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Bundled payments are increasingly used worldwide, yet long-term evidence remains limited, particularly in maternity care. This study evaluated five-year changes after bundled payments in maternity care in the Netherlands. Using a difference-in-differences design and 2008–21 nationwide data, we compared 22,307 pregnancies across six regions that adopted bundled payments in 2017 with 69,496 pregnancies in twenty matched control regions. Outcomes included maternity care use; maternal and neonatal health; and spending during pregnancy, childbirth, and the postnatal period. Bundled payments were associated with an 8.9 percent reduction in midwifery-to-obstetric transfers during delivery, a 1.1 percent decline in home births, and a US$121 reduction in spending per pregnancy.