Maternity models of care in Australia

What is a 'model of care'?

Each 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 the carers involved and the role they play during the maternity period, as well as aspects of how and where care is provided. A model of care can be designed to support women with specific pregnancy and birthing needs and in response to the context in which the maternity service operates. For example, the number and types of models of care available will differ between large urban hospitals and smaller rural settings, and between public and private maternity services.

Each individual model of care can be grouped into one of the following 11 categories:

• combined care
• general practitioner obstetrician care
• midwifery group practice caseload care
• private midwifery care
• private obstetrician specialist care
• private obstetrician and privately practicing midwife joint care
• public hospital high risk maternity care
• public hospital maternity care
• remote area maternity care
• shared care
• team midwifery care.

Why do we classify them?

Around 300,000 babies are born in Australia each year. While women have some choice around the health providers and care they receive during the maternity period, this may depend on where they live and their individual circumstances. The maternity period is a time of interaction with the health care system. Women may access maternity care through the public health system or privately or use a combination of both, 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.

Maternity services are provided by state and territory health departments and private providers, often with funding and subsidies provided by the Commonwealth Government, and may vary both within and between jurisdictions (Rolfe et al. 2017). The models of care available to women will depend on their specific geographic location, the nature of their local maternity service and factors such as workforce availability, individual resources, and whether there are complexities surrounding the pregnancy, for example the level of obstetric input required (COAG 2019).

Most maternity models of care in Australia include care in either a public or private hospital setting. A maternity service will provide one or more models of care and some of these may be designed to support specific groups of women.

In 2009, a review of maternity services in Australia recommended some changes to improve choices for women and increase the variety of care options available to them (DoHA 2009).

In 2019, all Australian governments agreed the Woman-centred care: Strategic directions for Australian maternity services and to the principle that women should have access to continuity of care with the care provider(s) of their choice – including midwifery continuity of care (COAG 2019).

To monitor the variety of care options available to and used by women requires the collection of this information in a standardised way. Reporting on models of care and the model categories they sit under helps to answer important questions about maternity care, such as which models of care are available to women across Australia, whether these provide continuity of care and how maternity care is changing over time.

These data are also designed to support the collection and reporting of model of care information via the National Perinatal Data Collection (NPDC). This report focuses on describing and monitoring changes at a system level in the models of care being developed and implemented over time. Linking NPDC data with model of care information is vital for understanding how different care models relate to pregnancy and birth outcomes over time.

What is the Maternity Care Classification System?

The Maternity Care Classification System (MaCCS) is a standardised nomenclature for maternity models of care. It is used to identify, describe, and report on the range of maternity models of care available to women in Australia. Funded by the Commonwealth Department of Health, Disability and Ageing, the MaCCS was developed by the National Perinatal Epidemiology and Statistics Unit at the University of New South Wales and the Australian Institute of Health and Welfare (AIHW), as part of the National Maternity Data Development Project (AIHW 2014a, 2016a, 2018). This involved consultation with a range of stakeholders across the country (AIHW 2014b, 2016b).

The MaCCS underpins the AIHW’s maternity models of care data collection and the Maternity Model of Care Data Set (MoC DS). The MoC DS contains information about the models of care available at maternity services across Australia. Collecting service-level data using the MaCCS has also facilitated the inclusion of model of care data elements into the NPDC. Two model of care data elements were added to the specifications for this collection in July 2020.

The AIHW would like to thank and acknowledge the maternity services and jurisdictions that contribute to the MoC DS. While this release reports on the characteristics of the models themselves, the AIHW also reports on the women utilising different models of care using data from the NPDC in jurisdictions where perinatal models of care data are available (currently Victoria, Queensland and Western Australia). This will expand as more jurisdictions implement the model of care data items in their perinatal data collections. See Australia's mothers and babies: Maternity models of care.