Look at economic analysis in our Cochrane review which summarise evidence on this, the Nice consultation on continuity and rcm paper.
All the best
Jane
Jane Sandall CBE PhD MSc BSc RM HV RN
Professor of Social Science and Women's Health
NIHR Senior Investigator
Division of Women’s Health | Faculty of Life Sciences & Medicine | King’s College London |Women’s Health Academic Centre | St. Thomas' Hospital
London| SE1 7EH
[log in to unmask] | 020 7188 8149 | Skype | jsandall
EA Rebecca Danks | [log in to unmask] | 020 7188 3639
http://www.kcl.ac.uk/lsm/research/divisions/wh/groups/maternalhealth/index.aspx
https://kclpure.kcl.ac.uk/portal/jane.sandall
I am part of the NIHR CLAHRC South London, a research organisation working to improve health services. www.clahrc-southlondon.nihr.ac.uk
Lead maternity and capacity building NIHR CLAHRC South London
http://www.clahrc-southlondon.nihr.ac.uk/
Lead capacity building King’s Improvement Science
http://www.kingsimprovementscience.org/
Latest publications:
Sandall, J., Coxon, K., Mackintosh, N., Rayment-Jones, H., Locock, L. and Page, L. (writing on behalf of the Sheila Kitzinger symposium) (2016) Relationships: the pathway to safe, high-quality maternity care; Report from the Sheila Kitzinger symposium at Green Templeton College October 2015. Green Templeton College, Oxford. http://www.clahrc-southlondon.nihr.ac.uk/news/2016/new-report-looks-widening-access-continuity-midwife-care
Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other
models of care for childbearing women. Cochrane Database of Systematic Reviews 2016 , Issue 4 . Art. No.: CD004667.
Furuta,M. Sandall,J. Cooper,D. Bick,D. (in press) Post-traumatic stress disorders; Postnatal care; Cohort studies; Zero-inflated negative binomial regression, May 13. Archives of Women's Mental Health.
Dunning, T., J. M. Harris, and J. Sandall. "Women and their birth partners’ experiences following a primary postpartum haemorrhage: a qualitative study." BMC Pregnancy and Childbirth 16.1 (2016): 1.
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Cecily Begley
Sent: 07 September 2016 22:47
To: [log in to unmask]
Subject: Re: Cost of normal birth MIDWIFERY-RESEARCH Digest - 4 Sep 2016 to 7 Sep 2016 - Special issue (#2016-182)
Dear Sophie,
Actually, I don’t think that “normal” birth is any more expensive, despite needing more midwives and more time and human resources, because of the decreased intervention and lower costs compared to instrumental and CS births. Attached our paper on the costs of midwife-led and consultant-led care in the MidU study - MLU care was €182 euro cheaper assessed on an "intention to treat" basis.
Regards,
Cecily
Prof. Cecily M. Begley,
Chair of Nursing and Midwifery,
School of Nursing and Midwifery,
Trinity College Dublin, the University of Dublin - Coláiste na Tríonóide, Baile Átha Cliath, Ollscoil Átha Cliath 24, D’Olier St, Dublin 2, Ireland - Baile Átha Cliath 2, Éire
Tel: 353 1 8962693
Fax: 353 1 896 3001
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Trinity College Dublin, the University of Dublin is ranked 1st in Ireland and in the top 100 world universities by the QS World University Rankings.
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MIDWIFERY-RESEARCH automatic digest system
Sent: 07 September 2016 14:21
To: [log in to unmask]
Subject: MIDWIFERY-RESEARCH Digest - 4 Sep 2016 to 7 Sep 2016 - Special issue (#2016-182)
There are 5 messages totaling 35079 lines in this issue.
Topics in this special issue:
1. Salutogenesis / "normal" birth / (5)
----------------------------------------------------------------------
Date: Wed, 7 Sep 2016 14:24:13 +0200
From: Sophie ULB <[log in to unmask]>
Subject: Re: Salutogenesis / "normal" birth /
Hi,
Me again for help.
Am writing a « letter of intent” (that means I am suggesting what they should work on) for the Belgian NICE which is called KCE.
Surprise surprise my idea is to enhance “normal birth”.
They have 6 sections and one is “economics”. I am a bit stuck.
Of course all I can find to say is that “normal” birth is going to be MORE expensive because we need more midwives and more patience ie time and human resources.
This is not going to be what they want.
I wondered: has anybody ever found better parenting skills or things like that so that mental health services are less used?
Or any other good argument in terms of $£€
I have written that it does not matter that it is expensive because it is about the values of a society, but I don’t think that will go down well either
Sophie
De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Soo Downe Envoyé : dimanche 4 septembre 2016 23:22 À : [log in to unmask] Objet : FW: Salutogenesis conference in Canberra
From: Deborah.Davis [mailto:[log in to unmask]]
Sent: 04 September 2016 03:33
To: Tracy.Robinson
Subject: Fw: Salutogenesis conference in Canberra
We would appreciate it if you would share this with your networks. It is going to be a great conference!
Hello,
The Midwifery team at the University of Canberra is proud to convene the October 26 & 27, 2016 conference entitled Optimising Health: Salutogenic approaches to health practice, policy, research and education to be held in Canberra, Australia. We are contacting you again as the Conference Program has been finalised.
We are excited to announce that Bengt Lindstrom, Professor of Salutogenesis in Norway, will present the Keynote Address. Plenary invited speakers include Professor Maralyn Foureur from the University of Technology Sydney, Professor John Macdonald from the University of Western Sydney, Sandra Nieuwenhuijzen, from Maintenance Operations Qantas Engineering, Professor Jan Golembiewski from the Centre for Urban Design and Mental Health and Meredith Tavener from the University of Newcastle. The conference program also offers a range of excellent concurrent speakers.
Conference information is available and registration is open through the link below.
https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.canberra.edu.au%2foptimising-health&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=g7EepdF0keNCeq%2bNPwkctaa%2f4j3R8jINo%2fmGtYkfUF8%3d
We hope to see you in Canberra in October and appreciate you circulating this email amongst your networks.
------------------------------
Date: Wed, 7 Sep 2016 12:40:15 +0000
From: "McCourt, Christine" <[log in to unmask]>
Subject: Re: Salutogenesis / "normal" birth /
Dear Sophie
Look at the Birthplace in England Programme economic evaluation as it helps to illuminate for those who find it difficult how investment in midwifery-led services does increase cost effectiveness of services. The savings are often not visible to service managers as they may work across different budget headers but can be realised via reduced hospital admissions/time in hospital/theatre use/staff resource for CS/reduced need for medical care (which is more expensive than midwifery care) or in some systems better focused use of medical care to provide better quality support for the higher risk women who need it most.
Look also at the Cochrane review of midwifery led continuity models, first author Jane Sandall, as it covers the few economic evaluations that have been done. A similar pattern is evident. Not included in that review is the economic evaluation of the one-to-one midwifery scheme in London, as it was a controlled cohort study, not a trial. The detailed economic evaluation also showed a consistent pattern with other studies. A bit more investment in midwifery (enhanced grade and salary over numbers) balanced by reduced medical and inpatient and CS costs.
This is all before even trying to count the longer-term cost consequences, which would be so hard to pin down to measure.
(I can supply you a copy of the one-to-one evaluation report if wanted, as it is quite old now and is not so easy to access but it really gives the same message as found in the Sandall et al. Cochrane review.)
Christine McCourt
PhD Programme Director &
Professor of Maternal & Child Health
Centre for Maternal and Child Health<https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.city.ac.uk%2fhealth%2fresearch%2fcentre-for-maternal-and-child-health-research%2fmodels-of-care&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=7kKQ1gllz74w82wYGyrHIhtuaG5L%2f%2flrSRZO9EKOMBI%3d>
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From: Sophie ULB <[log in to unmask]>
Reply-To: "A forum for discussion on midwifery and reproductive health research." <[log in to unmask]>, Sophie ULB <[log in to unmask]>
Date: Wednesday, 7 September 2016 13:24
To: "[log in to unmask]" <[log in to unmask]>
Subject: Re: Salutogenesis / "normal" birth /
Hi,
Me again for help.
Am writing a « letter of intent” (that means I am suggesting what they should work on) for the Belgian NICE which is called KCE.
Surprise surprise my idea is to enhance “normal birth”.
They have 6 sections and one is “economics”. I am a bit stuck.
Of course all I can find to say is that “normal” birth is going to be MORE expensive because we need more midwives and more patience ie time and human resources.
This is not going to be what they want.
I wondered: has anybody ever found better parenting skills or things like that so that mental health services are less used?
Or any other good argument in terms of $£€ I have written that it does not matter that it is expensive because it is about the values of a society, but I don’t think that will go down well either Sophie De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Soo Downe Envoyé : dimanche 4 septembre 2016 23:22 À : [log in to unmask] Objet : FW: Salutogenesis conference in Canberra
From: Deborah.Davis [mailto:[log in to unmask]]
Sent: 04 September 2016 03:33
To: Tracy.Robinson
Subject: Fw: Salutogenesis conference in Canberra
We would appreciate it if you would share this with your networks. It is going to be a great conference!
Hello,
The Midwifery team at the University of Canberra is proud to convene the October 26 & 27, 2016 conference entitled Optimising Health: Salutogenic approaches to health practice, policy, research and education to be held in Canberra, Australia. We are contacting you again as the Conference Program has been finalised.
We are excited to announce that Bengt Lindstrom, Professor of Salutogenesis in Norway, will present the Keynote Address. Plenary invited speakers include Professor Maralyn Foureur from the University of Technology Sydney, Professor John Macdonald from the University of Western Sydney, Sandra Nieuwenhuijzen, from Maintenance Operations Qantas Engineering, Professor Jan Golembiewski from the Centre for Urban Design and Mental Health and Meredith Tavener from the University of Newcastle. The conference program also offers a range of excellent concurrent speakers.
Conference information is available and registration is open through the link below.
https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.canberra.edu.au%2foptimising-health&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=g7EepdF0keNCeq%2bNPwkctaa%2f4j3R8jINo%2fmGtYkfUF8%3d
We hope to see you in Canberra in October and appreciate you circulating this email amongst your networks.
------------------------------
Date: Wed, 7 Sep 2016 13:15:46 +0000
From: Robyn Maude <[log in to unmask]>
Subject: Re: Salutogenesis / "normal" birth /
There was an economic evaluation of water in the context of improved perineal outcomes. I will look for it when I have better internet access and send reference (in Copenhagen airport at the moment)
Sent from my iPhone
On 7/09/2016, at 2:24 PM, Sophie ULB <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Hi,
Me again for help.
Am writing a < letter of intent" (that means I am suggesting what they should work on) for the Belgian NICE which is called KCE.
Surprise surprise my idea is to enhance "normal birth".
They have 6 sections and one is "economics". I am a bit stuck.
Of course all I can find to say is that "normal" birth is going to be MORE expensive because we need more midwives and more patience ie time and human resources.
This is not going to be what they want.
I wondered: has anybody ever found better parenting skills or things like that so that mental health services are less used?
Or any other good argument in terms of $?EUR I have written that it does not matter that it is expensive because it is about the values of a society, but I don't think that will go down well either Sophie De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Soo Downe Envoy? : dimanche 4 septembre 2016 23:22 ? : [log in to unmask]<mailto:[log in to unmask]>
Objet : FW: Salutogenesis conference in Canberra
From: Deborah.Davis [mailto:[log in to unmask]]
Sent: 04 September 2016 03:33
To: Tracy.Robinson
Subject: Fw: Salutogenesis conference in Canberra
We would appreciate it if you would share this with your networks. It is going to be a great conference!
Hello,
The Midwifery team at the University of Canberra is proud to convene the October 26 & 27, 2016 conference entitled Optimising Health: Salutogenic approaches to health practice, policy, research and education to be held in Canberra, Australia. We are contacting you again as the Conference Program has been finalised.
We are excited to announce that Bengt Lindstrom, Professor of Salutogenesis in Norway, will present the Keynote Address. Plenary invited speakers include Professor Maralyn Foureur from the University of Technology Sydney, Professor John Macdonald from the University of Western Sydney, Sandra Nieuwenhuijzen, from Maintenance Operations Qantas Engineering, Professor Jan Golembiewski from the Centre for Urban Design and Mental Health and Meredith Tavener from the University of Newcastle. The conference program also offers a range of excellent concurrent speakers.
Conference information is available and registration is open through the link below.
https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.canberra.edu.au%2foptimising-health&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=g7EepdF0keNCeq%2bNPwkctaa%2f4j3R8jINo%2fmGtYkfUF8%3d
We hope to see you in Canberra in October and appreciate you circulating this email amongst your networks.
------------------------------
Date: Wed, 7 Sep 2016 13:19:55 +0000
From: Soo Downe <[log in to unmask]>
Subject: Re: Salutogenesis / "normal" birth /
There is also the study by Conrad in the US that shows that the excess cost of unnecessary interventions in normal labour and birth for healthy women in the US is around $16 billion: of all the areas of over-medicalisation they looked at, maternity was by far the most costly:
Soc Sci Med. 2010 Jun;70(12):1943-7. doi: 10.1016/j.socscimed.2010.02.019. Epub 2010 Mar 10.
Estimating the costs of medicalization.
Conrad P<https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.ncbi.nlm.nih.gov%2fpubmed%2f%3fterm%3dConrad%2520P%255BAuthor%255D%26cauthor%3dtrue%26cauthor_uid%3d20362382&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=5uWj9PM%2femwmu3H%2bbVTRvmoYPEGW6Ycfyoh0ETbCUEo%3d>1, Mackie T<https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.ncbi.nlm.nih.gov%2fpubmed%2f%3fterm%3dMackie%2520T%255BAuthor%255D%26cauthor%3dtrue%26cauthor_uid%3d20362382&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=VvxFvPZuKW9pAGuMAQJpJDyzxZLrqO2Yo4VQyN7Az70%3d>, Mehrotra A<https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.ncbi.nlm.nih.gov%2fpubmed%2f%3fterm%3dMehrotra%2520A%255BAuthor%255D%26cauthor%3dtrue%26cauthor_uid%3d20362382&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=YpftmuX412gU2A334YWO%2fzQ2BIFjhf0wEwPjj9VloN0%3d>.
Author information
Abstract
Medicalization is the process by which non-medical problems become defined and treated as medical problems, usually as illnesses or disorders. There has been growing concern with the possibility that medicalization is driving increased health care costs. In this paper we estimate the medical spending in the U.S. of identified medicalized conditions at approximately $77 billion in 2005, 3.9% of total domestic expenditures on health care. This estimate is based on the direct costs associated with twelve medicalized conditions. Although due to data limitations this estimate does not include all medicalized conditions, it can inform future debates about health care spending and medicalization.
This is likely to be replicated (at scale) for most other high income countries.
I think Belizans team also looked at the cost of high rates of CS when compared to vaginal birth?
Just a note: be careful to separate out normal birth from vaginal birth Sophie (the latter includes forceps and epidurals and etc, and these are expensive).
All the best
Soo
From: Sophie ULB [mailto:[log in to unmask]]
Sent: 07 September 2016 13:24
To: 'A forum for discussion on midwifery and reproductive health research.'; Soo Downe
Subject: RE: Salutogenesis / "normal" birth /
Hi,
Me again for help.
Am writing a « letter of intent” (that means I am suggesting what they should work on) for the Belgian NICE which is called KCE.
Surprise surprise my idea is to enhance “normal birth”.
They have 6 sections and one is “economics”. I am a bit stuck.
Of course all I can find to say is that “normal” birth is going to be MORE expensive because we need more midwives and more patience ie time and human resources.
This is not going to be what they want.
I wondered: has anybody ever found better parenting skills or things like that so that mental health services are less used?
Or any other good argument in terms of $£€ I have written that it does not matter that it is expensive because it is about the values of a society, but I don’t think that will go down well either Sophie De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Soo Downe Envoyé : dimanche 4 septembre 2016 23:22 À : [log in to unmask]<mailto:[log in to unmask]>
Objet : FW: Salutogenesis conference in Canberra
From: Deborah.Davis [mailto:[log in to unmask]]
Sent: 04 September 2016 03:33
To: Tracy.Robinson
Subject: Fw: Salutogenesis conference in Canberra
We would appreciate it if you would share this with your networks. It is going to be a great conference!
Hello,
The Midwifery team at the University of Canberra is proud to convene the October 26 & 27, 2016 conference entitled Optimising Health: Salutogenic approaches to health practice, policy, research and education to be held in Canberra, Australia. We are contacting you again as the Conference Program has been finalised.
We are excited to announce that Bengt Lindstrom, Professor of Salutogenesis in Norway, will present the Keynote Address. Plenary invited speakers include Professor Maralyn Foureur from the University of Technology Sydney, Professor John Macdonald from the University of Western Sydney, Sandra Nieuwenhuijzen, from Maintenance Operations Qantas Engineering, Professor Jan Golembiewski from the Centre for Urban Design and Mental Health and Meredith Tavener from the University of Newcastle. The conference program also offers a range of excellent concurrent speakers.
Conference information is available and registration is open through the link below.
https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.canberra.edu.au%2foptimising-health&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=g7EepdF0keNCeq%2bNPwkctaa%2f4j3R8jINo%2fmGtYkfUF8%3d
We hope to see you in Canberra in October and appreciate you circulating this email amongst your networks.
------------------------------
Date: Wed, 7 Sep 2016 13:20:46 +0000
From: Mervi Jokinen <[log in to unmask]>
Subject: Re: Salutogenesis / "normal" birth /
Hi Sophie,
The RCM has a publication on the socio-economic value of the midwife (attached). You may find the discussions in that useful.
Mervi
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Sophie ULB
Sent: 07 September 2016 13:24
To: [log in to unmask]
Subject: Re: Salutogenesis / "normal" birth /
Hi,
Me again for help.
Am writing a « letter of intent” (that means I am suggesting what they should work on) for the Belgian NICE which is called KCE.
Surprise surprise my idea is to enhance “normal birth”.
They have 6 sections and one is “economics”. I am a bit stuck.
Of course all I can find to say is that “normal” birth is going to be MORE expensive because we need more midwives and more patience ie time and human resources.
This is not going to be what they want.
I wondered: has anybody ever found better parenting skills or things like that so that mental health services are less used?
Or any other good argument in terms of $£€ I have written that it does not matter that it is expensive because it is about the values of a society, but I don’t think that will go down well either Sophie De : A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] De la part de Soo Downe Envoyé : dimanche 4 septembre 2016 23:22 À : [log in to unmask]<mailto:[log in to unmask]>
Objet : FW: Salutogenesis conference in Canberra
From: Deborah.Davis [mailto:[log in to unmask]]
Sent: 04 September 2016 03:33
To: Tracy.Robinson
Subject: Fw: Salutogenesis conference in Canberra
We would appreciate it if you would share this with your networks. It is going to be a great conference!
Hello,
The Midwifery team at the University of Canberra is proud to convene the October 26 & 27, 2016 conference entitled Optimising Health: Salutogenic approaches to health practice, policy, research and education to be held in Canberra, Australia. We are contacting you again as the Conference Program has been finalised.
We are excited to announce that Bengt Lindstrom, Professor of Salutogenesis in Norway, will present the Keynote Address. Plenary invited speakers include Professor Maralyn Foureur from the University of Technology Sydney, Professor John Macdonald from the University of Western Sydney, Sandra Nieuwenhuijzen, from Maintenance Operations Qantas Engineering, Professor Jan Golembiewski from the Centre for Urban Design and Mental Health and Meredith Tavener from the University of Newcastle. The conference program also offers a range of excellent concurrent speakers.
Conference information is available and registration is open through the link below.
https://emea01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.canberra.edu.au%2foptimising-health&data=01%7c01%7cjane.sandall%40KCL.AC.UK%7cb41160a9b1ee46eed9d608d3d76876b5%7c8370cf1416f34c16b83c724071654356%7c0&sdata=g7EepdF0keNCeq%2bNPwkctaa%2f4j3R8jINo%2fmGtYkfUF8%3d
We hope to see you in Canberra in October and appreciate you circulating this email amongst your networks.
------------------------------
End of MIDWIFERY-RESEARCH Digest - 4 Sep 2016 to 7 Sep 2016 - Special issue (#2016-182)
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