Friedman Howard S, Liang Mengjia, Banks Jamie L
United Nations Population Fund (UNFPA), Technical Division, 605 3rd Avenue, New York, NY 10158, USA.
Collaborative Health Advisors, LLC, Lincoln, MA, USA.
Womens Health (Lond). 2015 Jul;11(4):553-64. doi: 10.2217/WHE.15.18. Epub 2015 Aug 10.
International agencies have advocated scaling-up of midwifery resources as an important method for improving maternal health and reducing maternal mortality rates (MMR). The cost-effectiveness of midwife-led versus physician-led intrapartum care is an important consideration in the human resource planning required to reduce MMR. Studies suggest that midwife-led teams can achieve comparable effectiveness and outcomes using less medically intensive care compared with physician-led teams. In the absence of adequate medical cost data, decision makers should consider the substantially lower average costs for three main drivers: salaries, benefits and incentives (≥two-times lower); preservice training (three-times lower) and attrition (two-times lower) necessary to deliver intrapartum care at the level of midwife competencies. This suggests that scale-up of midwifery resources is a less expensive and more cost-effective way to reduce MMRs and could potentially increase access to skilled intrapartum care.
国际机构倡导增加助产资源，将其作为改善孕产妇健康和降低孕产妇死亡率（MMR）的重要方法。在降低孕产妇死亡率所需的人力资源规划中，由助产士主导与由医生主导的产时护理的成本效益是一个重要考量因素。研究表明，与由医生主导的团队相比，由助产士主导的团队使用的医疗护理强度较低，但能取得相当的效果和结果。在缺乏足够医疗成本数据的情况下，决策者应考虑三个主要驱动因素的平均成本大幅降低：工资、福利和激励措施（低至少两倍）；职前培训（低三倍）以及提供助产士能力水平的产时护理所需的人员流失率（低两倍）。这表明增加助产资源是降低孕产妇死亡率的一种成本更低且更具成本效益的方式，并且有可能增加获得熟练产时护理的机会。
