The DOI matches its Crossref record; 5 of the 5 references it cites were found in a registry or an index.
Continuity of care by a primary midwife (caseload midwifery): a cost analysis using results from the COSMOS randomised controlled trial
Open accessAbstract
Introduction: Caseload midwifery (continuity of midwifery carer) offers benefits including lower caesarean section rates, lower risks of preterm birth and stillbirth, and improved maternal satisfaction of care. Despite these advantages, concerns about additional costs hinder widespread implementation. This study examines the cost of caseload midwifery compared with standard maternity care from the perspective of both public hospitals and public funders. Methods: A cost analysis was conducted using data from a randomised controlled trial of 2314 low-risk pregnant women in Melbourne, Australia. Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a ‘back-up’ midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care. The cost analysis compared differences in mean costs of health resources to public hospitals and to public funders. Additionally, a budget impact analysis estimated total costs to the health system between 2023 and 2027. Results: For public hospitals, there was no significant difference in overall costs between women receiving caseload midwifery (n=1146) versus standard care (n=1151) ($A12 363 (SD: $A4967) vs $A12 323 (SD: $A7404); p=0.85). Conversely, public funders incurred lower expenditures for women receiving caseload midwifery ($A20 330 (SD: $A8312)) versus standard care ($A21 637 (SD: $A11 818); p <0.001). The budget impact analysis estimated savings of $A625 million to the health system over the next 5 years with expanded access to caseload midwifery in Australia. Conclusion: Caseload midwifery in low-risk women is cost-neutral to public hospitals and cost-saving to public funders. Tweetable abstract: Continuity of midwifery for low-risk women reduces costs to public funders, with no additional costs to hospitals.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Midwifery- and nurse-led continuity of care models are recognized as effective strategies for improving maternal outcomes and patient satisfaction.
“Midwifery- and nurse-led continuity of care (CoC) models are recognized as effective strategies for improving maternal outcomes and patient satisfaction (Callander et al., 2024).”
From Extending the continuum: Mapping post-6-week nurse/midwife-led interventions for postnatal women – A scoping review (2026) · cites this paper as Callander et al., 2024
The ‘What is already known on this topic’ section (p. 1) associates continuity of care by a primary midwife with beneficial health outcomes and increased maternal satisfaction. The paper supports the midwifery-led part of the claim, but does not establish the same point for nurse-led continuity of care. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Caesarean section and risk of unexplained stillbirth in subsequent pregnancy
Smith, G. C., Pell, J. P., & Bobbie, R. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14896-9 · Cited by 378
Tracy, S. K., Hartz, D. L., Tracy, M. B., Allen, J., Forti, A., Hall, B., White, J., Lainchbury, A., Stapleton, H., Beckmann, M., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61406-3 · Cited by 288
McLachlan, H., Forster, D., Davey, M., Farrell, T., Gold, L., Biro, M., Albers, L., Flood, M., Oats, J., & Waldenström, U. (2012) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2012.03446.x · Cited by 268
Self-citationForster, D. A., McLachlan, H. L., Davey, M.-A., Biro, M. A., Farrell, T., Gold, L., Flood, M., Shafiei, T., & Waldenström, U. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-0798-y · Cited by 251
Self-citationMcLachlan, H. L., Forster, D. A., Davey, M.-A., Lumley, J., Farrell, T., Oats, J., Gold, L., Waldenström, U., Albers, L., & Biro, M. A. (2008) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-8-35 · Cited by 41
Self-citation
Flagged first, then by citations
Research works printed but not linked: 17
- Boerma, 2018, Global epidemiology of use of and disparities in caesarean sections, The Lancet, 392, 1341, 10.1016/S0140-6736(18)31928-7 · DOI
- Koblinsky, 2016, Quality maternity care for every woman, everywhere: a call to action, The Lancet, 388, 2307, 10.1016/S0140-6736(16)31333-2 · DOI · Paper page
- Callander, 2022, Value in maternal care: using the learning health system to facilitate action, Birth, 49, 589, 10.1111/birt.12684 · DOI
- Sandall, 2018, Short-term and long-term effects of caesarean section on the health of women and children, The Lancet, 392, 1349, 10.1016/S0140-6736(18)31930-5 · DOI · Paper page
- 10.1016/s0140-6736(18)32394-8 · DOI
- Ockenden D . Independent review of maternity services at shrewsbury and telford hospital NHS trust. 2019.
- Sibley, 2022, Ockenden report: the refusal of our healthcare service to take patient experience seriously, BMJ, 377, 875, 10.1136/bmj.o875 · DOI
- Thornton, 2022, Ockenden report a 'watershed moment', The Lancet, 399, 1371, 10.1016/S0140-6736(22)00655-9 · DOI
- de Jonge, 2023, Where the Ockenden report goes wrong: let us keep calm and follow the evidence, BJOG, 130, 11, 10.1111/1471-0528.17276 · DOI
- McLachlan, 2016, The effect of primary midwife‐Led care on women’s experience of childbirth: results from the COSMOS randomised controlled trial, BJOG, 123, 465, 10.1111/1471-0528.13713 · DOI · Paper page
- Sandall J , Soltani H , Gates S , et al . Midwife‐Led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2013;2016. doi:10.1002/14651858.CD004667.pub3 · DOI
- Dawson, 2016, Implementing caseload Midwifery: exploring the views of maternity managers in Australia - a national cross-sectional survey, Women Birth, 29, 214, 10.1016/j.wombi.2015.10.010 · DOI
- Betran, 2021, Trends and projections of caesarean section rates: global and regional estimates, BMJ Glob Health, 6, 10.1136/bmjgh-2021-005671 · DOI · Paper page
- Fox, 2019, A review of the impact of financing mechanisms on maternal health care in Australia, BMC Public Health, 19, 1540, 10.1186/s12889-019-7850-6 · DOI
- Callander EJ , Slavin V , Gamble J , et al . Cost-effectiveness of public caseload midwifery compared to standard care in an Australian setting: a pragmatic analysis to inform service delivery. Int J Qual Health Care 2021;33. doi:10.1093/intqhc/mzab084 · DOI
- Attanasio, 2020, Midwife-led care and obstetrician-led care for low-risk pregnancies: a cost comparison, Birth, 47, 57, 10.1111/birt.12464 · DOI
- Callander, 2020, Reducing caesarean delivery: an economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women, Paediatr Perinat Epidemiol, 34, 3, 10.1111/ppe.12621 · DOI
Cited by
Sorted by citations
Ibitoye, O. F., Hanson, V., Alshdefa, A., & Pitre, S. (2026) · Midwifery · doi:10.1016/j.midw.2026.104967
Metadata
- Authors
- Callander, E. J., Jackson, H., McLachlan, H. L., Davey, M.-A., & Forster, D. A.
- Affiliations
- University of Technology Sydney (AU)
- La Trobe University (AU)
- Monash University (AU)
- Royal Women's Hospital (AU)
- Corresponding author
- Callander, Emily J
- Venue
- Gynecology and Obstetrics Clinical Medicine
- Publisher
- BMJ
- Published
- 2024-06
- Volume
- 4
- Issue
- 2
- Pages
- e000008
- ISSN
- 2097-0587 (ISSN-L)
- 2667-1646
- OpenAlex
- W4399367221
- Cited by
- 12
- References
- 5
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 2
- FWCI
- 6.65
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Gynecology and Obstetrics Clinical Medicine (publishedVersion, cc-by)
- OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- La Trobe University (cc-by)
- Funders
- Australian National Health and Medical Research Council (433040)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- caseload midwifery, continuity of midwifery care, cost analysis, budget impact analysis, low-risk pregnancy, midwife-led care, COSMOS trial, maternity care costs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
