Homebirth will never be cost effective

Earlier this year I criticized a paper that claimed that the Birthplace study showed that homebirth is cost effective.

… the study CAN’T tell us about cost effectiveness since it does not take into account the largest costs, the costs of caring for a child injured during birth and the massive costs associated with legal settlements for babies who were injured or died.

There is another issue that I did not address in that post: even leaving aside long term costs of injuries and brain damage, homebirth can never be cost effective. To understand why, it helps to consider a simple example, such as making a pair of pants.

Which pair of pants costs more:

1. The pair of pants fabricated by Joe, using machinery costing tens of thousands of dollars?

2. The pair of pants sewn by Jane using her $800 sewing machine?

At first glance, it seems that the pair of pants created with the inexpensive machine surely costs less to produce, and that would be the case if Joe used his machinery to produce only a single pair of pants. However, Joe uses his machinery to produce 1,000 pairs of pants a day, 5 days a week, 50 weeks a year. Not only that, Joe obtains his fabric on industrial sized bolts at wholesale prices, while Jane has to pay retail price for a small quantity at her local fabric store. Similarly, Joe buys other supplies, like thread, needles and zippers in bulk, leading to lower prices per unit of each item than what Jane must pay.

When the cost of the expensive initial investment is spread over the hundreds of thousands of pairs of pants that Joe produces each year, the actual cost of a pair produced by Joe is far, far less than the cost of a pair produced by Jane. This principle is known as “economies of scale.” As Wikipedia explains:

… There are factors that cause a producer’s average cost per unit to fall as the scale of output is increased. “Economies of scale” is a long run concept and refers to reductions in unit cost as the size of a facility and the usage levels of other inputs increase.

… The common sources of economies of scale are purchasing (bulk buying of materials through long-term contracts), managerial (increasing the specialization of managers), financial (obtaining lower-interest charges when borrowing from banks and having access to a greater range of financial instruments), marketing (spreading the cost of advertising over a greater range of output in media markets), and technological (taking advantage of returns to scale in the production function). Each of these factors reduces the long run average costs (LRAC) of production …

The same economic rules apply to providing obstetric care. At first glance, it appears to cost less for Jane to have a homebirth, than for Joanna to give birth in the hospital. However, when governments are considering the cost of obstetric care, they aren’t looking at individual cases; they’re looking at providing obstetric care for an entire population. It is far more cost effective to provide obstetric care at a centralized facility where a variety of providers can care for many patients at the same time than it is to provide care in a private home where each midwife can care for only one patient at a time.

Many countries, like the UK, have moved to centralize care in regional hospital facilities instead of multiple community hospitals. In a regional facility, 10 midwives can care for 60 patients or more at the same time, since they are in different stages of labor and will not all deliver at the same time. In contrast, 10 homebirth midwives can care for 10 patients in the same amount of time. So while the cost of an individual homebirth attended by a midwife might appear smaller, long run average costs are much, much higher.

Homebirth advocates are looking at the wrong metric, the cost of an individual birth, when declaring that homebirth costs less than hospital birth. The correct metric is the cost of providing obstetric care to the entire population in a given time period. By that measure homebirth is woefully cost ineffective. In countries like the UK, where there is a shortage of midwives, homebirth is probably the least cost effective option of all.

Trackbacks/Pingbacks

  1. jaguar cubs for sale - July 29, 2021

    jaguar cubs for sale

    […]please pay a visit to the websites we stick to, such as this 1, as it represents our picks in the web[…]

  2. ptsd - July 28, 2021

    ptsd

    […]always a large fan of linking to bloggers that I enjoy but do not get lots of link adore from[…]

  3. canada pharmacy canada pharmacy canada pharmacy - July 27, 2021

    canada pharmacy canada pharmacy canada pharmacy

    […]please take a look at the web sites we stick to, such as this one particular, because it represents our picks from the web[…]

  4. where to buy a ruger - July 27, 2021

    where to buy a ruger

  5. buy glo extracts online - July 26, 2021

    buy glo extracts online

    […]although websites we backlink to below are considerably not connected to ours, we really feel they may be basically worth a go through, so possess a look[…]

  6. buy cannabis online usa - July 26, 2021

    buy cannabis online usa

    […]Wonderful story, reckoned we could combine several unrelated information, nonetheless really really worth taking a appear, whoa did one understand about Mid East has got more problerms at the same time […]

  7. THC edibles for sale - July 26, 2021

    THC edibles for sale

    […]very handful of sites that come about to be in depth below, from our point of view are undoubtedly nicely worth checking out[…]

  8. معرفة هوية المتصل - July 26, 2021

    معرفة هوية المتصل

    […]although web sites we backlink to beneath are considerably not related to ours, we really feel they’re basically worth a go through, so possess a look[…]

  9. juul cucumber pods - July 25, 2021

    juul cucumber pods

    […]usually posts some quite intriguing stuff like this. If you are new to this site[…]

  10. Discreet arms dealer - July 25, 2021

    Discreet arms dealer

    […]the time to read or check out the content material or websites we’ve linked to beneath the[…]

  11. latest technology - July 25, 2021

    latest technology

    […]Sites of interest we’ve a link to[…]

  12. HBCUC - July 25, 2021

    HBCUC

  13. Exchange Bulut Mail - July 24, 2021

    … [Trackback]

    […] Read More here on that Topic: skepticalob.com/2012/08/homebirth-will-never-be-cost-effective.html […]

  14. zierak - July 24, 2021

    zierak

    […]one of our visitors recently encouraged the following website[…]

  15. ถาดกระดาษ - July 22, 2021

    … [Trackback]

    […] Read More Info here to that Topic: skepticalob.com/2012/08/homebirth-will-never-be-cost-effective.html […]

  16. garden shed bunnings - July 21, 2021

    garden shed bunnings

    […]Here are several of the sites we advise for our visitors[…]

  17. Google - July 18, 2021

    Google

    Here is a great Blog You might Find Fascinating that we encourage you to visit.

  18. golden tilefish price - July 16, 2021

    golden tilefish price

    […]one of our visitors not too long ago encouraged the following website[…]

  19. Olympic Weight Set - July 16, 2021

    Olympic Weight Set

    […]very handful of internet websites that transpire to be comprehensive beneath, from our point of view are undoubtedly nicely worth checking out[…]

  20. Buy Vape Carts Online - July 14, 2021

    Buy Vape Carts Online

    https://theclearconcerntrate.com/ The Clear classic oil is mixed with CBD isolate and our preparatory flavorings for the best taste and consistency on the market today.

  21. Romeo Zero - July 14, 2021

    Romeo Zero

    […]The information mentioned inside the post are a few of the most effective out there […]

  22. pharmacy canada - July 13, 2021

    pharmacy canada

    […]just beneath, are several entirely not associated sites to ours, even so, they may be surely worth going over[…]

  23. turbanli escort - July 13, 2021

    turbanli escort

    […]Here are a number of the web-sites we recommend for our visitors[…]

  24. MILF Porn - July 12, 2021

    MILF Porn

    […]usually posts some very exciting stuff like this. If you are new to this site[…]

  25. Glock Guns for sale - July 8, 2021

    Glock Guns for sale

    […]the time to study or stop by the subject material or web sites we’ve linked to below the[…]

  26. movers Kelowna - July 7, 2021

    movers Kelowna

    […]Here is a superb Weblog You might Come across Fascinating that we Encourage You[…]

  27. order ruger guns online - July 6, 2021

    order ruger guns online

    […]here are some hyperlinks to websites that we link to since we believe they may be really worth visiting[…]

  28. golden teacher dosage - July 6, 2021

    golden teacher dosage

    […]check below, are some completely unrelated websites to ours, nevertheless, they are most trustworthy sources that we use[…]

  29. buy weed - July 5, 2021

    buy weed

    […]Here is an excellent Blog You might Uncover Intriguing that we Encourage You[…]

  30. Google - July 1, 2021

    Google

    Please take a look at the internet sites we adhere to, which includes this 1, because it represents our picks through the web.

  31. adult top site - February 15, 2013

    Title…

    […]the time to study or go to the material or internet sites we’ve linked to beneath the[…]…

Leave a Reply

You must be logged in to post a comment.