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Caseload midwifery is 'safe and cost effective'

Continued care from a named midwife throughout pregnancy and birth – known as caseload midwifery – is significantly cheaper than standard maternity care, according to researchers.

They said their findings contradict perceptions that caseload midwifery would be too expensive for healthcare systems like the NHS, where care is usually shared between different clinicians.

Lead author Professor Sally Tracy, from the University of Sydney, said caseload midwifery costs roughly £333 less per woman than current maternity care, and could play a “major part” in reducing health expenditure in countries like the UK.

“The caseload model of midwifery care has been largely overlooked because of a perception that the service will be too expensive and… not safe for complex pregnancies,” she said. “Our results show that in women of any risk caseload midwifery is safe and cost effective.”

Her study, published this week in the Lancet, involved 1,750 pregnant women who received either a named caseload midwife or standard shared care with rostered midwives and medical practitioners.

There was little difference between the groups for key factors such as caesarean rates, epidurals or admission to neonatal intensive care. Instead, the authors suggested small differences across a range of other outcomes might account for the lower average cost of caseload midwifery.

For example, women in the caseload group were more likely to have a spontaneous labour, required fewer pain drugs, experienced less blood loss and needed to stay in hospital for less time.

Commenting on research, Cathy Warwick, chief executive of the Royal College of Midwives, said the study added to a recent Cochrane Review, which she said also demonstrated an improvement in outcomes when women receive care from either the same midwife or a small team of midwives throughout the antenatal, labour and postnatal periods.

She said: “In the last national survey of women’s experiences of maternity care in England in 2010, 75% of women had not met any of the staff who cared for them during their labour and birth before. Also 43% of women did not see the same midwife every time or almost every time during pregnancy.

“The government has made a commitment to women receiving better continuity of care,” she added. “This evidence confirms that if we want to provide women with the highest possible quality of care commissioners and providers must work together to ensure this commitment is met.”

Readers' comments (1)

  • This appears to make a good case for care by midwives. This has had to be reduced in recent years due to purchasing contracts, in which antenatal care is provided some of the time by GP's, because they get paid for it regardless. There have also been reductions in midwives, specially senior ones, in order to make the service cheaper. Although not every midwife wants to undertake full caseload midwifery because of the poor work-life balance (flexi-hours, frequent call-outs at night) many midwives will contribute to a modified version of this.
    Patient safety and cost are obviously paramount!

    Unsuitable or offensive?

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