City Research Online

Abstract

Background: Midwifery-led models of care for low-risk pregnancies are associated with improved outcomes for mothers and babies, without additional adverse effects. These models are also considered more cost-effective than doctor-led or shared-care approaches.

Problem: In Portugal, midwifery-led antenatal care is not widely implemented, and its economic impact remains unexplored.

Aim: To estimate the cost implications of implementing a midwifery-led antenatal care model for low-risk pregnancies in Portugal, compared to standard doctor-led care, from the perspective of the Portuguese National Health Service.

Methods: A decision-tree model was developed to simulate the antenatal period through birth, comparing midwifery-led and doctor-led care. The eligible population included low-risk pregnant women. Outcomes included preterm birth, spontaneous vaginal birth, instrumental birth, and caesarean section. A budget impact analysis estimated the financial implications for the national health service. Sensitivity and scenario analyses tested the robustness of findings by varying key parameters and assumptions.

Findings: Midwifery-led care was estimated to cost €23.08 million, compared to €39.35 million for doctor-led care, resulting in projected savings of €16.27 million. Lower rates of preterm birth, instrumental deliveries, and caesarean sections, alongside increased spontaneous vaginal births, accounted for €10.07 million in cost-offsets. Total savings were estimated at €26.34 million, or €340 per pregnancy/birth, representing a 25.8 % reduction in maternity-related expenditure.

Discussion and conclusion: Midwifery-led care presents a promising, cost-saving alternative to the current standard of care in Portugal, with the potential to improve clinical outcomes and optimize resource use.

Further research is needed to evaluate long-term economic and health impacts beyond birth.

Publication Type:	Article
Additional Information:	© 2025 The Authors. Published by Elsevier Ltd on behalf of Australian College of Midwives. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Publisher Keywords:	Prenatal Care / organisation & administration, Prenatal care / economics, Cost savings, Midwifery
Subjects:	H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RG Gynecology and obstetrics
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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