About birth in public hospitals

Public hospitals are run by government, unlike private hospitals, which are run by private organisations. In the public hospital system, your pregnancy and birth care are mostly free.

Public hospitals support most birth preferences and options. And they offer a safe, affordable, high-quality environment for labour, birth and maternity care. Public hospitals have a more institutional feel than birth centres or homebirths.

If you choose to give birth in a public hospital, you’ll probably see different midwives and doctors throughout your pregnancy. Some women are OK with this, whereas others prefer to see the same midwife or doctor.

Public hospitals are an option for all pregnant women, including women with high-risk pregnancies. Major public hospitals in city areas have the facilities to care for women and babies who experience complications during labour and birth.

Most women in Australia have their babies in public hospitals.

Some public hospitals have information nights and hospital tours. Some might have online virtual tours. Call the hospital that you’re interested in or check its website to find out about these options.

Booking into a public hospital

If you think you might be pregnant, see your GP as soon as possible to start your pregnancy care.

Depending on your location, health and pregnancy history, you might have a few public hospital options. Your GP will discuss these and refer you to a hospital. This is usually the closest one to your home. Some hospitals accept bookings only from the local area, because of high demand.

Soon after your first GP appointment, you need to call the hospital antenatal clinic to book in your first appointment. If you need help to do this, you could ask a family member, friend, multicultural health worker, case manager, or Aboriginal Health Worker to help you.

Pregnancy care options through public hospitals

You might have a few different options for pregnancy care through the public hospital system:

• clinic care
• midwives clinic
• shared care
• midwifery group practice
• team midwifery care.

The option you choose determines who cares for you and where.

Note that some of these options might not be available, depending on your health and local hospital. Some options might also have limits on bookings.

It’s a good idea to discuss your options with a doctor or midwife early in pregnancy.

Clinic care
Your pregnancy care happens in a public hospital outpatient clinic or in the community, depending on the hospital you attend. You go to the same hospital for the birth and postnatal care. You might see different midwives and doctors at each visit.

Midwives clinic
Your pregnancy care happens in a public hospital midwives clinic. This is where midwives care for women with healthy, low-risk pregnancies. If any complications happen, they refer you to doctors at the hospital. You get to know the midwife or midwives during pregnancy. At the birth, the midwives and doctors on duty in the birthing unit care for you. After the birth, midwives on the postnatal ward care for you. Many hospitals can offer home visits by a midwife if you go home before 48 hours.

Shared care
Shared care is an arrangement between a GP and a birthing hospital or other birth setting. You see your GP for most pregnancy appointments, and you also have appointments at the hospital in early and later pregnancy.

Some women like this option because they’re familiar with their GP, their GP knows their medical history, and the care is usually close to home. If English is your second language, your GP might speak your first language or use an interpreter and know about your cultural needs.

You can have shared care between your birth setting and other health professionals like obstetricians or midwives, but this isn’t as common as GP shared care.

Midwifery group practice (caseload midwifery)
This is where a small group of public hospital midwives care for you during pregnancy, labour, birth and the early weeks after birth. One midwife, called a primary midwife, looks after most of your care. Your pregnancy visits might be at the hospital or in the community. Midwifery group practice is more likely to be available in city areas.

With this option, you’ll get to know the midwives during pregnancy, labour and birth, even if your birth plans change – for example, you have a caesarean. The big benefit is that you can develop a relationship with the midwife or midwives who’ll be caring for you during birth and after baby is born. This is known as ‘continuity of care’. Other benefits include higher breastfeeding success and fewer birth interventions.

Team midwifery care
Team midwifery care is similar to midwifery group practice. But instead of having one midwife giving most of your care, you have a team of up to eight midwives caring for you during pregnancy, labour, birth and after birth. Team midwifery care is more likely to be available in city areas.

More public hospitals are offering types of care that give women the chance to have positive, ongoing relationships with health professionals.

Around the day of the birth

When you think you’re in labour, you phone the public hospital. The midwives in the birth suite will talk to you about what’s happening and discuss the best time for you to come into hospital.

Midwives will care for you when you get to hospital. If you have any complications, a doctor will help with procedures or operations.

Most women stay in public hospitals for about 1-2 days after a vaginal birth, and around 3-5 days after a caesarean birth. But if you and your baby are well and you’re happy to go home, your stay could be less than 24 hours.

A midwife might visit you at home.

If you’re having a planned or elective caesarean, you’ll know the day of your baby’s birth in advance. The hospital will tell you how to prepare, including how long to fast and when to come to hospital. You’ll be admitted to the maternity ward, but your baby will be delivered in the operating theatre.

The birth environment at public hospitals

Many public hospitals have air-conditioned birthing suites, usually with ensuite and shower and often a bath. The birthing suites might also have birth balls, heat packs, electric oil burners and other equipment.

Many public hospitals also have birthing pools in their birthing suites.

Public hospital maternity wards (where you stay after the birth) often have double, single or twin-share accommodation, with ensuites or shared bathrooms. You might be able to have a private room and/or double bed, depending on availability.

Public maternity wards might also have:

• televisions (you might have to pay)
• telephones (you might have to pay)
• small kitchens.

Your partner or family members might be able to stay overnight.

Birth complications: how they’re handled at public hospitals

Most big public hospitals are set up to deal with serious complications like premature labour. But if your baby is very premature (less than 32 weeks) you’ll probably need to go to a specialist maternity hospital with a neonatal intensive care unit (NICU).

Sometimes you’ll be well enough to go home after a complicated birth, but your baby might need to stay in the NICU or special care nursery (SCN).

If you live in a rural area and your baby needs to stay in a NICU, you might have to travel to the city to be admitted to a public hospital with a NICU. Most regional birthing hospitals have SCNs. When your baby is well enough, you and/or your baby will go back to your local hospital or straight home.

Costs of giving birth at private hospitals

Here are some of the costs you can expect with public hospitals:

• If you’re eligible for a Medicare card, Medicare covers the cost of your care.
• If you don’t have a Medicare card, the cost could be much more. For information about applying for a Medicare card, call Medicare on 132 011.
• If you’re in shared care or live rurally, some of your care might be with your GP. Some GPs will bulk bill. If they don’t, you pay the difference between their fee and the Medicare rebate.
• Sometimes, there might be a cost for pregnancy tests and ultrasound scans. You can often get some money back through Medicare.
• There might be a cost for birth classes.
• Check with your midwife or doctor about any other costs.

It’s possible to be a private patient in a public hospital. This will lead to extra costs. If you’re interested in this option, call the public hospital and ask if they have a private patient liaison officer that you can speak to.

Other things to think about with public hospital births

If you’re thinking about whether to have a public hospital birth, it’s also worth considering:

• the hospital’s approach to care, family members and visitors
• facilities and services during and after the birth.

Also bear in mind that if you live rurally, you might need to go to a larger regional hospital for the birth.

Knowing your options and talking about them with your midwife or doctor can help you feel more prepared and happier about your pregnancy and birth experience in the long run.