Comparison of costs and associated outcomes between women choosing newly integrated autonomous midwifery care and matched controls: a pilot study.
OBJECTIVE
In response to consumer demand and a critical shortage of Canadian maternity care providers, provinces have integrated or are in the process of integrating midwives into their health care systems. We compared the costs and outcomes of newly integrated, autonomous midwifery care with existing health care services in the province of Alberta.


METHODS
Alberta Health and Wellness cost data from (1) physician fee-for-service, (2) outpatient, and (3) inpatient records, as well as outcome data from vital statistics records, were compared between participants in a midwifery integration project and individually matched women who received standard perinatal care during the same time period. Records of births occurring within the same time frame were matched according to risk score, maternal age, parity, and postal code.


RESULTS
For women who chose midwifery care, an average saving of $1172 per course of care was realized without adversely affecting maternal or neonatal outcomes. Cost reductions are partially realized through provision of out-of-hospital health services. Women who chose midwifery care had more prenatal visits (P < 0.01) and fewer inductions of labour (P < 0.01); their babies had greater gestational ages (P < 0.05) and higher birth weights (P < 0.05) than controls. The sample size was insufficient to compare events associated with extremely high costs, or rare or catastrophic outcomes.


CONCLUSIONS
Regulated and publicly funded midwifery care appears to be an effective intervention for low-risk women who make this choice. When compared with existing care, autonomous care by newly integrated midwives does not increase health care costs.
O'Brien
Beverley
B
Faculty of Nursing, University of Alberta, Edmonton, AB.
Harvey
Sheila
S
Sommerfeldt
Susan
S
Beischel
Susan
S
Newburn-Cook
Christine
C
Schopflocher
Don
D
D000328:Adult; D000416:Alberta; D001724:Birth Weight; D016022:Case-Control Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data; D008880:Midwifery / Q000191:economics*; D010865:Pilot Projects; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data