title: The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.
abstract: OBJECTIVE
  to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital.
  
  
  METHODS
  micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes.
  
  
  METHODS
  the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010.
  
  
  METHODS
  maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital.
  
  
  RESULTS
  women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units.
  
  
  CONCLUSIONS
  the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these services. This finding from this study contribute a local perspective and thus further weight to the evidence from the Birthplace Programme in support of freestanding midwifery unit care for women without obstetric complications.
authors.affiliation: National Perinatal Epidemiology Unit, United Kingdom.
authors.forename: Liz
authors.initials: L
authors.lastname: Schroeder
authors.affiliation: National Perinatal Epidemiology Unit, United Kingdom.
authors.forename: Nishma
authors.initials: N
authors.lastname: Patel
authors.affiliation: Barts Health NHS Trust, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Keeler
authors.affiliation: Barts Health NHS Trust, United Kingdom.
authors.forename: Lucia
authors.initials: L
authors.lastname: Rocca-Ihenacho
authors.affiliation: City, University of London, United Kingdom. Electronic address: A.J.Macfarlane@city.ac.uk.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Macfarlane
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000191:economics* / Q000592:standards; D036861:Delivery, Obstetric / Q000191:economics* / Q000592:standards; D004739:England; D005260:Female; D006761:Hospitals; D006801:Humans; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Birth centre; Cost; Freestanding midwifery unit; Health economics; Midwifery care