Costing childbirth at home, in a birth centre or in a hospital for women at low risk of pregnancy complications in New South Wales, Australia
- Publication Type:
- Thesis
- Issue Date:
- 2020
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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱
There are three settings available to women in which to give birth in New South Wales: Home, birth centre and hospital. The cost of giving birth for women at low risk of complications in each of these settings is not known.
𝗔𝗶𝗺
The aim of this study was to estimate the cost of giving birth for women at low risk of complications who are planning birth at home, in a birth centre or in a hospital in NSW from the perspective of the health service.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀
A cost analysis was conducted comprising four components. Firstly, two systematic reviews were conducted to examine the literature on 1) the safety of giving birth at home or in a birth centre, and 2) the cost associated with birth in these settings. Secondly, a decision tree framework was used to map the trajectories (or pathways) of women in New South Wales using linked health data. Thirdly, a micro-costing study employing time-and-motion observation along with resource use data collection via a unique data collection sheet was conducted. Finally, using the decision tree framework, a macro-costing analysis, the cost of the trajectories of the women who planned birth at home, in a birth centre or in hospital was estimated using Australian-Refined Diagnosis Related Groups (AR-DRGs).
𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀
Maternal and perinatal outcomes of planned place of birth were significantly better for women planning birth at home or in a BC, including higher rates of normal vaginal birth and lower rates of intervention and admission to the NICU for infants. The trajectories of women showed those who plan to give birth at home or in a BC have high rates of vaginal birth and women in all groups had low rates of intervention. When cost was explored, it was either less costly or the same to provide birth services at home or in a BC. The median micro-cost of providing care for women who plan to give birth at home, in a birth centre or in a hospital were AUD $2150.07, $2094.86 and $2097.30 respectively. Macro costs using AR-DRGs for homebirth, BC and hospital birth were $4748, $4979 and $5463 respectively.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻
Given the relatively lower rates of complex intervention and adverse neonatal outcomes associated with women at low risk of complications, expanding choices for women to give birth at home or in a BC would be less costly to the health system. However, what is required now is the political will and advocacy to progress the future planning of maternity service provision in New South Wales.
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