care is an important consideration in the human resource planning required to reduce MMR. Studies suggest that midwife-led teams can achieve comparable effectiveness and outcomes using less medically intensive care compared with physician-led teams. In the absence of adequate medical cost data, decision makers should consider the substantially lower average costs for three main drivers: salaries, benefits and incentives (≥two-times lower); preservice training (three-times lower) and attrition (two-times lower) necessary to deliver intrapartum care at the level of midwife competencies. This suggests that scale-up of midwifery resources is a less expensive and more cost-effective way to reduce MMRs and could potentially increase access to skilled intrapartum care.
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Affiliation(s)
- Howard S Friedman
- United Nations Population Fund (UNFPA), Technical Division, 605 3rd Avenue, New York, NY 10158, USA
| | - Mengjia Liang
- United Nations Population Fund (UNFPA), Technical Division, 605 3rd Avenue, New York, NY 10158, USA
| | - Jamie L Banks
- Collaborative Health Advisors, LLC, Lincoln, MA, USA
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Kenny C, Devane D, Normand C, Clarke M, Howard A, Begley C. A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study). Midwifery 2015; 31:1032-8. [PMID: 26381076 DOI: 10.1016/j.midw.2015.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. DESIGN ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. SETTING two maternity units in Ireland, with 'alongside' midwife-led units. PARTICIPANTS all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks׳ gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. INTERVENTIONS women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated ׳alongside׳ the consultant-led units, throughout pregnancy, birth and postnatal. MEASUREMENTS mean difference in clinician salaries, cost of care based on managers׳ data, known costs of postnatal bed days and costs of key interventions were measured. FINDINGS the average cost of caring for a woman allocated to the midwife-led units was €2598, compared to €2780 in the consultant-led units (average difference €182 per woman, analysed by 'intention to treat'). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.
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Affiliation(s)
| | - Declan Devane
- National University of Ireland Galway and Saolta University Health Care Group, Ireland.
| | | | - Mike Clarke
- The Queen׳s University of Belfast, Northern Ireland, UK.
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Ryan P, Revill P, Devane D, Normand C. An assessment of the cost-effectiveness of midwife-led care in the United Kingdom. Midwifery 2013; 29:368-76. [DOI: 10.1016/j.midw.2012.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 02/16/2012] [Accepted: 02/18/2012] [Indexed: 11/28/2022]
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Bernitz S, Aas E, Øian P. Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial. Midwifery 2012; 28:591-9. [PMID: 22901492 DOI: 10.1016/j.midw.2012.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 05/23/2012] [Accepted: 06/05/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to investigate the cost-effectiveness in birth care for low-risk women, in an alongside midwife-led unit (MU) compared to a standard obstetric unit (SCU) within the same hospital. DESIGN economic evaluation based on the findings of a randomised trial, randomising participants either into the MU or SCU. The hospital's activity-based costing system CPP was used to estimate costs, as no data on complete resource use exists. SETTING the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway. PARTICIPANTS the study population consists of 1,110 consenting healthy women, assessed to be at low-risk at spontaneous onset of labour. MEASUREMENTS effect measures; avoided caesarean sections, instrumental vaginal deliveries, complications requiring treatment in the operating room, epidural analgesia and oxytocin augmentation. Costs (€) were calculated by costs per day multiplied with length of stay, added costs for procedures performed outside the units. The results are expressed in incremental cost-effectiveness ratios (ICER) with SCU as comparator. FINDINGS total costs per stay were significantly lower for women at the MU (€1,672) compared to the SCU (€1,950, p<0.001). The ICER showed that MU was a dominant strategy (lower costs and reduction in clinical procedures) for all effect measures. Based on the sensitivity analysis, allocating low-risk women to MU significantly reduced costs, but was not a dominant strategy for all outcomes. KEY CONCLUSIONS the MU is more cost-effective than the SCU for low-risk women without prelabour preference for level of birth care provided equal capacity at the units. IMPLICATIONS FOR PRACTICE it is cost-effective to organise birth care for low-risk women in a separate midwife-led unit.
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Affiliation(s)
- Stine Bernitz
- Department of Obstetrics and Gynaecology, Østfold Hospital Trust, PO Box 24, 1606 Fredrikstad, Norway.
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Phillippi JC, Alliman J, Bauer K. The American Association of Birth Centers: History, Membership, and Current Initiatives. J Midwifery Womens Health 2010; 54:387-392. [DOI: 10.1016/j.jmwh.2008.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 12/17/2008] [Accepted: 12/17/2008] [Indexed: 11/24/2022]
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Hendrix MJ, Evers SM, Basten MC, Nijhuis JG, Severens JL. Cost analysis of the Dutch obstetric system: low-risk nulliparous women preferring home or short-stay hospital birth--a prospective non-randomised controlled study. BMC Health Serv Res 2009; 9:211. [PMID: 19925673 PMCID: PMC2784768 DOI: 10.1186/1472-6963-9-211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 11/19/2009] [Indexed: 11/18/2022] Open
Abstract
Background In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. Methods This study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis. Results In the group of home births, the total societal costs associated with giving birth at home were €3,695 (per birth), compared with €3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (€138.38 vs. €87.94, -50 (2.5-97.5 percentile range (PR)-76;-25), p < 0.05), 'cost of maternity care at home' (€1,551.69 vs. €1,240.69, -311 (PR -485; -150), p < 0.05) and 'cost of hospitalisation mother' (€707.77 vs. 959.06, 251 (PR 69;433), p < 0.05). The highest costs are for hospitalisation (41% of all costs). Because there is a relatively high amount of (partly) missing data, a sensitivity analysis was performed, in which all missing data were included in the analysis by means of general mean substitution. In the sensitivity analysis, the total costs associated with home birth are €4,364 per birth, and €4,541 per birth for short-stay hospital births. Conclusion The total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.
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Affiliation(s)
- Marijke Jc Hendrix
- Department of Obstetrics, GROW - School for Oncology and Development Biology, Maastricht UMC, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Abstract
BACKGROUND It is widely perceived that home births and birth centers may help decrease the costs of maternity care for women with uncomplicated pregnancies and deliveries. This structured review examines the literature relating to the economic implications of home births and birth center care compared with hospital maternity care. METHODS The bibliographic databases MEDLINE (from 1950), CINAHL (from 1982), EMBASE (from 1980), and an "in-house" database, Econ2, were searched for relevant English language publications using MeSH and free text terms. Data were extracted with respect to the study design, inclusion criteria, clinical and cost results, and details of what was included in the cost calculations. RESULTS Eleven studies were included from the United Kingdom, United States, Australia, and Canada. Two studies focused on home births versus other forms and locations of care, whereas nine focused on birth centers versus other forms and locations of care. Resource use was generally lower for women cared for at home and in birth centers due to lower rates of intervention, shorter lengths of stay, or both. However, this fact did not always translate into lower costs because, in the U.K. where many studies were conducted, more midwives of a higher grade were employed to manage the birth centers than are usually employed in maternity units, and because of costs of converting existing facilities into delivery rooms. The quality of much of the literature was poor, although no studies were excluded for this reason. Selection bias was likely to be a problem in those studies not based on randomized controlled trials because, even where birth center eligibility was applied throughout, women who choose to deliver at home or in a birth center are likely to be different in terms of expectations and approach from women choosing to deliver in hospital. CONCLUSIONS This review highlights the paucity of economic literature relating to home births and birth centers. Differences in results between studies may be attributed to differences in health care systems, differences in methods used, and differences in costs included. Further economic research that involves detailed bottom-up costing of alternative options for place of birth and measures multiple outcomes, including women's preferences, would help address the question of whether out-of-hospital birth is beneficial in economic terms.
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Affiliation(s)
- Jane Henderson
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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Gregory KD, Johnson CT, Johnson TRB, Entman SS. The content of prenatal care. Womens Health Issues 2006; 16:198-215. [PMID: 16920524 DOI: 10.1016/j.whi.2006.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time. METHODS The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed. RESULTS The USPHS recommendation of a reduced prenatal visit schedule has support, and new content for the preconception visit has been identified, although this preconception visit has not been validated or widely implemented. CONCLUSIONS We identified new opportunities and initiatives for the content of prenatal care, particularly improvement in the electronic medical record, attention to multidisciplinary approaches to patient education and improved patient literacy, and an extended maternal life span approach, including postgestation visits.
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Affiliation(s)
- Kimberly D Gregory
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California, USA
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Abstract
Women have always braved their way through childbirth one way or another. The hands surrounding them as they make their journey have offered many things. For some it has been herbs or a totem to hold. For others, it has been a tether to a beeping machine or a drug to transform the experience. No one has yet found the method(s) that addresses every pregnant woman's fear or pain during labor and birth. And no one can truly guarantee that all will be okay. The contemporary medical profession offers to shoulder the burden for women by "taking care of it for them," The managed care industry assures the public that they will provide pregnant women with the highest quality of care and the greatest decision-making power. Elected officials promise that they will save women and newborns from unscrupulous legal practices and from the abuses of managed care. But these goals, for better or worse, have yet to be fully realized. No matter the circumstances, women will continue to have babies. Their labors will be short or long, will occur surrounded by flowered décor or in sterile wards, and will be attended by physicians who are overburdened by the demands of maintaining a practice or by a midwife who must battle with institutional protocols to care for her clients. The battle for the political victories in women's health care will undoubtedly continue for some time to come. The strength and resolve of women and their families will determine the outcome and give voice to the consumer and the midwife in the board-room, in the hearing room, and in the birthing room.
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Affiliation(s)
- Dawn Durain
- School of Nursing, Nurse-Midwifery Graduate Program, Women's Health Care Studies, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA 19104, USA.
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