{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:31:05Z","timestamp":1792524665849,"version":"4.5.0"},"reference-count":61,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,11,3]],"date-time":"2019-11-03T00:00:00Z","timestamp":1572739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Low\u2010risk 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\u2010led care vs obstetrician\u2010led care for low\u2010risk pregnancies using a decision\u2010analytic approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed a decision\u2010analytic 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\u2010led vs obstetrician\u2010led 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\u20102012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The costs of childbirth for low\u2010risk women with midwife\u2010led care were, on average, $2262 less than births to low\u2010risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife\u2010led care, compared with obstetrician\u2010led care. Across the population of US women with low\u2010risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167\u00a0259 vs 219\u00a0427 for midwife\u2010led vs obstetrician\u2010led care) and fewer episiotomies (170\u00a0504 vs 415\u00a0686, for midwife\u2010led vs obstetrician\u2010led care).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A shift from obstetrician\u2010led care to midwife\u2010led care for low\u2010risk pregnancies could be cost saving.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12464","type":"journal-article","created":{"date-parts":[[2019,11,4]],"date-time":"2019-11-04T05:39:01Z","timestamp":1572845941000},"page":"57-66","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Midwife\u2010led care and obstetrician\u2010led care for low\u2010risk pregnancies: A cost comparison"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9294-0718","authenticated-orcid":false,"given":"Laura B.","family":"Attanasio","sequence":"first","affiliation":[{"name":"Department of Health Promotion and Policy School of Public Health and Health Sciences  University of Massachusetts Amherst Amherst Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5076-1172","authenticated-orcid":false,"given":"Fernando","family":"Alarid\u2010Escudero","sequence":"additional","affiliation":[{"name":"Center for Research and Teaching in Economics (CIDE) CONACyT Aguascalientes Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy B.","family":"Kozhimannil","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management School of Public Health University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,3]]},"reference":[{"issue":"8","key":"e_1_2_5_2_1","article-title":"Midwife\u2010led continuity models versus other models of care for childbearing women","author":"Sandall J","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12287"},{"issue":"1","key":"e_1_2_5_4_1","first-page":"1","article-title":"Births: final data for 2016","volume":"67","author":"Martin JA","year":"2018","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2016.02.003"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.17.2.190"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192523"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)34328-6"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60930-2"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2011.09.002"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181954e5b"},{"issue":"1","key":"e_1_2_5_12_1","first-page":"1990","article-title":"Births: final data for 2010","volume":"61","author":"Martin JA","year":"2012","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2014.4779"},{"issue":"1","key":"e_1_2_5_14_1","first-page":"1","article-title":"Births: final data for 2009","volume":"60","author":"Martin JA","year":"2011","journal-title":"Natl Vital Stat Rep."},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2010.00459.x"},{"key":"e_1_2_5_16_1","unstructured":"HamiltonBE MartinJA OstermanMJK DriscollAK RossenLM.Births: Provisional data for 2017. 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