ObjectiveThe aim of this study is to identify items of economic evaluation guidelines that are frequently not complied within obstetric economic evaluations and to search for reasons for non‐adherence.DesignScoping review and qualitative study.SettingLiterature on economic evaluations in obstetric care and interviews with experts.Population or sampleThe sample included 229 scientific articles and five experts.MethodsA systematic literature search was performed. All types of literature about economic evaluations in obstetric care were included. The adherence to guidelines was assessed and articles were qualitatively analysed on additional information about reasons for non‐adherence. Issues that arose from the scoping review were discussed with experts.Main outcome measuresAdherence to guideline items of the included economic evaluations studies. Analytical themes describing reasons for non‐adherence, resulting from qualitative analysis of articles and interviews with experts.ResultsA total of 184 economic evaluations and 45 other type of articles were included. Guideline items frequently not complied with were time horizon, type of economic evaluation and effect measure. Reasons for non‐adherence had to do with paucity of long‐term health data and assessing and combining outcomes for mother and child resulting from obstetric interventions.ConclusionsThis study identified items of guidelines that are frequently not complied with and the reasons behind this. The results are a starting point for a broad consensus building on how to deal with these challenges that can result in special guidance for the conduct of economic evaluations in obstetric care.Tweetable abstractNon‐adherence to guidelines in obstetric economic evaluation studies: the difficulties in detail.