A baby is born in Australia every two minutes.
The vast majority of these babies will come into the world in a hospital setting, with just a tiny number born in birth centres or at home.
Choosing where to have your baby is often a complex and personal decision — influenced by health risks, availability of services, personal preference and, of course, cost.
But the cost of health care is often shrouded in secrecy and confusion.
“There is a lack of availability of linked data,” says Dr Emily Callander, a health economist at James Cook University.
She says this means information is not collected about each patient and the various services they access, making it difficult to calculate the total costs.
The lack of clear potential costs makes things harder for many expectant parents, especially if it’s their first major experience with the health system.
Many are unaware of what is covered by Medicare or their private health insurance, Dr Callander says.
Whatever the budget and choice of setting, every birth is different.
This is not about the merits of each choice. This is about the real cost of childbirth.
Public hospital out-of-pocket costs: $0-$1,500*
Despite the available alternatives, three-quarters of all pregnant women choose to give birth in the public system.
Cassy Oberin had her baby Flynn at the local public hospital seven months ago.
“After everything I’d heard from talking to friends, it just didn’t make sense to pay the extra money to go private,” she says.
She says she was also pleased to be given a private room with her own bathroom — not common in the public system, but clearly still a possibility.
However, the experience was in stark contrast to the birth of her eldest son, three-year-old Archer, at the same public hospital.
“I was in the admittance area for four hours, and the only painkiller they could give me was paracetamol,” she says.
When she did get into a birthing suite hours later, midwives were in short supply.
“We were left alone a lot. I didn’t get any pain relief except gas — there wasn’t anyone available,” she said.
And afterwards there was little help with breastfeeding.
But it didn’t deter her from going public second time around.
“I understand they were busy — it was no-one’s fault. It was the system at its peak and every birth is different,” Cassy says.
And the total cost? About $600.
“The only things we had to pay for were the ultrasounds — probably about $200 to $300 each,” she says.
But the total out-of-pocket costs could be up to $1,500, depending on which provider you use and how many scans and other tests you require.
If you give birth using the public hospital system, most of your costs will be covered by Medicare.
- Your visits to midwives or obstetricians in the public hospital during pregnancy
- The actual birth, whether it’s via caesarean or vaginally
What’s not covered?
- Some scans or pathology tests if done outside the hospital, but Medicare offers a rebate for most
Private hospital out-of-pocket costs: $2,500-$20,000*
Joeline Hamilton gave birth to her two daughters, four-year-old Lucrezia and 21-month-old Emiliana in the private system.
“I had a miscarriage in the public health system and had a very bad experience,” she says.
Joeline was keen to see just one doctor for the entire experience, which is possible in the private system.
“I was a bit more emotionally vulnerable in a sense. I was bit more anxious about the pregnancy,” says Joeline.
But the cost was substantial, about $9,000 for each birth, which included the obstetrician’s fees, the gap payment for her hospital stay, anaesthetist’s fees and scans.
That out-of-pocket expense was on top of what was covered by her private health insurance and Medicare. While she was prepared for the obstetrician’s fees, she received a few surprise bills in the weeks after she came home from hospital.
“I remember when the anaesthetists bill arrived. You go to the letterbox and go, ‘Oh, OK, another $850!’ It was a nice little present a month later.”
Caroline Homer, professor of midwifery at University of Technology Sydney, says Joeline wouldn’t be the only one to experience post-baby bill shock.
“I suspect the level of awareness and transparency around these costs varies hugely across the country and women are often shocked when their private health insurance does not cover everything,” Professor Homer says.
Our research confirms this suspicion.
The ABC called 40 obstetricians, across all capital cities and some regional areas, and found huge variances in the cost of giving birth through the private system.
For the obstetrician’s fees alone: the cheapest price we found was $2,145 in Hobart and the most expensive was $8,500 in Sydney.
But when you add up the costs of scans, and a complicated birth requiring extra medical attention, out-of-pocket expenses can reach up to $20,000.
And the wide range in prices is because specialists can set their own fees.
There is also confusion over what rebates are available. Patients will receive some money back from Medicare for most appointments before and after pregnancy.
However, the actual birth is covered by private health insurance. But according to Dr Callander’s research, most new parents will have to fork out around $780 in “gap” fees.
“Depending on whether your provider charges above the Medicare schedule fee, it also depends upon your private health insurance coverage. There’s so many ifs and butts,” Dr Callander says.
Most doctors don’t list their fees on their websites, but you are entitled to ask before you start treatment (it’s called “informed financial consent”).
While insurance companies say fewer women are accessing the private system, for Joeline, it was not negotiable — even though it stretched the family finances.
“We had to juggle the cards, juggle the money and just make do,” she says.
- All private health insurers and health funds have a one-year waiting period for obstetric services
- Check to ensure your baby is covered from birth in case he or she requires hospital care immediately
- IVF and other assisted reproductive services are not covered on all policies
What’s covered by your obstetrician’s fees?
- There are fees for the first visit and subsequent check-ups (around 10-13 visits during pregnancy) but a Medicare rebate is available
- Planning and management fee (this is a lump sum to cover expensive indemnity insurance) on average $1,800^ (however in the ABC’s small survey, the cheapest was $1,000 in Hobart, the most expensive was $5,000 in Darwin and Sydney)
- Health funds cover part or all of the cost of a hospital stay. The average gap is $780
- Scans and tests (prices can vary between bulk billed and private providers)
- Specialist fees including anaesthetists, paediatrician, assisting doctor
- If you don’t have health insurance, be prepared to foot the entire bill for a birth through the private system.
^Department of Health, via Dr Emily Callander.
Homebirth out-of-pocket costs: $3,500-$6,000*
Amy Rushbrook’s son Archie was born on her dining room floor, after 10 hours of labour.
“The pain is like nothing else I have experienced. But I did it, and I did it completely naturally, using only water for pain relief,” she says.
Amy chose a homebirth after attending one as a birth photographer.
Homebirth is usually with a private midwife, and your GP can point you in the right direction of one. Make sure your midwife is registered with the Nursing and Midwifery Board of Australia.
Some public hospitals also offer a homebirth service, but you must have a referral from your GP.
“I did a lot of research, and found that, provided I stayed ‘low risk’ and healthy throughout my pregnancy, this was a perfectly safe option for me,” Amy says.
She considered booking into a hospital birth centre, which would have been free.
“But we ultimately wanted the 1:1 midwifery care that came with home birth,” she says.
“I was free to move from the pool to walking around my house. I had showers. I rested on my bed. I got back in the [birthing] pool. I led the entire process according to my own instincts,” Amy says.
Archie was born in perfect health, however Amy had a complication and spent a night in hospital after surgery to manually remove her placenta.
“I was reunited with my baby once I was in recovery and spent the night staring at my magic little baby,” she said.
“It’s not for everyone, but it is something I would absolutely do again. I felt so supported and cared for, and not once did I feel ‘scared’.”
Like obstetricians, private midwives can set their own rates.
- They provide care at home (check-up appointments and assistance at birth)
- Private health insurance may cover some costs
- Some public hospitals offer Medicare-funded homebirths, where midwives will attend your birth at home if you live close to the hospital and are considered ‘low risk’.
- Scans and pathology tests
- Hire of a pool for water birth and liner for the pool
- Extra towels and hot water bottles
- A doula, if you choose to have one.
Shared care GP
For women living in rural areas, there are fewer choices for where to give birth locally.
Often, it’s necessary to have a shared care arrangement during pregnancy, with a local GP or midwife and a private or public hospital in a bigger town. Sandie Richmond lives in Birchip in regional Victoria, a town with a population of around 700, about 300 kilometres north-west of Melbourne.
For her three pregnancies, she saw her local GP in between visits to a private obstetrician in a regional centre about two and a half hours’ drive away.
It cost about $40 for each GP visit, plus around $5,000 in obstetrician and hospital fees.
“I was happy with the shared care arrangement,” Sandie says. “I am lucky to have had pretty low risk pregnancies.
When it came close to her due date, Sandie and her husband Josh travelled into town and stayed a few nights, adding an extra cost.
“You do have to be more prepared,” Sandie says.
“For Sienna and Ari there were no worries about an early delivery. But with my third, Jock, the doctor was a little concerned and he ended up booking me in to get induced.”
- Cost depends on whether your shared care is with a public or private hospital.
Register for the Medicare Safety Net
For most expectant mothers, the first port of call is usually your GP, who will help your decide what’s right for you.
No matter where you choose to give birth, expectant parents are advised to register as a family for the Medicare Safety Net.
This means once you have paid a “threshold” amount of out-of-pocket expenses, you will receive a higher level of rebates.
And while potential cost is just one factor in a multifaceted decision, it pays to be informed.
*These figures are provided by the Murdoch Children’s Research Institute and the Parenting Research Centre.
This article contains general information only. All reasonable efforts have been made to ensure the information is accurate but its accuracy is not guaranteed. It should not be relied on as advice in relation to your particular circumstances and issues, for which you should obtain specific, independent professional advice.