Delivering continuity of midwifery care to Queensland women

A recent Cochrane Review also identified alternative maternity settings such as birth centres
alongside standard hospitals offered improved outcomes for women receiving midwifery care
without increasing perinatal mortality (Hodnett, Downe, Walsh & Weston 2010).
Cost-effectiveness of midwifery continuity models
Maternity service managers are understandably very interested in the cost of running midwifery
continuity models, given their responsibilities for budgets and expenditure. After the initial
cost invested in the transition, these models are cheaper to run than standard care.
In 2001 Caroline Homer found that the cost per birth of the St George Hospital’s communitybased
team midwifery service was about 74 per cent that of standard care while caring
for women of all risk levels. Savings included reduced antenatal midwifery care costs,
reduced antenatal admissions, a major reduction in admissions to special care and reduced
caesarean section rate. The community midwifery model had extra costs in on-call and
postnatal home care, but these were much smaller than the savings in other areas (Homer,
Matha, Jordan, Wills & Davis 2001).
Savings mostly arise from reduced demand on services other than primary midwifery care
and are largely due to the preventative and early intervention characteristics of care. A
whole of service perspective is needed to recognise these benefits. Several international
and Australian studies over several years document the direct cost savings of midwifery
continuity models. However the indirect savings, from improved outcomes such as
breastfeeding, are also potentially significant.
A 2008 research project compared the cost of care for women receiving MGP care at Gold
Coast Hospital’s Birth Centre to the cost of providing standard care to women with the same
risk profile. From a hospital cost perspective, caseload care in the birth centre saved $825
per birth, at $4 696 per birth compared to $5 521 per birth in standard care. MGP caseload
postnatal care is inclusive of home visits to six weeks compared to home visits to one week
in standard care. Therefore postnatal costs were higher in MGP care, but intrapartum and
newborn care costs were low enough to realise overall savings (Toohill, Turkstra, Gamble &
Scuffham 2011).
It is relevant to note that costs of standard maternity care are likely to rise, with new
requirements such as universal postnatal contact for all women which is already in-built to
MGP models. Further savings can be realised in Australia through the evidence of reduction
in sick leave, retention of workforce and midwives’ improved satisfaction levels from working
in MGP (Collins, Fereday, Pincombe, Oster & Turnbull 2010; Toohill, 2008).
A more detailed analysis of costing issues is offered in Section 7.
Consumer Demand
Women have been the biggest driver of midwifery continuity models in recent years.
Birth centres and other continuity models are very popular with women and families who
experience their care. Many birth centres have associated consumer groups established
by users, which focus on supporting the service and ensuring other women have access.
Urban birth centres offering continuity of midwifery care tend not to be able to meet demand,
despite often having locally defined “low risk” entry criteria.
We also met our first midwife, who we liked immediately. She read our birth plan which
detailed our desire for an active labour. She read it carefully and respectfully and declared
that she felt very comfortable in supporting us in the way that we had identified. We felt
comfortable and reassured. This midwife was wonderful. She provided considered support
and advice, whilst allowing my husband and I to have our own space and ‘do our own
thing’. We felt strong and capable and excited about the imminent birth of our baby.
(submission, Review of Maternity Services in Queensland)
A guide to implementation
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