Cost analysis of planned out-of-hospital births in Italy

Main Article Content

Roberta Vittoria Cicero
Sofia Colaceci
Rosanna Amata
Federico Spandonaro


Birth Setting, Birthing Centers, Costs and Cost Analysis, Midwifery


Background and aim: In Italy, the main birthplace is a hospital, and only a few women choose an out-of-hospital setting. This study assessed the costs related to delivery in different birthplaces in Italy.

Methods: The cost analysis considered direct and amortizable costs associated with mother-child care in physiological conditions. An analysis of the hospital births considered the Diagnoses-Related Groups 373 and 391. To estimate the cost of the births assisted privately by freelance midwives, an evaluation based on an experts’ opinion was carried out.

Results: Childbirth hospital care in Italy amounts to € 1832.00, and birth in an out-of-hospital setting accredited with the National Health System has a full cost of € 1345.19 in the ‘maternity home’ and € 909.60 at home. The average cost of the birth in ‘private maternity homes’ amounted to € 3260.00, while at-home births amounted to € 2910.00.

Conclusions: Any accreditation of out-of-hospital settings by the NHS would considerably reduce the waste of economic resources compared to hospital childbirth.


Download data is not yet available.
Abstract 42 | PDF Downloads 66


1. Safe Motherhood. Care in Normal Birth: A Practical Guide: Report of a Technical Working Group. Department of Reproductive Health & Research, World Health Organization 1996. Geneva.
2. Olsen O. Meta-analysis of the Safety of Home Birth. BIRTH 1997;(24):4-13. doi: 10.1111/j.1523-536x.1997.tb00330.x.
3. Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database of Sistematic Reviews 2012; Issue 9. doi: 10.1002/14651858.CD000352.pub2.
4. Bolten N, Jonge A, Zwagerman E, et al. Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands. BMC Pregnancy and Childbirth 2016; 16,329. doi:10.1186/s12884-016-1130-6.
5. Northern Region Perinatal Mortality Survey Coordinating Group. Collaborative survey ofperinatal loss in planned and unplanned home births. BMJ 1996;313:1306-9. doi:10.1136/bmj.313.7068.1306.
6. Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009;181 (6-7) 377-383. doi:10.1503/cmaj.081869.
7. Colaceci S, Cicero RV, Reali L, et al. Il parto extra-ospedaliero: un’indagine quanti-qualitativa presso una casa maternità di Roma. Quaderni acp 2021; 6: 258-262.
8. Campiotti M, Campi R, Zanetti M, Olivieri P, Faggianelli A, Bonati M. Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings. Int J Environ Res Public Health 2020 Apr; 17(8): 2718. Published online 2020 Apr 15. doi: 10.3390/ijerph17082718.
9. Escobar MF, Nassar AH, Theron G, et al. FIGO Safe Motherhood and Newborn Health Committee. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022 Mar;157 Suppl 1:3-50. doi: 10.1002/ijgo.14116.
10. MacDorman MF, Declercq E. Trends and state variations in out‐of‐hospital births in the United States, 2004‐2017. Birth 2018;00:1-10. doi: 10.1111/birt.12411.
11. Australian Institute of Health and Welfare 2019. Australia’s mothers and babies - 2017. Aviable from
12. Japanese Nursing Association. Midwifery in Japan 2018. Aviable from:
13. Ministry of Health, New Zeland Government 2019. Report on Maternity 2017. Aviable from:
14. Zielinski R, Ackerson K, Kane-Low L. Planned home birth: benefits, risks, and opportunities. International Journal of Women’s Health. 2015;7:361-377. doi: 10.2147/IJWH.S55561.
15. CareQuality Commission, National statistics, NHS 2020. 2019 Survey of women’s experiences of maternity care: Statistical release. Aviable from:
16. Government Wales 2020. Maternity and Birth Statistics, Wales 2019. Aviable from:
17. Gottfredsdottir H, Magnúsdóttir H, Hálfdánsdóttir B. Home birth constructed as a safe choice in Iceland: A content analysis on Icelandic media. ELSEVIER - Sexual & Reproductive Healthcare 2015; 6, 138-144. doi:10.1016/j.srhc.2015.05.004.
18. Ross-Davie M, on behalf of the Models of care Sub-Group, Scottish Government Review of Maternity and Neonatal Services. The evidence relating to place of maternity care including place of birth 2019. Available from:
19. Blix E, Kumle MH, Ingversen K, et al. Transfers to hospital in planned home birth in four Nordic countries – a prospective cohort study. Acta Obstet Gynecol Scand 2016; 95:420-428. doi: 10.1111/aogs.12858.
20. Vermeulen J, Luyben A, Buyl R, et al. The state of professionalisation of midwifery in Belgium: A discussion paper. ELSEVIER - Women and Birth 2021;34(1):7-13. doi: 10.1016/j.wombi.2020.09.012.
21. Commissione consultiva tecnico-scientifica sul percorso nascita. Linee di indirizzo per l’assistenza al travaglio e parto fisiologico in ambiente extra-ospedaliero. Bologna: Regione Emilia-Romagna. Ultimo aggiornamento – Settembre 2021.
22. Combier E, Roussot A, Chabernaud J-L, Cottenet J, Rozenberg P, Quantin C. Out-of-maternity deliveries in France: A nationwide population-based study. PLoS ONE 2020;15(2). doi:10.1371/journal.pone.0228785.
23. Ministero della Salute - Direzione Generale della digitalizzazione, del sistema informativo sanitario e della Statistica Ufficio di Statistica. 2021. Certificato di assistenza al parto (CeDAP) Analisi dell’evento nascita - Anno 2019. Aviable from:
24. Società Italiana di Neonatologia. Parto in casa: trend in aumento a causa della pandemia, 2020. Aviable from:
25. National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. 2014, 12 3 (Last updated: 21 February 2017). Aviable from:
26. Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfusion Medicine, British Blood Transfusion Society 2014. doi:10.1111/tme.12091.
27. Nusee Z, Mohamed Nor NH, A. Rashid AR, Ismail H, Zakaria H. Overt and Covert Postpartum Urinary Retention, Risk Factors and Complications. European Journal of Medical and Health Sciences 2020, 2(4). doi:10.24018/ejmed.2020.2.4.391.
28. Madar J, Roehr CC, Ainsworth S, et al. European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth Published by Elsevier B.V. March 24, 2021. doi: 10.1016/j.resuscitation.2021.02.014.
29. World Health Organization. WHO recommendations on Postnatal care of the mother and newborn. October 2013. Aviable from:;jsessionid=14CF8560D2A98D936C5AA3FED8F9C247?Sequence=1.
30. Kimmel PD, Weygandt JJ, Kieso DE. Accounting Tools for Business Decision Making. Wiley 2011.
31. Ministero della Salute. Principali caratteristiche DRG. 15/05/2009, ultimo aggiornamento 30/12/2020. Aviable from:
32. Ministero della Salute. Glossario. 7/02/2013, ultimo aggiornamento: 31/08/2015. Aviable from:
33. Bellager MM, Or Z. What can we learn from a cross-country comparison of the costs of child delivery? Health Economics 2008;17(S1), S47–S57. Doi: 10.1002/hec.1325.
34. Rocca-Ihenacho L, Batinelli L, Thaels E, Rayment J, Newburn M, McCourt C. Standard Europei per le Midwifery Units, 2018 (G. M.-I. Traduzione Italiana del 2020 a cura di Batinelli L., Ed.) Milano.
35. Schroeder E, Petrou S, Hollowell J, Redshaw M, Brocklehurst P. Birthplace cost-effectiveness analysis of planned place of birth: decision analytic model. Birthplace in England research programme. Final report part 7. NIHR Service Delivery and Organisation programme; 2014. Aviable from:
36. Scarf V, Catling C, Viney R, Homer C. Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review. Plos ONE 2016; 11(2): e0149463. Doi:10.1371/journal.pone.0149463.
37. Callander EJ, Bull C, Mclnness R, Toohill J. The opportunity costs of birth in Australia: Hospital resource savings for a post– COVID-19 era. Birth 2021;00:1-9. Doi:10.1111/birt.12538.
38. Associazione Nazionale Culturale Ostetriche Parto a Domicilio e Casa Maternità. Nascere in casa si può. Aviable from:
39. Italia, Regione Piemonte. Deliberazione della Giunta Regionale 7 maggio 2002, n. 80-5989. Modalità di accesso e rimborsi per le prestazioni accessorie a favore degli uremici cronici, per il parto a domicilio e per l’ossigenoterapia iperbarica. Bollettino Ufficiale n.20 del 16/05/2002.
40. Italia. Regione Emilia-Romagna. Legge Regionale 11 agosto 1998, n. 26. Norme per il parto nelle strutture ospedaliere, nelle case di maternità e a domicilio. Bollettino Ufficiale n. 104 del 14 agosto 1998.
41. Italia. Regione Marche. Legge Regionale 27 luglio 1998, n.22. Diritti della partoriente, del nuovo nato e del bambino spedalizzato. B.u.r. 4 agosto 1998, n.66.
42. D.G.P. n. 3322/24.09.2001. (n.d.). Rimborso delle spese di ostetricia sostenute per il parto a domicilio - Linee guida ed assegnazioni alle Aziende Sanitarie. Bolzano.
43. Azienda Provinciale Per I Servizi Sanitari, Provincia Autonoma di Trento - Osservatorio Epidemiologico, Direzione Promozione ed Educazione alla salute. 2007. Il parto a domicilio in provincia di Trento - Trend e caratteristiche materno-infantili - Anni 2000-2005. Aviable from:
44. Italia. Regione Lazio. Decreto del Commissario ad Acta 12 maggio 2014, n.U00152. Rete per la Salute della Donna, della Coppia e del Bambino: ridefinizione e riordino delle funzioni e delle attività dei Consultori Familiari regionali. Tariffa per il rimborso del Parto a domicilio ad integrazione del Decreto del Presidente in qualità di Commissario ad Acta n.U0029 del 1/04/2011. Bollettino Ufficiale della Regione Lazio 22/05/2014, n. 41, supplemento n.1.
45. Italia. Regione Lazio. Decreto del Commissario ad Acta 23 dicembre 2016, n. U00395. “Protocollo assistenziale per il parto a domicilio in Centro Nascita ed in Casa Maternità. Regione Lazio”, redatto ed approvato dal Gruppo di Lavoro Regionale Tecnico Parti a Domicilio ed in Casa di Maternità, istituito con Det. N. G09667 del 4/8/2015 e Det. N. G11586 del 28/9/2015. Bollettino Ufficiale della Regione Lazio 29/12/2016, n.104, supplemento n.1.
46. Regione Piemonte. Profilo assistenziale per l’assistenza al travaglio e parto fisiologico extra-ospedaliero, 2003. Aviamble from:
47. Nascere in casa - Associazione Nazionale Culturale Ostetriche Parto a Domicilio e Casa Maternità. Linee guida di assistenza al travaglio e parto fisiologico a domicilio e in casa maternità, 1991 - Ultima revisione: maggio 2017. Aviable from:
48. Anderson G, Zega M, D'Agostino F, et al. Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals. J Obstet Gynecol Neonatal Nurs 2021; Jan;50(1):6-19. Doi:10.1016/j.jogn.2020.10.005.
49. Colaceci S, Corsi E, Berardi F, Coscarella P, Mariotti M, Ramacciati N. Maternal Satisfaction and Birth: a web-based survey. Prof Inferm 2020; 73(3):181-187. Doi:10.7429/pi.2020.733181.
50. Menichini D, Zambri F, Govoni L, et al. Breastfeeding promotion and support: a quality improvement study. Ann Ist Super Sanita 2021; 57(2):161-166. Doi: 10.4415/ANN_21_02_08.
51. Colaceci S, Chapin EM, Zambri F, et al. Verba volant, scripta manent: breastfeeding information and health messages provided to parents in the neonatal discharge summary in the Lazio Region, Italy. Ann Ist Super Sanita 2020; 56(2):142-149. Doi: 10.4415/ANN_20_02_03.
52. Cernigliaro A, Palmeri S, Casuccio A, Scondotto S, Restivo V; In Primis Working Group. Association of the Individual and Context Inequalities on the Breastfeeding: A Study from the Sicily Region. Int J Environ Res Public Health 2019;16(19):3514. Doi: 10.3390/ijerph16193514.
53. Colaceci S, Zambri F, D'Amore C, et al. Long-Term Effectiveness of an E-Learning Program in Improving Health Care Professionals' Attitudes and Practices on Breastfeeding: A 1-Year Follow-Up Study. Breastfeed Med 2020 Apr;15(4):254-260. doi: 10.1089/bfm.2019.0203.