Outcomes for Australian mothers and newborn babies are far better with continuity of care.
Australian births with continuity of obstetric-led care in private hospitals have significantly fewer adverse outcomes and cost less than births in public hospitals with care by multiple health professionals and limited continuity, Monash University-led research has found.
The research contributes to the evidence base to inform continuing improvements in healthcare so that all Australians continue to benefit from our health system.
The core objective of this research program is to improve the system so that the most important pregnancy outcomes - healthy mothers and babies - are optimised for all, irrespective of provider, setting, model of care or mode of birth.
Published in BJOG: An International Journal of Obstetrics and Gynaecology, the study analysed matched outcomes and costs for more than 382,000 births in Australia over four years to December 2019. It compared births under private obstetric-led care—where a single obstetrician leads care throughout pregnancy—to those in standard public care models, which typically involve multiple healthcare professionals with limited continuity.
Drawing on a national data set covering around 80 per cent of Australian births, the Monash Centre for Health Research and Implementation (MCHRI) research team found that outcomes were consistently better in the private obstetric-led care model across a range of maternal and neonatal measures. This aligns to studies on continuity of midwifery care which also show benefits over standard care.
Women in Australia who used the private obstetric-led care (25 per cent) were matched to similar women attending standard public models of care based on age, weight, socioeconomic and clinical factors. Despite populations being matched on measured factors, other unmeasured determinants of health are likely to play a role in the differences and do warrant further research.
In these 368,292 matched pregnancies/births over four years to December 2019, the standard public model had an extra:
- 778 stillbirths or neonatal deaths (0.9 versus 0.4 per cent)
- 2,301 neonatal intensive care admissions (3.5 versus 1.3 per cent)
- 3,273 women with more severe vaginal tears (2.5 versus 0.7 per cent)
- 10,627 women with postpartum haemorrhage or excessive bleeding (9.6 versus 3.8 per cent)
- AU$5,929 cost per pregnancy (AU$28,645 versus AU$22,757) including costs to all payers when compared to the private obstetric-led model.
The analysis controlled for a range of clinical, demographic and socioeconomic factors, ensuring comparability across the care models.
Australia has excellent pregnancy outcomes by international standards. Many government agencies routinely report maternity outcomes, however this data was unique with matched populations and linked cost data, allowing for more comprehensive reporting.
This Monash University led cohort study identified consistent disparities in clinical outcomes and efficiency between the care models studied.
Australia's hybrid health system and high-quality linked data provided a unique opportunity for this research, which is the first to comprehensively compare these care models for cost and outcomes in matched populations.
The study also identified that key contributors to higher rates of adverse outcomes included maternal age, obesity, country of birth, model of care and mode of birth—factors that reflect broader social and health inequities seen globally.
The researchers emphasised that these differences in outcomes reflect systemic issues rather than individual performance, and that efforts to improve outcomes should focus on collaborative reform across sectors.
Nationally, the cumulative additional cost of the standard public maternity model—factoring in all payment sources—was estimated at approximately $400 million per year.
The Monash team is now leading a national initiative to accelerate the development of a Maternity Learning Health System, supported by the National Maternity Clinical Quality Registry. This system aims to enable continuous data-driven improvement, optimise care delivery, and support informed choice for women and families.
The researchers are working with the community, obstetricians, midwives and other stakeholders, in a multi-pronged strategy to strengthen maternity care in Australia, including:
- Expanding access to continuity of care models across midwifery and obstetric settings
- Investing in a robust national data systems to inform clinical care and policy
- Supporting women through targeted public health strategies that address key risk factors during pregnancy.
The findings contribute evidence to strengthening models of care that deliver the best health outcomes, experiences and value for Australian women and their families.
