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Preterm birth and the cost to women

When a baby is born preterm, they are more likely to face significant health challenges. As a consequence, the care they receive is more expensive than a baby born around term. Some of this cost is met by government funding, but not all. Women who give birth to preterm babies provide the bulk of the care for preterm babies during their first years of life, and therefore incur most of these cost shortfalls. Just how much this amounts to is a question that has recently been addressed (Fox & Callander, 2021).

Ms Haylee Fox from James Cook University and Associate Professor Emily Callander, a Transforming Maternity Care Collaborative member, set out to determine both the out-of-pocket health care costs women who have recently given birth face, and the loss of income incurred as a consequence of a delayed return to employment. They did this for women who gave birth at term, and those who gave birth preterm so any differences could be measured. Data from the Longitudinal Study of Australian Children and the Maternity 1000 dataset were used to provide answers.

Women who gave birth preterm took longer to return to employment (2.8 years) than women who gave at term (1.9 years). Mothers of preterm babies were more likely to not return to paid employment at all, while those who did had a lower income than women who gave birth at term. Out of pocket healthcare expenses were $1059 for women who gave birth at term, $1298 for women who gave birth between 32 and 36 weeks, and $2491 for those who gave birth at less than 32 weeks.

It has long been recognised that being born preterm does not provide the optimum start to life. Fox and Callander’s research suggests that financial hardship is likely to compound the health challenges preterm children face during early childhood. They have demonstrated that preterm birth limits women’s capacity to participate in the workforce. While ensuring adequate government income support for new mothers is an important step in rectifying the financial shortfall, interventions to prevent preterm birth are likely to be far more cost effective and assist women to re-enter the workforce in a timely manner.

Midwifery led continuity of care is backed by sound evidence demonstrating both a reduction in preterm birth and lower mortality rates related to this (Medley et al., 2018). Implementation of continuity models has been found to be cost neutral, however the research to date has not considered the potential impact of changes to downstream costs from a reduction in preterm birth (Sandall et al., 2016). Access to continuity of midwifery care models remains below demand for such services (Donnellan-Fernandez et al., 2020). Addressing barriers to accessing such models should be a priority focus for policy makers.

References

Donnellan-Fernandez, R. E., Creedy, D. K., Callander, E. J., Gamble, J., & Toohill, J. (2020, Aug 28). Differential access to continuity of midwifery care in Queensland, Australia. Australian Health Review, 45(1), 28-35. https://doi.org/10.1071/AH19264

Fox, H., & Callander, E. (2021, Jan 10). Cost of preterm birth to Australian mothers: Assessing the financial impact of a birth outcome with an increasing prevalence. Journal of Paediatrics and Child Health, in press. https://doi.org/10.1111/jpc.15278

Medley, N., Vogel, J. P., Care, A., & Alfirevic, Z. (2018, Nov 14). Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews, 11, CD012505. https://doi.org/10.1002/14651858.CD012505.pub2

Sandall, J., Coxon, K., Mackintosh, N., Rayment-Jones, H., Locock, L., & Page, L. A. (2016). Relationships: the pathway to safe, high-quality maternity care.

Building birthing on country for the Yuin community

First Nations women of Australia have given birth on their country and within their cultural practices for most of their history. The colonisation of Australia by Europeans disrupted this, and it is now challenging for Aboriginal and Torres Strait Islander women to access maternity care that is local to them, and which honours their culture. Midwifery continuity of care delivered in models designed by and for Aboriginal and Torres Strait Islander women, by clinicians who are answerable to their local community can build the strength and vitality of communities.

The IBUS study (Hickey, et al., 2018) has been examining the outcomes of providing birthing on country services within a midwifery continuity of care model. Preliminary findings have shown a significant reduction in preterm birth rates (Kildea, et al., 2019). Preterm birth rates are higher for children born to indigenous women compared to non-indigenous women, and these children are at a life-long disadvantage. Few interventions designed to prevent preterm birth have been as effective as these structural changes to the way care is provided. Despite this, midwifery continuity of care models remain limited around Australia and access to such care is particularly lacking for Aboriginal and Torres Strait Islander women living in regional areas.

Waminda, the South Coast Women’s Health and Welfare Aboriginal Corporation – located on Yuin land in Nowra, NSW – is poised to solve this access issue for their local community. Extensive consultation within the community occurred in 2017 in the form of the Building on Our Strengths (BOOSt) project (Roe, Kildea, & Briggs, 2017). Participants identified that they wanted maternity systems based on Aboriginal ways of knowing and doing, that provide holistic care, and that were committed to giving their children the best start in life.

Waminda have designed a Birthing on Country program that puts the needs of the community first and is underpinned by sound research. A central part of this program is to build a Birthing and Community Hub which will enable the provision of maternity services, including birthing services. The major obstacle in their way at the present time is funding. To overcome this, Waminda are seeking public funding for the project. You can help make this happen by making a donation to support this work.  More information is available on the Waminda Birthing on Country website.

 

References
Hickey S, Roe Y, Gao Y, Nelson C, Carson A, Currie J, et al. The Indigenous Birthing in an Urban Setting study: the IBUS study: A prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland, Australia. BMC Pregnancy Childbirth. 2018;18(1):431.

Kildea, S., Gao, Y., Hickey, S., Kruske, S., Nelson, C., Blackman, R., Tracy, S., Hurst, C., Williamson, D., & Roe, Y. (2019, Jul). Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia. EClinicalMedicine, 12, 43-51. https://doi.org/10.1016/j.eclinm.2019.06.001

Roe, Y., Kildea S. and Briggs, M. (2017). Birthing on Country, Best Start to Life, Illawarra Shoalhaven, 2017. Birthing on Country Working Group, Midwifery Research Unit, University of Queensland.