The Birthplace cost-effectiveness study looked at the short term costs and cost-effectiveness of planned births in four settings: obstetric units, midwifery units located in the same hospital as an obstetric unit, free-standing midwifery units and home. The study assessed NHS costs associated with the birth itself – for example midwifery care during labour and immediately after the birth, the cost of pain relief and any medical care and procedures needed in hospital if complications developed, and the cost of any stay in hospital, midwifery unit, or neonatal unit immediately after the birth either by the mother or the baby. The costs for planned home and midwifery unit births took account of interventions and treatment that the women and babies received if they were transferred into hospital during labour or after the birth. The costs did not include any longer term cost, for example the life-long cost of caring for babies who suffer serious birth injuries or any increased maternity care costs in subsequent births if the woman suffers complications which increase her risks in future pregnancies.
The study evaluated cost-effectiveness by looking at the relative short term costs of achieving good outcomes for the mother and baby in each planned birth setting.
Results show that for low-risk women having a second or subsequent baby, the most cost-effective planned place of birth was at home. For this group of women, planned home births were safe for the mother and baby, resulted in fewer expensive obstetric interventions and cost the NHS less than births in other settings. Planned births in midwifery units were also safe and cost saving relative to planned birth in an obstetric unit. Planned birth in an obstetric unit was the most expensive option with mean costs at £1,142 per woman with planned birth at home the cheapest at £780 per woman.
For low-risk women having a first baby, a planned birth in a midwifery unit compared with planned birth in an obstetric unit was less expensive. Planned birth at home was also cost saving but was associated with poorer outcomes for the baby. Because poor outcomes for the baby can be associated with long-term disability and substantial life-time care costs, it is unclear which setting would be most cost effective in the long term for women having a first baby.
The findings show that, within a comprehensive maternity service - which includes an obstetric unit providing care for more complicated births - the most cost effective place of birth for women having a second or subsequent baby appears to be at home. In terms of short term costs effectiveness, this is also true for women having a first baby, but although planned home births are cost effective by standard health economic criteria, there is a higher risk of a poor outcome for the baby in this group and the analysis did not take account of any longer term costs associated with disability The analysis did not take account of women’s preferences and the study did not assess the financial impact on the NHS of changing the configuration of services.