Queensland case study: Maternity models of care
In Australia, there are many ways maternity care is provided to women during their pregnancy, birth and postnatal period, depending on where they live, their care needs and their individual circumstances, these are known as maternity models of care.
Maternity models of care can be grouped into one of 11 major model categories according to characteristics such as who the model is designed for, where care is provided, who provides and/or coordinates care and the specific roles of maternity carers. Two items relating to maternity models of care were added to the National Perinatal Data Collection in 2020, for which Queensland provided complete data in 2021 and 2022. Table 1 describes the antenatal care provided for the most common major model categories for Queensland births in 2022.
| Major model of care group | Antenatal care | % of mothers who gave birth in Queensland |
|---|---|---|
| Public hospital maternity care | Provided in public hospital outpatient clinics (either onsite or outreach) by midwives and/or doctors. Care could also be provided by a multidisciplinary team. | 38 |
| Private obstetrician (specialist) care | Coordinated by a private specialist obstetrician. | 21 |
| Midwifery group practice caseload care | Provided within a publicly funded caseload model with a designated primary midwife providing and coordinating care within a team of midwives. Usually provided in the hospital, community or home. | 18 |
| Shared care | Provided by a community maternity service provider (doctor and/or midwife) in collaboration with hospital medical and/or midwifery staff under an established agreement and can occur both in the community and in hospital outpatient clinics. | 14 |
| Other major models of care | Includes:
| 7.0 |
| Not stated | Includes mothers whose model of care was missing, inadequately described, whose care was primarily received outside of Queensland (interstate or overseas) and planned home births with unknown characteristics of care. | 1.7 |
Mothers are described as having received continuity of carer if their maternity care is provided or coordinated by a single care provider. Continuity of carer is closely tied to the model of care a mother receives. For example, in midwifery group practice caseload care, care is coordinated by a primary midwife so all mothers receiving this type of care have continuity of carer.
Mothers with continuity of carer may receive care from providers other than their primary care coordinator. For example, private specialist obstetricians may be assisted by midwives and other health practitioners providing antenatal care.
Where there is continuity of carer, screening for mental health and psychosocial risk factors may be conducted by someone other than the primary or coordinating care provider.
Figure 5 shows the common major models of care used, by the percentage of mothers with an Edinburgh Postnatal Depression Scale (EPDS) score, and the percentage of mothers receiving continuity of carer in the antenatal period who gave birth in Queensland in 2022.
Figure 5: Percentage of mothers with a recorded EPDS score and antenatal continuity of carer, by major model categories of maternity care, Queensland 2022
Source: AIHW analysis of NPDC data.
This figure groups mothers by major categories of model of maternity care they received and shows:
- The percentage of mothers receiving that model of care who had continuity of carer in the antenatal period (X-axis)
- The percentage of mothers receiving that model of care who had an EPDS score recorded (Y-axis)
- The percentage of mothers receiving that model of care (size of the bubble, see also Table 1).
Mothers most likely to have an EPDS score recorded were those receiving midwifery group practice caseload care (89%) or public hospital maternity care (89%). In comparison, fewer than 2 in 5 mothers whose care was coordinated by a private specialist obstetrician (38%) had an EPDS score recorded during their antenatal period.
In Queensland in 2022, private obstetrician (specialist) care made up the majority of privately provided care and is the model of care provided to 1 in 5 (21%) mothers regardless of sector. As with midwifery group practice caseload care, all mothers whose care was coordinated by a private specialist obstetrician in Queensland in 2022 had continuity of carer in the antenatal period. While there are overall differences in the proportion of mothers with an EPDS score between mothers who had or did not have antenatal continuity of carer, these differences appear to be associated with the underlying model of care rather than the continuity of carer (Figure 5).
Differences in screening rates between models of care may explain some of the differences in the maternal characteristics of women who are or are not receiving antenatal mental health screening. For example, in 2021:
- Young mothers, and mothers from the most disadvantaged areas were more likely to receive public hospital maternity care.
- First Nations mothers were more likely to receive midwifery group practice caseload care.
- Older mothers, non-Indigenous mothers, and mothers from the least disadvantaged areas were more likely to receive private obstetrician (specialist) care.
These findings provide an explanation for why the maternal and pregnancy characteristics associated with increased mental or psychosocial risks are also associated with an increased likelihood of receiving antenatal mental health screening.
Mothers with characteristics associated with increased mental health or psychosocial risks are also those more likely to receive care under widely used publicly funded models where mental health screening is routinely conducted. Conversely, characteristics associated with lower mental health and psychosocial risks, such as living in higher socioeconomic areas, are associated with increased access to private models of maternity care, of which private obstetrician (specialist) care was the largest in Queensland in 2022.
Access to different models of maternity care can be influenced by the same demographic and socioeconomic characteristics that influence mental health and psychosocial risk. It may be that screening practices are more robust in some antenatal care settings because of the risk profile of mothers receiving care there. However, screening for mental health and psychosocial risk factors during the antenatal period is recommended for all mothers. Mothers accessing private obstetrician (specialist) care, more commonly mothers who are older, non-Indigenous, or living in the highest socioeconomic areas, appear more likely to miss out on screening.
For more information about models of care in Queensland, see Maternity models of care.