Understanding the Limitations of Maternity Cost Studies: Why Context Matters


Kellie Thiessen, RM, RN, PhD, Julia Witt, Alexander Peden, MA, PhD(c), Margaret Haworth-Brockman, BSc, MSc, Nathan Nickel, MPH, PhD, Margaret Morris, MD, FRCSC, MEd, Kristine Robinson BScN, RM, MSc, Ivy Bourgeault, PhD, and Shelley Derksen, BSc, MSc



Background: Limited, publicly available evidence exists to inform maternity care workforce planning in Manitoba as well as elsewhere in Canada. This manuscript offers a discussion about how context is critical when considering how cost, efficiency, and efficacy data are used.

Methods: Our cost analysis of maternity care in Manitoba, Canada, focused exclusively on women with low-risk pregnancies from combined dates (2004/05 to 2008/09 and 2009/10 to 2012/13).

Results: Although our cost analysis found that maternity care provided by family physicians had the lowest overall expected cost, and that highest effectiveness, measured by avoided neonatal intensive care unit (NICU) admissions, midwives had the lowest hospital costs and similar cost-effectiveness to other provider types.

Interpretation: The context of how different maternity care professions are integrated into the system has a substantial impact on the assessment of overall cost. Caution must be used in interpreting these findings from significantly different models of care. The roles of providers are rarely articulated in cost study analyses to capture the breadth of services beyond “in-patient” costs.


midwifery, cost-effectiveness, health services, maternity care, Manitoba


This article has been peer reviewed.


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