OBJECTIVES: Efficacy of midwife-led models of care (MLMC) has been already assessed in a Cochrane systematic review (Hatem 2008) but there is a lack of cost comparisons in Brazil. This study aims to compare costs and consequences of MLMC versus other models of care (OMC) for women with low or mixed risk of complications from the private payer perspective. METHODS: Efficacy data was obtained from Hatem 2008 which compared MLMC with OMC including models centered in obstetricians, family doctors or shared models. As major maternal and neonatal events had not shown statistically significant differences between groups, efficacy of both models was considered similar. Significant differences in favor of MLMC (analgesia, episiotomy, instrumental birth, etc.) were used only for cost estimation. Resource use was obtained through local published data and input from clinical experts. Only direct medical costs related to the delivery room setting were considered. Unit costs were obtained from Brazilian official sources. RESULTS: Risk Ratios for regional analgesia (RR=0.81) and episiotomy (RR=0.82) were selected as important for the adopted setting. The current episiotomy rates in Brazil varied from 76.20% to 94.50% due to differences between studies and regional analgesia rate was 99.40% in the only identified study. The incremental estimated costs for one additional episiotomy and analgesia were 42.82 BRL and 359.95 BRL, respectively. For each 1000 deliveries in the private setting, 137 to 170 episiotomies and 179 analgesias would be prevented with the adoption of MLMC, resulting in cost savings of 70,274 to 71,685 BRL. CONCLUSIONS: MLMC has shown similar efficacy and safety profiles when compared with OMC and our findings indicated potential cost savings with MLMC in the Brazilian private system. Further researches including other clinical outcomes, longer follow-up and complications as results of medical interventions could result in higher savings for the private payer.