Where to give birth in Australia: hospital, birth centre or home

Three settings, two payment systems

Australia gives you the same three physical choices as most comparable countries, and then layers a second decision on top: public or private. Pregnancy, Birth and Baby, the national service funded by the Australian Government and operated by Healthdirect Australia, lists the options as at home with a registered midwife, at a midwifery unit or birthing centre, or at a hospital with midwives and obstetricians.

Your maternity care may include a combination of public and private care from obstetricians and midwives. Your preference for where you want to give birth should be respected, but the practical constraint is blunt: the choice may also depend on where you live, because access to birth services varies across Australia.

Public hospital

Most Australian women give birth in a public or private hospital maternity unit. In a public hospital you are cared for by midwives employed by the hospital, and if you have a Medicare card this can cover the costs of giving birth in a public hospital.

Many public hospitals offer a model where you see the same midwife or group of midwives throughout your pregnancy and sometimes during the birth. This is called caseload or team midwifery, and the midwives refer you to an obstetrician if complications develop. Others offer shared care between the hospital and your GP, where you see your GP regularly, attend the hospital for some appointments, and give birth at the hospital.

The advantages are access to anaesthetists who give epidurals, access to neonatologists and paediatricians, a caesarean if needed, and easy transfer of your baby to a special care nursery or neonatal intensive care unit. The trade-offs are that you may be looked after by different doctors or midwives through the pregnancy, and you may be encouraged to go home early with a midwife visiting you the next day.

Birth centre

A birth centre may feel more like a home than a hospital maternity unit, which can help you relax. You are also more likely to go home 24 hours after giving birth, with follow-up care by midwives at home.

Two practical points. Birth centres are popular, so book in as early as you can. And if you give birth at a birthing centre attached to a public hospital, Medicare will cover the costs of your birth, although there may be some out-of-pocket costs for some tests.

You may need to be transferred to a hospital birth unit if complications arise, and you may not be able to have certain kinds of pain relief, such as an epidural. A birth centre might not be suitable if you have a higher chance of pregnancy complications or have had previous labour complications.

Homebirth

If you have a normal pregnancy and both you and your baby are healthy, you may be able to give birth at home, supported by a registered midwife or doctor. Some public hospitals and birth centres also provide homebirth services.

The routes differ. For a public homebirth service you will need a referral from your doctor. Alternatively you can arrange antenatal care with a private midwife. Either way, the standing advice is to book in to your local hospital as well, just in case complications arise.

Your midwife may recommend hospital birth if you are expecting twins, your baby is breech, or you have had a caesarean section previously. Epidurals are not available at home; water immersion, a TENS machine and breathing exercises are the alternatives.

Private hospital, and the fees question

Choosing the private system lets you choose a private hospital, or a public hospital with private wards, and lets you choose your obstetrician. The first step is a GP referral to an obstetrician, who books you into the private hospital where they work.

Private health insurance may cover some of the costs. Medicare and your fund will cover some of a private hospital stay, but you may still pay extra out-of-pocket fees. Ask your doctor, obstetrician or midwife what out-of-pocket fees are expected, and ask before you book, not after. If you do not have insurance you can pay for private care yourself.

You can also be a private patient in a public hospital, cared for by your chosen doctor, though a single room is not guaranteed and you may be responsible for hospital, medical and diagnostic expenses.

The waiting period that catches people out

If you are thinking of taking out private cover for the birth, check whether your policy covers maternity care and whether there is a waiting period before you are covered. Australian law sets a maximum hospital waiting period of 12 months for pregnancy and birth, which means cover generally has to be in place before you conceive to be useful for this pregnancy.

What varies by state and territory

Which public hospitals run caseload midwifery, which run a publicly funded homebirth programme, and where freestanding birth centres exist are state and territory decisions, and rural access differs sharply from metropolitan access. We are not going to generalise from one state. Pregnancy, Birth and Baby's maternal child health nurses take calls on 1800 882 436, and your state health department publishes what is actually running near you.

How long you stay afterwards

How long you stay depends on your recovery, your choice and where you gave birth. After the birth you might go home the next day, or need to stay in hospital for several days, and some people choose to go home from as little as six hours after giving birth. From a birth centre you are more likely to go home 24 hours after the birth, with follow-up care by midwives at home.

Practical questions before you book

Ask whether you can tour the maternity facilities before the birth, when you can discuss your birth plan, what pain relief you will be able to use, what birthing aids such as a birthing chair or bean bags are available, how long you and the baby will be in hospital, and what happens if you need to be transferred from a birth unit to a hospital.

If you are considering a birth centre or a public homebirth service, ask about capacity early. Both are limited in number, and a place is not guaranteed simply because you meet the clinical criteria.