Employment during pregnancy and obstetric intervention without medical reason: labor induction and cesarean delivery

Midwife-led care and obstetrician-led care for low-risk pregnancies: A cost comparison

OBJECTIVE

Low-risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife-led care vs obstetrician-led care for low-risk pregnancies using a decision-analytic approach.

METHODS

We developed a decision-analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife-led vs obstetrician-led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011-2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments.

RESULTS

The costs of childbirth for low-risk women with midwife-led care were, on average, $2262 less than births to low-risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife-led care, compared with obstetrician-led care. Across the population of US women with low-risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife-led vs obstetrician-led care) and fewer episiotomies (170 504 vs 415 686, for midwife-led vs obstetrician-led care).

CONCLUSIONS

A shift from obstetrician-led care to midwife-led care for low-risk pregnancies could be cost saving.

Male partner involvement in efforts to eliminate mother-to-child transmission of HIV in Kisumu County, Western Kenya, 2015

INTRODUCTION

rates of caesarean sections (CS) have been rising globally over time. Our study sought to identify factors associated with CS among mothers delivering at Mama Lucy Kibaki Hospital in Nairobi city county, Kenya.

METHODS

we conducted an unmatched case-control study using a 1:2 case-to-control ratio. Cases were defined as mothers who delivered through CS at the hospital while controls were defined as mothers who delivered through vaginal birth. Semi-structured questionnaires were used to interview study participants. We calculated means and proportions of demographic and obstetric characteristics of the mothers and crude odds ratios (cOR) and 95% confidence intervals (CI) to identify factors associated with CS. We performed multivariable logistic regression to identify independent factors associated with CS.

RESULTS

we enrolled 396 participants consisting of 132 cases and 264 controls. We identified 148 (56.1%) spontaneous vaginal births. There were 89 (67.4%) primary CS. Among the 67 (50.7%) cases that had intrapartum complications, 28 (41.8%) had arrest of labor while among the 52 (19.7%) controls that had intrapartum complications 21 (40.4%) had abnormal intra-partum bleeding. There were 85 (65.4%) emergency caesarean sections, out of which 33 (25%) were due to failure of labor to progress. Of the elective caesarean sections, 26 (19.7%) were repeat caesarean. Delivering a baby with a normal birth weight (cOR = 0.39,95% CI 0.18, 0.94) and being formally employed (cOR = 1.90 (95% CI 1.4, 3.1)) were associated with CS. Being formally employed (AOR = 1.78, p = 0.030) was independently associated with a mother undergoing CS compared to mothers who were not formally employed, while mothers whose babies had a normal birth weight, ≥ 2.5kg (AOR = 0.40, p = 0.040) were less likely to undergo CS as compared to mothers whose babies had a low birth weight.

CONCLUSION

employment status and birth weight were associated with CS in urban Kenyan mothers.