Maternity model of care

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Models of care Continuity of carer Maternal characteristics Antenatal, labour and birth characteristics and outcomes Baby outcomes

A maternity model of care describes how a group of women are cared for during pregnancy, birth and the postnatal period at a maternity service. This includes information about the carers involved, the continuity of carer within the model, the groups of women they are designed to support and where care is provided.

For more information on the number and characteristics of models of care reported in Australia see Maternity models of care in Australia.

About the data in this section

This section uses data from the National Perinatal Data Collection (NPDC) for information about mothers, and the Maternity Model of Care Data Set (MoC DS) for information about the models of care. Analyses are based on the primary maternity model of care a woman used. This is the model of care in which they had most of their antenatal care, based on the number of antenatal visits. Some women may change their model of care during their pregnancy.

Analyses includes women giving birth in Victoria, Queensland and Western Australia only, as models of care are not yet being reported for all women giving birth. This represents almost 60% of women who gave birth in 2023. 

Models of care

Australian women have some choice around the health providers and care they receive during pregnancy; however, this may depend on where they live and their individual circumstances. Women may access maternity care through the public health system or privately, and care may involve midwives, obstetricians, general practitioners (GPs) and other health care providers (Healthdirect 2022). Sometimes a woman will see the same provider throughout the maternity period – known as continuity of care – and sometimes they will see different providers, for example, have some appointments with a GP and others with a midwife. 

Women want access to continuity of care and to be able to choose a model of care that meets their needs and is close to their home (COAG 2019). Recent Australian Government reports have recommended ways to improve maternity services, choices for women and the range of models of care available to them (DoHA 2009; AHMC 2011; COAG 2019).

Delivery of maternity care in Australia

Maternity services are planned and provided by state and territory governments in collaboration with public and private services. This is influenced by the needs of communities, geographic location and workforce availability (COAG 2019). As such, the characteristics and types of models of care available in different locations and jurisdictions may vary and should be considered when interpreting results. 

Maternity services may provide one or more models of care. Each of these can be categorised into one of 11 categories based on their key characteristics. The four most common models of care are:

Public hospital maternity care: care is provided in public hospitals and outpatient clinics (either onsite or outreach) by midwives and/or doctors or a multidisciplinary team. This category is broad and covers a range of models of care, for example, those led by midwives designed for women with low-risk pregnancies and those led by obstetricians designed for women with obstetric risk factors such as diabetes.

Midwifery group practice caseload care: care across the whole maternity period is provided within a publicly funded caseload model by a known primary midwife, in collaboration with doctors in the event of identified risk factors. Models must provide continuity of carer for the whole maternity period to be included in this category. 

Shared care: antenatal care is provided by a community maternity service provider (doctor and/or midwife) in collaboration with hospital medical and/or midwifery staff and includes an agreed schedule of antenatal care between the two providers. Intrapartum and early postnatal care usually takes place in the hospital.

Private obstetrician specialist care: care is provided by a private specialist obstetrician in either a private or public hospital in collaboration with hospital midwives.

For detailed information on all 11 categories see Major model category definitions.

In 2023, the most common model of care was public hospital maternity care which was used by 45% of women in Victoria, Queensland and Western Australia combined. This was followed by private obstetrician specialist care and midwifery group practice caseload care (23% and 11% of women, respectively).

The models of care used varied by jurisdiction. The proportion of women using public hospital maternity care ranged from 37% in Queensland to 53% in Victoria, while use of midwifery group practice caseload care ranged from 5.3% in Victoria to 20% in Queensland. Use of private obstetrician specialist care was similar across these jurisdictions, ranging from 22% in Queensland to 24% in Victoria.

Public hospital high risk maternity care was used by 3.3% of women, and was similar across jurisdictions. This type of model is designed for women with medical high risk and complex pregnancies, and care is provided by public hospital specialist obstetricians and maternal-fetal medicine subspecialists in collaboration with midwives and other carers.

Western Australia had a higher proportion of women using other models of care (18%) including 7.7% of women who used general practitioner obstetrician care and 6.3% who used combined care.

Figure 1 presents data on the model of care women used in Victoria, Queensland and Western Australia.

Figure 1: Proportion of women who gave birth, by model of care and state and territory of birth - Victoria, Queensland and Western Australia, 2023

Stacked bar chart showing public hospital maternity care is the most common model category used by women in Victoria, Queensland and Western Australia.

Stacked bar chart showing public hospital maternity care is the most common model category used by women in Victoria, Queensland and Western Australia.

Continuity of carer

The extent of continuity of carer is a measure of the one-to-one care provided by the same named care giver across the maternity period (from pregnancy until after birth). There is a growing evidence base pointing to the benefits of having the same midwifery carer throughout pregnancy and birth (Forster et al. 2016; Sandall et al. 2024). The extent of continuity of carer varies by model of care and not all models provide continuity of carer. 

Midwifery group practice caseload care (also known as midwifery continuity of care) includes models where antenatal, intrapartum and postpartum care are provided within a publicly funded model by a known primary midwife. This model has a public midwife as the designated (lead) carer and provides continuity of carer for the whole maternity period.

Around 11% of women in Victoria, Queensland and Western Australia combined, had whole duration – midwifery group practice continuity of carer. A further 24% of women had continuity of carer for the whole maternity period using another model of care (mostly from private obstetrician specialist care models).

Continuity of carer varied by state of birth. One in five (20%) of women in Queensland had whole duration – midwifery group practice continuity of carer, compared with 10% in Western Australia and 5.3% in Victoria.

Figure 2 presents data on the continuity of carer women had in Victoria, Queensland and Western Australia.

Figure 2: Proportion of women who gave birth, by continuity of carer and state and territory of birth - Victoria, Queensland and Western Australia, 2023

Bar graph showing nearly half the models of care (47%) have no continuity of carer. Over one-third have continuity across the whole maternity period provided by midwifery group practice or other maternity care.

Bar graph showing nearly half the models of care (47%) have no continuity of carer. Over one-third have continuity across the whole maternity period provided by midwifery group practice or other maternity care.

Continuity of carer varies by major model category

For example, the 2024 Models of care in Australia report shows:

  • All models of care classified as midwifery group practice caseload care and private midwifery care had continuity of carer across the whole maternity period. 
  • Most (85%) models classified as private obstetrician specialist care had continuity of carer across the whole maternity period.
  • More than half (56%) of public hospital maternity care models had no continuity of carer. 
  • Nearly 60% of shared care models had some continuity of carer, for example in the antenatal (34%) or antenatal and postpartum periods (21%) (AIHW 2024). 

All women in Victoria, Queensland and Western Australia who received care through midwifery group practice caseload care or private midwifery care models had continuity of carer for the whole maternity period, as did nearly all women (93%) who used private obstetrician specialist care models. Conversely, most women (89%) using a public hospital maternity care model of care had no continuity of carer.

Nearly three-quarters (73%) of women who used shared care models had continuity of carer for some part of their pregnancy (antenatal period only, antenatal/intrapartum, intrapartum/postnatal or antenatal/postnatal continuity). Shared care is where antenatal care is provided in the community by a maternity service provider (for example, a GP) in collaboration with hospital medical and midwifery staff under an established agreement. Shared care models allow women to choose their care provider in the community and can be a way to access antenatal care closer to home or care that provides some level of continuity (RANZCOG 2021).

Figure 3 presents the number and proportion of women who had continuity of carer by model category.

Figure 3: Continuity of carer for women giving birth, by model category - Victoria, Queensland and Western Australia, 2023

Stacked bar chart showing that the proportion of women who used models that had continuity of carer varies by model category. Al midwifery group practice caseload care and private midwifery care models provide continuity of carer for the whole maternity period.

Stacked bar chart showing that the proportion of women who used models that had continuity of carer varies by model category. Al midwifery group practice caseload care and private midwifery care models provide continuity of carer for the whole maternity period.

Maternal characteristics

There are differences in the models of care that women use by maternal characteristics. This is, in part, because some models of care are designed for different groups of women.

Some models of care are designed for different groups of women

In looking at differences in maternal characteristics and outcomes by model of care it is important to be aware that models of care may be designed for different groups of women. For example:

  • Midwifery group practice caseload care may be designed for women with low or normal-risk pregnancy.
  • Public hospital high risk maternity care is designed for women with complex maternal, medical and fetal conditions only. 
  • Public hospital maternity care includes a range of models of care from those led by midwives that have no target group or are designed for women with low or normal-risk pregnancies, to those led by public specialist obstetricians for women with specific obstetric complexities (for example, gestational diabetes, multiple pregnancy, next birth after caesarean section).
  • Private obstetrician specialist care may not be designed for a specific group of women, but there will be a financial cost for this type of care, and most women who choose this will have private health insurance to help cover the cost. 

Around 11% of women in Victoria, Queensland and Western Australia combined used a midwifery group practice caseload care model of care. Women were more likely to use this model if they were:

  • younger mothers (23% of mothers aged under 20, and 17% of mothers aged 20-24)
  • First Nations (29%)
  • living in Outer regional, remote and very remote areas (23%, 25% and 26% respectively).

Women were more likely to use a private obstetrician specialist care model (compared with 23% of all women) if they were:

  • aged 35-39 (32%) or 40 and over (35%)
  • born in China (59%) or South Africa (35%).

The use of public hospital maternity care decreased from 56% of those living in the lowest socioeconomic areas to 31% of those living in the highest socioeconomic areas, while the use of private obstetrician specialist care increased from 9.2% of those living in the lowest socioeconomic areas to 45% in the highest socioeconomic areas.

Figure 4 presents data on the model of care used by selected maternal characteristics. Select the topic drop down to see the data.

Figure 4: Proportion of women who gave birth, by model category and maternal characteristics - Victoria, Queensland and Western Australia, 2023

Dashboard with 7 bar graphs show that 45% of women used a public hospital maternity care model of care. The model used varies by maternal characteristics, such as age, Indigenous status, country of birth, parity, remoteness and socioeconomic status.

Dashboard with 7 bar graphs show that 45% of women used a public hospital maternity care model of care. The model used varies by maternal characteristics, such as age, Indigenous status, country of birth, parity, remoteness and socioeconomic status.

Overall, around half (47%) of women had no continuity of carer. This was more common among women:

  • born in Pakistan (78%), Vietnam (69%), India (68%), Nepal (65%) and the Philippines (60%)
  • living in the lowest socioeconomic areas (55%)
  • with higher parity (57% of women with 3 previous pregnancies, 58% of women with 4 or more previous pregnancies).

Figure 5 presents data on continuity of carer by selected maternal characteristics. Select the topic drop down to see the data.

Figure 5: Proportion of women who gave birth by continuity of carer and maternal characteristics - Victoria, Queensland and Western Australia, 2023

Dashboard with 7 bar graphs shows that the proportion of women using a model of care with continuity of carer across the whole maternity period varies by selected maternal characteristics.

Dashboard with 7 bar graphs shows that the proportion of women using a model of care with continuity of carer across the whole maternity period varies by selected maternal characteristics.

Antenatal, labour and birth characteristics and outcomes

Antenatal behaviours and labour and birth outcomes can vary by model of care.

When compared with all women, women who used public hospital high-risk maternity care had higher rates of:

  • gestational diabetes (27% compared with 17%)
  • pre-existing diabetes (5.2% compared with 1.1%)
  • pre-existing hypertension (4.0% compared with 0.9%)
  • a body mass index over 25.0 (60% compared with 52%).

This is not surprising as this model of care is designed for women with more complex or high-risk pregnancies.

Nearly three-quarters (73%) of women who used private midwifery care in Victoria, Queensland and Western Australia combined, had spontaneous labour, as did 61% of women who used midwifery group practice caseload care. This compares with 41% of women overall. Most women who received care through private midwifery care and midwifery group practice caseload care models had a non-instrumental vaginal birth (64% and 66% respectively). This compares with just under half (47%) of all women who gave birth in these jurisdictions.

Figure 6 presents data on model category, by selected antenatal, labour and birth characteristics and outcomes. Select the topic drop down to see the data.

Figure 6: Proportion of women who gave birth, by model of care and antenatal labour and birth characteristics and outcomes - Victoria, Queensland and Western Australia, 2023

Dashboard with 10 bar graphs show there are differences in maternal antenatal, labour or birth outcomes related to the model of care a woman uses.

Dashboard with 10 bar graphs show there are differences in maternal antenatal, labour or birth outcomes related to the model of care a woman uses.

Baby outcomes

Most babies are born healthy. Outcomes for babies were similar across most model categories in Victoria, Queensland and Western Australia. Those born to women using public hospital high risk maternity care, however, had higher rates of preterm birth (28%, compared with 8.7% of babies overall), low birth weight (22% compared with 6.6%) and admission to SCN/NICU (38% compared with 18%). This is not surprising, as this model of care is designed for women with complex maternal, medical or fetal conditions.

Figure 7 presents data on model category by selected baby outcomes. Select the topic drop down to see the data.

Figure 7: Proportion of babies, by model of care and baby outcomes - Victoria, Queensland and Western Australia, 2023

Dashboard with 7 bar graphs showing outcomes for babies by the model of care used by their mothers during pregnancy. Outcomes for most babies are good however, do vary across the model of care used.

Dashboard with 7 bar graphs showing outcomes for babies by the model of care used by their mothers during pregnancy. Outcomes for most babies are good however, do vary across the model of care used.
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