Choosing Your Perinatal Care in Australia: A Guide to Help You Get Started
Artwork: Kim Blue Studio
Welcome! If you're navigating pregnancy care options in Australia, you've probably discovered there's no one-size-fits-all approach. Or maybe you didn’t know that you had options until you arrived here. That’s okay! This guide provides an overview of the primary perinatal care models available across Australia, along with the potential benefits and considerations for each option. Before we dive in, here are a few important things to keep in mind:
Access varies. Not all options will be available to you. What's on offer depends on where you live, your financial circumstances, your personal preferences, your health circumstances, and the capacity of local services. In 2024, around 1,100 models of care were reported across approximately 250 maternity services in Australia, but availability differs significantly by location.
Your choice is unique to you. Every person's preferences about where and how they want to give birth are deeply personal. What feels like a benefit to one person might be a drawback to another, depending on individual circumstances, values, and needs.
This is just a starting point. Use this guide as a foundation for your own research and conversations with healthcare providers. Trust your instincts about what feels right for you, your family, and your baby.
The Foundation: Informed Choice and Continuity of Care
When it comes to your perinatal journey, two factors make a big impact: informed decision-making and continuity of care. True continuity of care - having a known, trusted provider throughout your pregnancy, birth, and postpartum - isn't just about convenience. Recent research from the Australian Institute of Health and Welfare comparing maternity outcomes across Australia found that continuity of care models consistently show better outcomes for mothers and babies This continuity doesn't have to come from a single source either. Many people create meaningful continuity by building a collaborative care team within community that can include midwives, doctors, doulas, physiotherapists, lactation consultants, and other trusted support providers working together around your needs.
The challenge? Currently, only 28% of Australian maternity care models offer continuity throughout the entire perinatal period and only 42% of maternity services have a model with midwifery continuity of care available. This means many families must actively seek out and advocate for the care they want. This guide exists to help you understand your options, ask the right questions, and build a care team that truly supports you. Let’s dive in.
Public Hospital Care
Public hospital maternity care is the most common model of care in Australia, accounting for 42% of all models. As a public patient, you'll have access to the midwives and doctors on staff at the time you arrive when you’re in labour, along with the hospital's facilities and resources.
This option is the most affordable for many individuals and families. Being free (or low-cost) allows women and birthing people to allocate funds toward other forms of support such as a doula, birth photography, a private midwife, lactation consultant, or postnatal support for their return home. This can provide a form of continuity of care while still accessing the benefits and safety net of the public hospital system.
Public hospitals in Australia are classified as either primary, secondary, or tertiary facilities. Primary hospitals provide basic maternity services and are suitable for low-risk births. Tertiary hospitals are major referral centres with specialist services including Neonatal Intensive Care Units (NICU), high-risk obstetric care, and access to specialists across multiple disciplines. If complications arise during pregnancy or birth, you may be transferred to a tertiary hospital for higher-level care.
Some Benefits:
While there are variations depending on whether they are a Tertiary or primary hospital, public hospital care offers several advantages, particularly for those seeking access to broader medical care without the financial burden:
Low or no cost – publicly funded care with no or minimal out-of-pocket expenses
High-quality medical facilities equipped to handle a variety of circumstances and complications
Convenient location – the hospital may be closer to your work or home
Direct access to specialists including obstetricians, anaesthetists, and paediatricians when needed
Financial flexibility – money saved on insurance or private fees can be used for other areas of independent care and support
Some Considerations:
Public hospital maternity care has the most variation of any model category, and experiences can differ significantly depending on your hospital and the specific model of care you access. Here are some considerations:
Short hospital stays – the average length of stay for a vaginal birth in public hospitals is 24-48 hours and 48-72 hours for a caesarean section. In some cases, you may be able to go home 4-6 hours after an uncomplicated vaginal birth. This may be seen as a benefit by some and a drawback by others
No known antenatal care provider – in standard public care, you typically won't have continuity with a known provider, and often won't have in-person care until around 16-18 weeks
Limited postnatal care – unless under a midwifery caseload model, postnatal care is usually provided by staff you haven't met before
Potentially long wait times for antenatal appointments, depending on the hospital and service demand
Different providers at each visit – you may see different midwives, doctors, or obstetricians at each appointment, which can feel fragmented
How to Connect with This Service:
Your GP can provide you with a referral to your local or "zoned" public hospital - usually based on your postcode - after your first appointment to confirm the pregnancy.
Important: It's valuable to have at least a basic understanding of the available care models at your chosen public hospital before your GP appointment, as GPs are not always up to date with the specific options available. For example, you may wish to be referred to the hospital's Midwifery Group Practice (MGP) or Caseload program, or you might prefer shared care with a registered GP. Its helpful to know your options and so you can ask for what you want.
Most hospitals have an overview of their care models on their website. Review these before your GP appointment so you can clearly make your request - this is especially important if you're hoping to access specific care models (such as MGP), as these programs often have limited places and specific eligibility criteria.
You can also contact your local public maternity provider directly, and ask them what kind of care they offer. The following are examples of care models that are offered in public settings for women and birthing people who have uncomplicated pregnancies:
Shared Care – your pregnancy care is shared between the hospital and a local doctor or midwife who is affiliated with the hospital. Medicare usually covers the cost of the doctor or midwife visits not held at the hospital. This offers a form of continuity of care for your clinical needs, however, you will still be assigned a hospital midwife on roster the day you give birth
Team Midwifery – you are placed in the care of a small team of midwives so that you are more likely to develop a relationship with them. A midwife from this team will also be on call for your birth, so you have a greater chance of being supported during labour by someone who you’ve met before
Group Practice or Caseload Midwifery – care provided by a small group of midwives (often two) throughout your pregnancy, who are also on call for your birth. You will have a chance to build a relationship with the same midwives through pregnancy, and have them attend your birth as well. Some programs include the option of a homebirth (below)
Public Funded Homebirth Programs - care is provided throughout your pregnancy, labour, birth, and for a period after the birth, by a primary midwife that has specific training to attend homebirths. Costs are covered by the hospital, however, places are very limited and available only to women and birthing people who meet the hospitals strict eligibility requirements.
Privately Practicing Midwives (PPMs)
Birthing with a privately practicing midwife offers what is considered true continuity of care. Your midwife can begin supporting you and your chosen support people right from very early pregnancy. While 'official' antenatal appointments typically start around 16 weeks, it's best to reach out to your midwife early and arrange a consultation to get to know them and discuss your care.
As of November 2024, GP referrals are no longer required to access Medicare rebates for antenatal and postnatal care from a privately practicing midwife. This recent change makes it easier to access this model of care.
Homebirth with a Privately Practicing Midwife
In Australia, it is a legal requirement that two midwives attend homebirths. Your primary midwife will work with a backup midwife who you'll have the opportunity to meet before birth. Both will be on call and will attend your birth. Often your primary midwife will arrive first, and the second midwife will arrive before your baby is born. If the second midwife is unavailable and there are no other backup midwives available, paramedics may be called to observe and support if necessary.
After the birth, your midwife will support you for up to 6-8 weeks postpartum, with daily visits initially, then weekly appointments as needed.
Hospital Birth with a Privately Practicing Midwife
You may also choose to work with a privately practicing midwife and birth at your zoned public hospital. This offers continuity of care with a known provider throughout pregnancy, birth, and postpartum. However, unless your midwife has admitting rights (clinical practicing rights) at that hospital, they will transfer your care to the hospital staff upon arrival and remain with you as a support person only.
Some privately practicing midwives have admitting rights at certain public hospitals, which means they can provide your clinical care throughout labour and birth. This is worth asking about when you're choosing your midwife.
Some Benefits:
Privately practicing midwives offer comprehensive continuity of care that research shows improves outcomes:
Early and flexible care – care can begin as early as you would like in your pregnancy, with appointments at times that suit you
True continuity of care – the same known, trusted midwife provides in-home antenatal, birth, and postpartum care
Family inclusion – ability to have your family with you and as many support people as you wish, particularly with homebirth
Lower intervention rates – research consistently shows that continuity of midwifery care is associated with significantly lower risks of intervention
Choose your primary midwife – you can select a midwife whose philosophy and approach aligns with your values and goals
Familiar environment – with homebirth, you have a higher chance of birthing in your own familiar environment surrounded by known, trusted support people
Comprehensive postpartum support – up to 6-8 weeks of postnatal care in your home
Some Considerations:
While privately practicing midwives offer exceptional continuity, there are important considerations:
Cost – fees vary significantly but can range from $3,000-$6,000 or more, often paid out-of-pocket. In Australia, Medicare rebates are available for antenatal and postnatal appointments for endorsed midwives (typically $50-70 per visit), but birth attendance is not covered by Medicare
Scope of practice limitations – the practice of a privately practicing midwife is prescribed by their insurance company and regulations. Certain situations (such as breech presentation, gestational diabetes, or other complications) may require collaboration with obstetricians or may be outside their scope. Make sure you discuss these limitations and their approach to various scenarios early in your care
Limited availability – it can be difficult to find an available midwife in your area, particularly in regional and remote locations. Some areas no longer have any privately practicing midwives
Transfer of care – if complications arise during pregnancy requiring specialist care, you may need to transfer to obstetrician-led care. If transfer to hospital is needed during or after birth, your midwife will accompany you but (unless they have admitting rights) will transfer your clinical care to hospital staff and remain as a support person
Insurance changes – as of July 2025, new professional indemnity insurance arrangements came into effect for homebirth. The eligibility criteria for insured homebirth may affect which clients midwives can accept. Discuss this with your midwife to understand any implications
How to Connect with This Service:
Contact a privately practicing midwife as soon as possible to start your pregnancy care. You do not need a GP referral to access care or Medicare rebates.
If you're interested in homebirth, call midwifery practices in your area and have a chat with them about their requirements, availability, and approach. Many midwives have websites or social media pages where you can learn about their philosophy and services.
If you need to transfer to hospital during or following birth, your midwife will accompany you. Unless they have clinical practicing rights at that hospital, they will transfer your care to the hospital and remain with you as your support person.
Private Obstetric-Led Care
This option is available to anyone with private health insurance who has the appropriate level of cover for pregnancy and birth and has completed the required waiting periods. Private health funds usually require membership for at least one year before they will cover you for maternity services. Check your policy carefully to understand what is covered and what is not. You can also access private obstetric care if you're willing and able to pay the full costs out-of-pocket.
Usually, when under the care of a private obstetrician, you will have your baby in a private hospital. However, you can also choose to be a private patient in a public hospital. Some obstetricians hold appointments at both private and public hospitals.
Some Benefits:
Private obstetric care offers continuity with a known provider throughout your pregnancy, which many families value. Here are some of the key benefits:
Continuity of care with a chosen provider throughout your pregnancy
Specialised support for high-risk pregnancies and complications
Private room with amenities for your recovery, with the option to stay longer if needed
Partner accommodation – partners can usually stay overnight
Private consulting rooms for appointments, rather than hospital waiting rooms
Obstetrician presence at birth – while midwives support you during labour, your obstetrician will be present for the birth (unless on leave or unable to arrive in time) and will visit you in hospital afterwards
Some Considerations:
Research shows that care model matters for outcomes, particularly for low-risk pregnancies. Here are some important considerations:
Higher costs – obstetrician fees typically range from $2,500-$3,400, plus accommodation costs of around $700-850 per day, with substantial out-of-pocket expenses even with private health insurance
12-month waiting period – most health funds require you to have held appropriate pregnancy cover for at least 12 months before giving birth to claim obstetric benefits
Higher intervention rates – in 2022, 46% of births in private hospitals were caesarean sections compared to 31% in public hospitals. Research shows private hospital birth increases the likelihood of unplanned caesarean by 4.2 percentage points overall, and 7.7 percentage points for first-time mothers
Evidence for low-risk pregnancies – a large systematic review of 1.4 million pregnancies found that for low-risk pregnancies, midwife-led care resulted in lower rates of intervention without compromising safety. Australian research consistently shows that midwifery continuity models result in higher rates of spontaneous vaginal birth and lower caesarean sections and epidurals, with women experiencing fewer interventions and lower costs while maintaining safety
Initial monitoring – on arrival at hospital, you may be offered an 'intake tracing' CTG (continuous fetal monitoring), often because your obstetrician monitors remotely. This can pose a hurdle if you're hoping to remain mobile and avoid early interventions
Unfamiliar midwives – you're unlikely to know the midwives who support you during labour
Limited NICU facilities – not all private hospitals have tertiary-level Neonatal Intensive Care Units, which may result in transfer to a public hospital if specialist neonatal care is needed
Obstetricians are trained specialists in managing complications and high-risk pregnancies, and so this is often the lens they view birth through. If you're hoping for minimal intervention and physiological birth, ensure that you're asking potential obstetricians detailed questions about their approach, philosophy, and their personal intervention and caesarean rates to understand whether their practice aligns with your goals.
How to Connect with This Service:
Start by speaking with your GP, who can provide a referral to an obstetrician. If you already know who you'd like to work with, this can be specified on the referral. If you're not sure, talk with your GP about local practitioners and their recommendations.
You can also contact the private hospital where you want to give birth - they should be able to provide a list of obstetricians with admitting rights there. Some popular obstetricians book up early, so you may want to secure an appointment quickly once you've decided. At your first appointment, your obstetrician will discuss hospital options and arrange your booking at the private hospital.
19.04.2025
