Who leads your pregnancy care in Australia: models of care explained

Australia calls them models of care, and the label matters

In Australia the useful question is not only who your provider is, but which model of care you are in. The same public hospital can offer several, and they produce quite different experiences. Pregnancy, Birth and Baby, funded by the Australian Government and operated by Healthdirect Australia, sets out the main options.

The three kinds of professional

A midwife has special training to support and care for you during pregnancy, labour and birth. Midwives work in public and private hospitals, with obstetricians and in the community. If there are no complications they can also help you give birth, and they care for you and your baby in the first few weeks afterwards.

An obstetrician is a doctor with special training to look after you and your baby during pregnancy, birth and straight after birth. In a public hospital you might only see an obstetrician if there is a medical need. If you choose a private obstetrician, they manage your antenatal care throughout pregnancy and may be present at the birth.

A GP obstetrician is a GP with additional training in women's health. They offer shared care, where you see your GP as well as midwives or obstetricians. In rural or remote areas, your GP might provide all of your pregnancy care and assist during the birth.

Public hospital models

Many hospitals offer a service where you see the same midwife or group of midwives throughout your pregnancy, and sometimes during the birth. This is called caseload or team midwifery. The midwives caring for you refer you to an obstetrician if you experience complications.

The advantages of public hospital care are that you may be able to choose your model of antenatal care, Medicare covers most of the cost of care during pregnancy and birth, most major public hospitals can care for you and your baby if there are complications, and you may be able to see allied health professionals if needed. The main disadvantage is that in a standard clinic you will not be able to choose which midwife or doctor you see.

Shared care

Shared care is when your pregnancy care is shared between your GP and the health professionals at a hospital or birth centre. You see your GP regularly, attend the hospital for some appointments with a midwife or obstetrician, and go to the hospital to give birth. It may be an option if your pregnancy is low risk.

If your GP does not offer shared care, your hospital can give you a list of GPs who do, and some hospitals offer shared care with midwives or obstetricians instead. One practical warning: make sure the details of each of your shared care providers are recorded in your medical records so they can be contacted if needed.

Private care

If you decide to give birth in a private hospital you will be cared for by a private obstetrician or GP obstetrician, and you need to book in at one of the hospitals where your doctor works. The first step is to see your GP for a referral to an obstetrician, who then books you into the private hospital.

The advantage is that you choose the doctor who will care for you through pregnancy, labour and after birth, and can build a relationship with them. Most people who choose a private hospital pay for it with private health insurance.

You can also be a private patient in a public hospital, cared for by your chosen doctor, though you are not guaranteed a single room and may be responsible for hospital, medical and diagnostic expenses, with a Medicare benefit for some services.

What it costs, and the question to ask early

In Australia the costs of pregnancy care in a public hospital or birth centre are mostly covered by Medicare, which covers Australian citizens and some visitors. In the private system you pay for your care or take out private health insurance. Medicare and your fund cover some of a private hospital stay, but you may still pay out-of-pocket fees.

Two questions save money and stress. Ask your obstetrician's rooms for the expected out-of-pocket fee in writing. And check whether your private health insurance covers maternity care and whether there is a waiting period, because the maximum hospital waiting period for pregnancy and birth is 12 months.

What we cannot answer nationally

Which models of care your nearest hospital actually runs, and whether caseload midwifery has places for your due month, are hospital-level facts that change with staffing. Rural and remote access differs sharply from metropolitan access. We are not going to generalise from one state. Pregnancy, Birth and Baby's maternal child health nurses take calls on 1800 882 436, and your hospital's maternity booking office is the definitive source.

What antenatal care involves

Antenatal appointments matter even if you are healthy and the pregnancy is going well, because they let your midwife or doctor check on your health and your baby's health and identify and manage problems early. They are also the opportunity to ask questions and raise concerns, which is easier if you write them down beforehand.

How long you stay after the birth

After the birth you might go home the next day, or stay in hospital for several days, and some people choose to go home from six hours after giving birth. How long you stay depends on your recovery, your choice and where you gave birth. In a public hospital you may be encouraged to go home early with a midwife visiting you at home the next day.

If you are in a rural or remote area

Access to maternity services varies across Australia, and in rural or remote areas your GP might provide all of your pregnancy care and assist during the birth. That is a recognised model rather than a compromise, but it changes the questions worth asking about transfer arrangements and the distance to the nearest hospital with an operating theatre.