Journal of Modern Medical

Introduction
The most important challenges that health care systems face with two deliberate challenges include cost control and service quality improvement. Considering the importance of the health of mothers and the infants, providing quality reproductive services is one of the most important services of health systems in all countries. For healthy reproductive care, maintaining and improving the health of mothers during pre-pregnancy, reducing infant and maternal mortality, diagnosing high-risk cases and paying special attention to them, predicting pregnancy complications and preventing them, and preparing parents for the birth of their babies are important goals.
One of the most important recommendations to increase the quality of reproductive services is the use of continuous care models. Continuous care focuses on the two basic issues of continuous care and the individual needs of the patient. Using this model to provide continuous midwifery care can have an impact on the economic aspect of providing reproductive services, which needs to be investigated and evaluated economically and cost-effectively. In this regard, the aim of the current study is to critically review the related literature on cost management of healthy reproductive services with the continuous midwifery care model.
Methods
This is narrative review study. A search was conducted in national online databases including SID, IranMedex, IranDoc, and Magiran using the keywords: Midwifery, reproductive health, continuous care, model, healthy reproductive services, cost, economic, cost effectiveness in Persian, as well as a search in international online databases including PubMed, Google Scholar, eRice, and ScienceDirect using the keywords: Midwife‐led care, cost, economy, cost-effective, and midwifery reproductive health in English using the Boolean operators (AND, OR) for studies on examining the economic effects of the continuous midwifery care model published from 2010 to 2020 in English and had available full texts. Letters to the editor and conference papers were excluded. Initial search yielded 1040 records. Of these, 86 articles were evaluated by the CONSORT checklist. It was found that 4 studies had moderate quality and 12 had good quality. Therefore, 16 eligible articles were finally reviewed.
Results
The results of the literature review were presented in two parts, including the concept of continuous midwifery care and economic evaluations of the model. The main feature of a continuous midwifery care model is the natural and normal ability of women to give birth without routine interventions. This model is based on the assumption that pregnancy or birth is a natural event in life. The components of this model include: continuity of care; monitoring the physical, mental, spiritual and social health of women and their families during pregnancy; providing individual education, counseling and prenatal care for women; the presence of a skilled midwife during and after birth; continuous support during the postpartum period; minimizing unnecessary interventions; and identifying, referring, and care coordination of women in need of reproductive services.
The economic analysis of the findings of studies varied depending on the health care structure of countries and the factors included in the model. Significant difference in the cost-effectiveness of this model was seen by examining the results and efficiency of using the model, which emphasized its effect on the rates of maternal death, infant death, or prevented complications such as cesarean delivery rate and episiotomy rate. Another important factors in cost-effectiveness of the use of continuous midwifery care model were the job satisfaction and motivation of midwives responsible for providing midwifery care services. Studies indicated an increase in midwives’ satisfaction and a decrease in their job burnout based on this model.
Dissection
Continuous midwifery care is a suitable model in terms of saving costs and reducing unnecessary procedures such as labor induction, cesarean section and instrumental delivery. In addition to affecting the safety of mothers and quality of patient care and the overuse of medical procedures during childbirth, the use of this model affects the care costs. The continuous midwifery care model can reduce the complications during pregnancy and empower pregnant mothers by using regular and targeted education. On the other hand, today, examining the health expenditures is of particular importance due to their increasing day by day. Therefore, considering the positive results of the continuous midwifery care model on improving the quality of reproductive services, healthy labor, and reducing its economic costs, and given that in Iran, no clinical study has focused on the impact and role of this model in midwifery services, there is need to conduct research in Iran to investigate the effects of this model on midwifery and healthy reproductive services.

Ethical Considerations
Compliance with ethical guidelines
This article has been done as a critical review in Isfahan University of Medical Sciences and all ethical principles have been observed in it.

Funding
The present study was a review study and had no financial support from organizations

Authors' contributions
Conceptualization, Supervision, Writing-Review & Editing: Leila Asadi, Farzaneh Mohammadi; Methodology: Leila Asadi, Farzaneh Mohammadi, Marzieh Reisi;  Investigation: Leila Asadi, Farzaneh Mohammadi, Zahra Mohebbi Dehnavi; Writing-Original Draft: Leila Asadi, Zahra Mohebbi Dehnavi, Marzieh Reisi; Funding Acquisition & Resources: Leila Asadi.

Conflicts of interest
There is no conflict of interest between the authors of this article.


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