Study: Midwife-led maternity care is safe and cost-effective than consultant-led care

The average cost of maternity care for a woman in a midwife-led unit is €182 less than in a consultant-led unit, according to new research conducted by the School of Nursing and Midwifery and School of Medicine (Health Policy and Management) at Trinity College Dublin.

The study, which involved 1,635 low-risk women cared for in the HSE Dublin North-East region between 2004 and 2009, found that the average cost of caring for a woman in midwife-led units (MLU) was €2,598, compared to €2,780 in consultant-led units (CLU).

The research looked at the mean difference in clinician salaries, cost of care based on manager's data, known costs of postnatal bed days and costs of key interventions. The findings, which have recently been published in the journal Midwifery, have significant implications for future policy-makers and funders of maternity care and point to the need to incorporate more midwife-led units into maternity care in Ireland.

Professor of Health Policy & Management, Charles Normand, one of the lead authors of this economic analysis, commented: "For every 1,000 women cared for in an MLU, almost €200,000 will be saved; consultant obstetricians will be able to devote more time to caring for women with pregnancy complications, so that all women in Ireland benefit from midwife-led care."

The research is the second major publication from the MidU study, commissioned by the HSE and conducted by the School of Nursing and Midwifery at Trinity, which set out to compare consultant-led maternity care with a new model of care provided by midwives in two integrated midwife-led units (MLUs) in Our Lady of Lourdes Hospital, Drogheda and Cavan General Hospital. These two integrated midwife-led units were established in 2004, to provide more choice in maternity care in the North East, and were the first of their kind in Ireland. Despite the positive results of this randomised trial, no further such units have been established.

The overall conclusion of the MidU study is that midwife-led care, as practised in this study, is a safe, cost-effective, alternative method of delivering maternity services for healthy women who have no risk factors for labour and birth.

Previous findings from the same study showed that care provided in MLUs is as safe as that in CLUs and results in less intervention. In labour, fewer women in the MLU group chose to have epidurals (19%) than did those in the CLU (25%). Other methods of pain relief chosen included immersion in warm water in a birthing pool (24% in MLU compared with 3% in CLU).Despite having fewer epidurals, 83% of women in the MLUs expressed satisfaction with their pain relief, compared with 68% of women in the CLU.

Professor of Nursing and Midwifery at Trinity, Cecily Begley, principal investigator of the MidU study, explained: "When women are supported by one-to-one midwifery care, they are encouraged to labour gently at their own pace and have the pain-relieving benefits of relaxing in warm water, they are far better able to tolerate pain, and labour more effectively."

Krysia Lynch, Chairperson of the Association for the Improvements of Maternity Services in Ireland, welcomed the results. "Women tell us that they want more choice in maternity care provision in Ireland. Specifically, they want more midwifery-led options. In our recent What Matters To You Survey carried out last year with 2,832 respondents, 55% said they would avail of midwifery-led care if it were available and over 90% felt that there should be free-standing birth centres in Ireland. Given these findings, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources are used more effectively."