Maternity Care – A Cost Benefit Analysis

The Irish government has pledged to improve maternal choice by expanding midwifery-led care throughout the country. Earlier this year, I posted about an Irish study examining women’s preferences for maternity care and subsequent motivations when choosing place of birth (Maternity Care – what do women want?). Since then, the cost-benefit analysis of midwifery- and consultant-led care in Ireland has been published in Applied Health Economics & Health Policy.


This is the first study to estimate the net benefit of consultant- and midwifery-led models of care using cost-benefit methodology and women’s preferences for maternity care, with the results arriving at a particularly useful juncture in Irish policy formulation. While both models of care are cost-beneficial for low-risk patients, the net benefit for consultant led-care is considerably smaller. This study demonstrates the demand for midwifery-led care in Ireland, which is currently provided in only two hospitals in the north-east of the country.  It also demonstrates potential cost-savings from providing midwifery-led care for low-risk women as an alternative to consultant-led care in hospitals across Ireland. It is important to note that consultant-led care is necessary for high-risk patients and is an important maternal choice for all maternity care patients.


This research was supported by the National Perinatal Epidemiology Centre of Ireland.

5 replies on “Maternity Care – A Cost Benefit Analysis”

Excellent news. I had all my babies in mid-wifery led care by Holles St. Stupendous service so delighted to hear it makes financial sense too.
Now all you need to do is persuade middle-class mums to dispense with their fancy consultants* and trust the midwives 🙂
*to whom of course one is very grateful when mother or baby are actually sick…

Are there any figures available for what consultant obstetricians are paid annually in private fees by expectant mothers which may not be captured as a cost in this paper?

In my experience when any relatives, friends or work colleagues announce that they are expecting a baby a fairly common following question is: “Are you going public or private?” and discussion around this will invariably then take place. An expectant mother with private health insurance will still have to decide if she wants to pay an additional private fee to a consultant obstetrician for the benefit of being seen at clinics by the consultant and having him/her personally deliver the baby (or at least oversee the birth) in the labour ward. When Mrs E had our children she “went private” and we paid approx. €3-4k each time to the consultant obstetrician. This was in a regional maternity hospital. I’m guessing that the fee in Dublin, for example, must now be in excess of €5k and consultants are getting very wealthy on this model. I don’t think they would be much in favour of midwifery-led models.

Women who can afford it pay this money largely out of fear in my view: fear that pre-birth scans won’t be properly analysed or there’ll only be a junior doctor on duty when they go in to labour. Let’s be honest: you get extra care and attention by paying this fee to a consultant. Mrs E’s third pregnancy unfortunately resulted in an early miscarriage but when she went to the hospital there was a Senior Reg from the consultant’s team on hand to oversee all her care, to ensure tests were carried out, blood samples and pathology samples were taken and results followed up. When that sad case in Galway a few years back occurred this issue of private consultant care was completely ignored by the media and no one asked the question: did the woman die because she did not have private care i.e. were blood tests taken and followed up, etc? I work in the health service and any midwife I spoke to said that the issue was simply that no one in the hospital realised how sick this woman was. In all the cases I’ve read about in recent years of poor care and treatment in maternity hospital with fatalities the common denominator was that the women did not have private care.

“Let’s be honest: you get extra care and attention by paying this fee to a consultant”

That is not necessarily a good thing. There is evidence that going private leads to excessive interventions.

You are correct that the current model is very lucrative for consultants, and also morally obscene. Makes a mockery of any crocodile tears they shed about the need for extra resources.

This response, and the feeling that women have, that they can’t trust the public system, is I believe a consequence of the absolute determination to maintain a narrative in the media that the public system is a disaster, and one is only safe when in the good hands of ones own consultant. A narrative that conveniently suits certain consultants who are only too happy to pop up on the news every 5 mins assuring the public that people are dying daily. I had my 3 publicly and the care was fantastic, and specifically because it was midwifery led I developed good personal relationships with the midwives – so they knew me – which is important in medical terms.
Indeed as Charles Normand said at this weekend’s DEW – once medicine is privatised – the costs go up. Many reasons why this is so but the first is that rather than price being a useful way to ration medicine, in fact, it increases waste as interventions of all kinds are made unnecessarily. That’s another reason I suspect why midwifery led is cheaper.
As for the Galway case – I read the coroner’s report. She was unbelievably unlucky. Every single thing that could have gone wrong went wrong, starting with her getting sick on a weekend. But it’s worth bearing in mind that hers was the first maternal death in Galway in 17 years and our MMR is, even when you use the broadest possible definitions, statistically insignificant from the UK, where yes, sepsis is the leading cause of maternal death. It’s always tempting to fall into Irish Exceptionalism, but there be dragons…

One thing the media could do every time a consultant sticks their hand up for more resources is ask them about their private practice. Practice that is carried out in public hospitals which were built by and are funded by the taxes which low and middle income patients pay – and who often can’t afford to go private. Practice that is built upon a medical education which was also funded by the taxes of those same people.

After the Slaintecare report came out the silence from consultants who are normally very voluble on all sorts of subjects was deafening. As with many things in Ireland the insider response is to sit tight and hope everyone forgets all about it.

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