title: A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study).
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.
  
  
  METHODS
  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.
  
  
  METHODS
  two maternity units in Ireland, with 'alongside' midwife-led units.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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').
  
  
  CONCLUSIONS
  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.
authors.affiliation: RCSI Hospitals Group, 111 St Stephen׳s Green, Dublin 2, Ireland. Electronic address: cfo@rcsihospitals.ie.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kenny
authors.affiliation: National University of Ireland Galway and Saolta University Health Care Group, Ireland. Electronic address: declan.devane@nuigalway.ie.
authors.forename: Declan
authors.initials: D
authors.lastname: Devane
authors.affiliation: Trinity College Dublin, Dublin 2, Ireland. Electronic address: normandc@tcd.ie.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.affiliation: The Queen׳s University of Belfast, Northern Ireland, UK. Electronic address: mclarke@qub.ac.uk.
authors.forename: Mike
authors.initials: M
authors.lastname: Clarke
authors.affiliation: Trinity College Dublin, Dublin 2, Ireland.
authors.forename: Aoife
authors.initials: A
authors.lastname: Howard
authors.affiliation: Trinity College Dublin, Dublin 2, Ireland. Electronic address: cbegley@tcd.ie.
authors.forename: Cecily
authors.initials: C
authors.lastname: Begley
mesh_terms: D036861:Delivery, Obstetric / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007494:Ireland; D008427:Maternal Health Services / Q000191:economics*; D008880:Midwifery / Q000191:economics*; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics; D017063:Outcome Assessment, Health Care; D049590:Postpartum Period; D011247:Pregnancy
keywords: Cost-; Economic analysis; Midwife-led care; Normal birth; Randomised trial