Public vs. private birth options

Trends toward comfort and natural birthing in Australia have opened up a host of new ways to give birth.

As long as your pregnancy looks like it will be complication-free, you can choose to greet your new bub in one of three places: the hospital, a birthing centre or your home. These options will be open to you whether you use the public system or the private one, although the private one offers a bit more choice and more opportunity for comfort.

Hospital delivery

Nearly all Australian births happen in hospitals, which accounted for a steady 97% of all births in 2016 - a rate that has remained unchanged since at least 2010.

There's a reason they are so popular. When you're in a hospital, you know there are heaps of medical professionals and all of the right medical equipment available if you need help. In fact, if the doctor thinks your delivery will be complicated, they probably won't give you any other choice but to deliver in a hospital.

A hospital is only the only place equipped to provide an epidural or c-section, and you can choose to deliver in a public hospital or a private one.

If you don't have private health insurance, you'll deliver in a public hospital unless you want to pay out of your own pocket to use a private one. Here are the basics of delivering in a public hospital:
  • Your GP will assign you to a hospital. You need to see your GP first so they can refer you to a public hospital, usually the one closest to you. If you prefer one that is a little farther out, just ask your GP.
  • You will be assigned to a team of midwives. For your first appointment and all others after that, you will be cared for by a team of midwives at the hospital. In a private practice, the teams are usually smaller.
  • Obstetricians will be available when needed. You won't have one specific obstetrician (OB) assigned to you, but the hospital will have obstetricians on rotation who can see you when needed. When it's time to deliver, it will be the OB on duty who delivers the baby.
  • You may have to share a room with other mothers. Since it is a public birth, you might not get your own private room. However, some public hospitals will allow you to pay extra for one, but only if one becomes available at the right time.

If you have private cover, you'll still pay some out-of-pocket expenses to deliver in a private hospital, but not as much as you would if you didn't have the cover. Plus, there are a few very attractive benefits to going this route. Here are some basics around delivering in a private hospital:

  • You choose your own obstetrician. You can make an appointment directly with the OB without going through your GP first (unless you want to). You will meet with this same OB for all your appointments, and they will be the one delivering the baby.
  • Your appointments will most likely be at the OB's office. Many private OBs have offices away from the hospital, meaning you may never have to step foot in a hospital until it's time to deliver.
  • You'll have a smaller team looking after you. An OB's team of midwives is usually smaller, meaning you'll be able to develop closer relationships with them.
  • You'll get your own room at the hospital. When you deliver privately, you are more likely to get your own private room, and you can usually stay there to recover longer than you could in a public hospital. Some private hospitals will even allow you to transfer to a partner hotel after the birth, so you can recover in a little more comfort.

Birthing centre

A birthing centre is a home-like environment connected to a hospital and usually run by midwives. It's for women expecting a complication-free pregnancy. You can choose to deliver in a birthing centre through the public and private systems, but only if there is one near you.

Most birthing centres are publically funded, meaning Medicare will cover most (if not all) of the costs. Here's what to keep in mind if you use a public birthing centre:
  • You'll need to book quickly. Spots are limited in these very popular units, so book yourself in as soon as you know you are pregnant.
  • There are fewer pain-relief options. If the pain gets to be too much, you won't have access to epidurals. For that, you would need to be transferred to the normal labour ward.
  • These centres promote natural birthing. These centres will usually offer larger beds and a variety of cushions that allow you to move around and find a delivery position that is unique to you. Some may even offer water birth options, where you can use a birth pool or large bath to possibly deliver your baby underwater.

Private hospitals don't typically have birthing centres as such, because birthing centres are made for the public system - with the focus being on a team of midwives who see you through your care. With private health, you are seeing a private OB with their own team of midwives. That said, there are ways you can have the birthing centre experience.

If you want your own private OB, but want to deliver in a home-like setting, here are your choices:

  • Ask your OB to deliver your baby in a public birthing centre. If you run it by the hospital and the OB first, you may be allowed to have your own OB deliver the baby in the public birthing centre.
  • Get a private suite in the private hospital. Getting your own private room is standard in a private hospital, but some hospitals take it one step further and offer private suite or birthing centre. These are extra spacious and offer on-demand television programming, refreshments, air-conditioning, fully adjustable labour beds and even water delivery options.

Home birth

A home birth is exactly what it sounds like: when you give birth in the comfort of your own home. That may sound a little intimidating since you won't have all of the hospital's lifesaving technology at your disposal. With the birthing centres and private suites offering the comforts of home without having to leave the hospital, it's no wonder home births are on the decline. In 2010, they made up 0.5% of all Aussie births, down to 0.3% in 2016.

That said, the option is still open to you both publicly and privately. Regardless of what system you use, the actual treatment will be the same:

  • You'll hire or be assigned to a midwife or OB (usually a midwife). You'll meet with this one person throughout your pregnancy, either in your home, at a hospital or in their offices.
  • You'll deliver your baby at home. When it is time for delivery, another midwife should be there with your primary midwife to offer support. Based on what you discussed with your midwife and what equipment you have around your house, you can choose to have a traditional birth or a water birth.
  • You will access limited pain relief. When you have a home birth, you are basically signing up for a natural birth with either non-medical or natural pain relief options. There won't be any epidurals or other forms of pain relief associated with delivery.
  • You should live close to a hospital. You shouldn't have a homebirth unless you live close to a hospital. That way you can quickly be taken there in an emergency.
  • You should be healthy with a low-risk pregnancy. This reduces the chances of an emergency or complications during childbirth.
If you want the public system to fund your homebirth, your choices are somewhat limited although it is still possible:
  • Use a private midwife who is registered with Medicare. If you can find a midwife who is registered with Medicare, you're eligible for Medicare rebates to help with the cost but these will only cover 75-85% of Medicare-covered procedures. You'll be responsible for the rest plus whatever extra the midwife tacks on. So it's likely you'll have significant out-of-pocket costs.
  • Find a publicly funded homebirth program. There are a handful of these throughout Australia, in every state/territory except for TAS, ACT and QLD. They'll cover most of your expenses, but you'll have to live within a certain range of the local hospital that runs the program.

Most home births are performed by private midwives or obstetricians, so it's better suited to someone with private health insurance. You'll still get the Medicare rebate, but you'll also be covered for that additional 15-25% Medicare has left unpaid on those Medicare-covered procedures. You will have to pay any additional costs the midwife or OB charges so make sure you ask up front how much you will be expected to pay.

Here are a few things to keep in mind if you want to have a home birth in the private system:

  • Read your policy documents carefully. Only a few insurers specifically state that their pregnancy cover includes home births, but that doesn't mean they won't cover it. If you are unsure, speak to your provider.
  • Decide if it's really for you. With private health insurance, you have a lot of options at your disposal including delivering in a birthing centre or a private suite where you can have a natural birth but also have access to a hospital's state-of-the art technology. With the decline of home birthing and fewer midwives offering the service, there are few upsides to delivering at home.

What are some other benefits of using the private system?

Private health gives you a whole lot of options for choosing where and how to deliver, but it can go even further. If you use your hospital cover to choose your own OB, the OB will most likely offer complimentary birthing courses. You can learn skills like how to breastfeed properly, how to pump and store breast milk for later use and how to keep yourself fit through prenatal yoga and Pilates.

Your extras cover will also help out a lot and give you ways to shake some of those pregnancy-related aches and pains through natural therapies like massage, acupuncture and physio.

Compare health insurance that covers pregnancy from Finder partners

If you're thinking about starting a family, and think private is the route you want to follow, you'll need to take out a top (or gold tier level of hospital cover. There’s a 12-month waiting period too - so if you’re thinking about starting a family, it’s a good time to start looking, so you’re covered in time for the birth.

Provider Policy Treatments included Excess Price Apply
Hospital Gold
  • Pregnancy and birth services
  • Benefits towards theatre and labour ward fees
  • Antenatal and Postnatal Services
$500 $164.05 Go to Site
ahm logo Top Hospital Gold
  • Pregnancy, Childbirth and Obstestrics
  • Benefits towards labour ward
  • Midwife assisted births
$750 $168.90 Go to Site

*Quotes are based on a single individual with less than $90,000 income and living in Sydney.

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Picture: Unsplash

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