Public or private? Midwife or obstetrician? Hospital, birth centre or home?

Choosing a model of care is one of the first big decisions you'll make in pregnancy and for many women, it can feel confusing and overwhelming.

You may hear strong opinions from friends, family, social media or even care providers. You might come across information that feels biased or fear-based, or that leaves you wondering whether you're "making the right choice".

As a midwife, I've worked across multiple models of care in the Australian hospital system, so here's the most important thing I want you to know upfront:

There is no single "best" model of care - only the model that best aligns with your values, needs, preferences and circumstances.

This guide is here to inform, not persuade. You deserve access to clear, evidence-based information, the freedom to explore your options and the support to choose care that feels right for you.

What Even Is a Model of Care?

A model of care is the way your pregnancy, birth and postnatal care is organised and delivered. It describes:

• Who provides your care (midwives, obstetricians, GPs or a combination)
• How your care is structured
• Whether you have continuity of care (seeing the same care provider or team throughout)
• Where you give birth

In Australia, there are several different models available through both the public and private health systems. Each comes with its own benefits and limitations, and availability can vary depending on where you live.

Importantly, the way your care is structured - not just where you give birth - can influence both your outcomes and how supported you feel throughout your pregnancy and birth.

What Does the Evidence Say?

You may have heard midwifery continuity of care called the "gold standard" and from a research and evidence perspective, this is true. Research consistently shows that continuity of care with a known and trusted midwife is associated with:

• Higher rates of vaginal birth
• Lower rates of intervention
• Lower rates of preterm birth 
• Higher satisfaction with care

But evidence doesn't exist to take away your choice.

Your values, your health, your preferences, your previous experiences, your finances and what feels safe for you all matter too. A model of care that feels empowering for one family may not feel right for another - and that's okay!

The goal isn't to choose the "most recommended" option. The goal is to choose the option that best supports you to feel informed, safe, respected and confident through pregnancy, birth and beyond.

How Do I Decide What's Best for Me?

Choosing a model of care is a personal decision and it's okay if your thoughts change as your pregnancy progresses. Taking the time to reflect on what matters most to you can help this decision feel clearer and less overwhelming.

Here are some helpful questions to ask yourself:

The System

• Do I prefer public or private care?
• What costs am I comfortable with, if any?

Continuity of Care

• Do I value seeing the same care provider throughout pregnancy, birth and postpartum?
• Or am I comfortable seeing multiple care providers?

Philosophy of Care

• Do I prefer a midwifery-led approach, an obstetric-led approach, or a combination of both?
• How important are shared decision-making and informed consent to me?
• What type of birth am I working towards? Vaginal birth or caesarean? As natural as possible, or wanting medical pain relief options? (Your care provider has a massive impact on your birth experience.)
• How do I feel about the medicalisation of birth? (Research has shown that hospital-based, obstetric-led models are often associated with increased intervention when compared to midwifery-led or home birth models.)

Health and Risk Factors

• Is my pregnancy currently considered low risk?
• Are there any medical considerations that may influence my options?

Birth Environment

• Where do I feel safest giving birth - a hospital birth suite, a birth centre or at home?
• How important is the physical environment to me?

Availability

• What models of care are actually available in my local area?
• Would I be disappointed if I missed out on a particular option?

Some models - such as Midwifery Group Practice (MGP), birth centres and publicly funded homebirth - have limited places and fill quickly. If you're interested in any of these options, it's worth exploring them early in your pregnancy.

👉 If you're feeling unsure about what matters most to you, my free guides are designed to help you clarify your values and priorities, so you can make confident, informed choices - without the overwhelm.

Let's Deep Dive Into Your Model of Care Options in Australia

Below is an overview of the most common models of care available in Australia. Availability, eligibility criteria and how each model runs can vary by location, so it's important to check what's offered in your local area.

At a Glance

Model of care	System	Cost	Continuity of care
Midwifery Group Practice (MGP)	Public	Free under Medicare	Yes - a known midwife
Publicly funded homebirth	Public	Free under Medicare	Yes - known midwives
Birth centre	Public	Free under Medicare	Sometimes (if offered with MGP)
Public hospital midwifery clinic	Public	Free under Medicare	No
Public hospital obstetric clinic	Public	Free under Medicare	No
Shared care (GP + hospital)	Public + GP	GP fees vary; hospital care free	With your GP, not a midwife
Private obstetrician	Private	Approx. $3,000–$10,000+ out of pocket (with insurance)	Yes - with an obstetrician
Private midwife	Private	Approx. $2,000–$7,000+ (some Medicare rebates); Some endorsed midwives bulk-bill antenatal and postpartum appointments under medicare.	Yes - full continuity
Combined care (private obstetrician + private midwife)	Private	Approx. $5,000–$12,000+ out of pocket	Yes - known midwife and obstetrician (in many cases)

Public Options

Midwifery Group Practice (MGP) / Caseload Midwifery

What it is

Midwifery Group Practice (MGP) offers continuity of care, meaning you're cared for by a known midwife (or a small team of midwives) throughout pregnancy, birth and the postnatal period. Your midwife is on call for your birth and often provides postnatal care at home for up to six weeks.

Cost

Free under Medicare.

Who provides care

• One primary midwife (working within a hospital or birth centre)
• A backup midwife if your primary midwife is unavailable

Pros

• Builds a strong, trusting relationship with a known midwife
• A strong evidence base supporting it as the gold standard of maternity care, with improved outcomes and maternal satisfaction
• Lower rates of intervention compared to obstetric-led models
• Your midwife knows you well, so they can strongly advocate for your preferences within the hospital system

Cons

• Limited availability and high demand (meaning many women miss out)
• Often restricted to low-risk pregnancies or women who meet specific criteria
• You usually need to apply early in pregnancy

Publicly Funded Homebirth

What it is

This model supports women with low-risk pregnancies to give birth at home with publicly employed midwives, while staying connected to a hospital service.

Cost

Free under Medicare.

Who provides care

• A small team of hospital-employed midwives
• Postnatal care provided at home

Pros

• Continuity of care with known midwives
• Strong support for physiological birth
• Low rates of intervention

Cons

• Very limited availability (not every hospital offers this model of care)
• Only suitable for low-risk pregnancies
• Some pain relief options and interventions aren't available at home (e.g. an epidural)

Note: If any labour and birth complications arise during a home birth (no matter if it is public or privately funded), you will be transferred to hospital for care.

Birth Centre

What it is

A birth centre is a midwife-led unit, either stand-alone or within a hospital, designed for women with low-risk pregnancies. Birth centres offer a more home-like environment while keeping access to hospital support if it's needed.

Cost

Free under Medicare.

Who provides care

• A team of midwives
• Some birth centres offer continuity models such as MGP, where you have a known care provider

Pros

• A calm, home-like environment
• Encourages physiological birth (natural birth with minimal intervention)
• Access to hospital support and services if needed

Cons

• Limited availability and some birth centres have strict eligibility criteria
• Transfer to the main birth suite is required if complications arise or you are wanting certain medical pain relief options like an epidural

Public Hospital Midwifery Clinic

What it is

A common public model where your antenatal care is provided by hospital midwives in an antenatal clinic. You'll usually see a different midwife at each appointment.

Cost

Free under Medicare.

Who provides care

• Rotating midwives (likely a different midwife at each of your appointments)
• Obstetric involvement if pregnancy complications arise

Pros

• Free care with access to public hospital facilities
• Suitable for most pregnancies
• Midwifery-led care - midwives are highly trained and experienced in pregnancy and birth

Cons

• No continuity of care
• Busy clinics, which can mean longer wait times
• You may not know the midwife caring for you during labour and birth

Public Hospital Obstetric Clinic

What it is

Care is provided by hospital obstetricians and midwives, often for pregnancies that are higher risk or need specialist input. This could include medical conditions, pregnancy complications or multiple pregnancies.

Cost

Free under Medicare.

Who provides care

• Obstetricians, midwives and other specialists as required
• Likely a different care provider at each appointment

Pros

• Appropriate for high-risk pregnancies
• Immediate access to medical interventions and specialists

Cons

• No continuity of care
• Wait times can be long
• Higher average rates of intervention
• Women have reported this model is often more medically focused, with less time for education when compared to midwifery models

Shared Care (GP + Hospital)

What it is

A model where your antenatal care is shared between your General Practitioner (GP) and the hospital. Your GP provides most of your routine appointments, while the hospital manages your birth and any complications.

Cost

• GP fees vary (bulk billing may apply)
• Hospital care is free under Medicare

Who provides care

• Your GP for most antenatal visits
• Hospital midwives and obstetricians for a few key appointments (usually your booking-in appointment, and your 36-week and 40-week appointments)
• Hospital midwives and obstetricians for your birth and any pregnancy complications

Pros

• Convenient if you have a GP you trust (especially if they're trained in pregnancy!)
• Suitable for low-risk pregnancies
• Familiarity with a known care provider (as you'll likely see the same GP at every appointment)

Cons

• GPs may not specialise in maternity care
• Less in-depth antenatal education (usually due to short appointment times and a lack of training in pregnancy and birth)
• No continuity of care with a midwife and limited involvement from midwives and the hospital until birth

Private Options

Private Obstetrician

What it is

You receive care from a private obstetrician throughout your pregnancy and give birth in a private hospital (or as a private patient in a public hospital).

Cost

Out-of-pocket costs typically range from $3,000–$10,000+ with private health insurance (and higher without). This varies depending on your obstetrician and your level of cover. Even with insurance, some costs such as ultrasounds and certain blood tests may not be covered.

If you're considering this model of care, ask your private health insurer what the gap fee is and what's included in your policy. Some health funds also have waiting periods after you sign up before you can claim pregnancy cover. Then talk to your obstetrician about their specific costs, so you can work out the overall cost.

Who provides care

• A private obstetrician for your antenatal care
• Hospital midwives during labour
• An obstetrician present for your birth or any complications (this may be your primary obstetrician or another obstetrician in their team who is on call)

Pros

• Continuity of care with an obstetrician
• More choice over your care provider
• Private hospital amenities and often a longer hospital stay

Cons

• Cost involved (may also be other costs that you will not know about until the day for example: getting an epidural or care provided for your baby such as testing or a stay in the special care nursery)
• On average, higher rates of intervention when compared to public or midwifery-led models
• May not align with low-intervention birth preferences (if a low-intervention birth is your preference, have an honest conversation with your obstetrician about their philosophy of birth - you need a care provider who aligns with your preferences)

Private Midwife (Home or Hospital Birth)

What it is

Continuity of care with a private midwife throughout pregnancy, birth and the postnatal period. This is most commonly used for homebirth, though some private midwives have hospital admitting rights.

Cost

Approximately $2,000–$7,000+, with some Medicare rebates. This varies between midwives, so it's best to contact them directly about their specific costs.

Who provides care

• One primary midwife for all of your care
• A second midwife present at your birth

Pros

• Full continuity of care
• Highly personalised, holistic support for a physiological birth
• Lower intervention rates and high maternal satisfaction

Cons

• Cost involved
• Typically limited to low-risk pregnancies
• Some private midwives don't have hospital admitting rights, meaning homebirth is the only option
• Hospital transfer is required if complications arise during labour and birth

Note: You may choose to do a shared care approach where you have a private midwife for your antenatal care and postnatal care but birth in the public hospital system - some private midwives bulk bill their appointments and this could be a way to access private midwifery while keeping costs low. You will have the continuity through pregnancy and postpartum but will just receive routine public hospital care during your birth.

Combined Care: Private Obstetrician + Private Midwife

What it is

A collaborative model where your care is shared between private midwives and a private obstetrician, offering a combination of both midwifery and medical support.

Cost

Typically $5,000–$12,000+ out of pocket. This varies widely, so check with your clinic for more information on pricing.

Who provides care

• A team of midwives and obstetricians
• In many cases, a known midwife provides your labour care and a known obstetrician is present for your birth

Pros

• The best of both worlds - midwifery continuity combined with obstetric support
• Access to private hospital facilities and often a longer hospital stay

Cons

• Cost involved
• Limited availability - only some obstetric clinics offer this model
• Higher intervention rates when compared to midwifery-led care

Note: Every combined care model runs a little differently. It's important to speak to your clinic so you understand exactly what care they provide.

Why Your Model of Care Matters

The model of care you choose can influence:

• How informed and supported you feel
• Your confidence going into birth
• Your support person's involvement
• Your postpartum experience

Understanding your options helps you move away from fear-based decision-making and towards informed, empowered choices.

Final Thoughts

You deserve maternity care that feels respectful, supportive and aligned with your values. Evidence matters - but so do you. 💕

Whatever model of care you choose, you are allowed to:

✔️ Ask questions

✔️ Change your mind

✔️ Seek a second opinion

✔️ Choose care that feels right for you and your family

👉 If you'd like extra support navigating your options, my free guides are designed to give you clarity, confidence and evidence-based education - without judgement or overwhelm.

• Free Guides and Resources
• Birth Education Course – Empowered Birth
• Postpartum Education Course – Beyond Birth: The Postnatal Essentials

I'm here for you,

Tam xx