Relative costs of home and hospital confinement.

The first study in a series concerned with the costs of different strategies of maternity care showed the differences between the costs of booked confinement at home, in a GP hospital for 48 hours, and in a consultant obstetric unit for 48 hours to be small. The study costed 1977 home confinements in Dudley and compared them with matched samples of hospital births. The factors that compensated, in the home booked deliveries, for the cost of hospital stay were an average of 11 extra visits from community midwives, midwife attendance for six hours at delivery, and a proportion who were transferred to hospital after receiving the extra antenatal care of a home booked delivery. This differential transfer rate is a crucial factor that merits further investigation. Family-borne costs were included in the study. The most significant was time off work by the husband. Average family costs were 68 pounds, about 30% of public sector costs. Any acceptable strategy of home confinements must provide for last-minute transfers to hospital.