Two decades of Birth Centre and midwifery-led care in South Australia, 1998–2016

  • Pamela Adelson
    Corresponding author at: Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, City East Campus, Playford Building P4-27D, North Terrace, Adelaide SA 5000, Australia.
    Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
    Search for articles by this author
  • Julie-Anne Fleet
    Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
    Search for articles by this author
  • Lois McKellar
    Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
    Search for articles by this author
  • Marion Eckert
    Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
    Search for articles by this author



      Birth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA).


      To describe BC utilisation and the growth of midwifery-led care in SA over the past two decades.


      The SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive.


      Women who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care.


      Whilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Laws P.J.
        Birth Centres in Australia: Safety, Relevance and Sustainability [Doctor of Philosophy].
        Faculty of Medicine, University of New South Wales, Sydney2014
        • Senate Community Affairs References Committee
        Rocking the Cradle. A Report into Childbirth Procedures.
        Commonwealth of Australia, Canberra, ACT1999
        • Laws P.J.
        • Lim C.
        • Tracy S.
        • Sullivan E.A.
        Characteristics and practices of birth centres in Australia.
        Aust. N. Z. J. Obstet. Gynaecol. 2009; 49: 290-295
        • Laws P.J.
        • Tracy S.K.
        • Sullivan E.A.
        Perinatal outcomes of women intending to give birth in birth centers in Australia.
        Birth. 2010; 37: 28-36
        • Australian Institute of Health and Welfare
        Metadata Online Registry. Birth Event-setting of Birth.
        (Accessed 3 December 2019)
        • Ryan M.
        • Roberts C.
        A retrospective cohort study comparing the clinical outcomes of a birth centre and labour ward in the same hospital.
        Aust. Midwifery. 2005; 18: 17-21
        • Turnbull D.
        • Baghurst P.
        • Collins C.
        • et al.
        An evaluation of midwifery group practice. Part I: clinical effectiveness.
        Women Birth. 2009; 22: 3-9
        • Tracy S.K.
        • Dahlen H.
        • Caplice S.
        • et al.
        Birth centers in Australia: a national population-based study of perinatal mortality associated with giving birth in a birth center.
        Birth. 2007; 34: 194-201
        • Scarf V.L.
        • Rossiter C.
        • Vedam S.
        • et al.
        Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis.
        Midwifery. 2018; 62: 240-255
        • Homer C.S.E.
        • Cheah S.L.
        • Rossiter C.
        • et al.
        Maternal and perinatal outcomes by planned place of birth in Australia 2000–2012: a linked population data study.
        BMJ Open. 2019; 9
        • Commonwealth of Australia
        Improving Maternity Services in Australia. The Report of the Maternity Services Review.
        Commonwealth of Australia, Barton, ACT2009
      1. National Maternity Services Plan 2010. Commonwealth of Australia, Canberra ACT2011
        • Australian Institute of Health and Welfare
        Australia’s Mothers and Babies 2017—in Brief.
        AIHW, Canberra2019
      2. Australia’s Mothers and Babies 2017 Data Visualisations.
        2019 (Accessed 7 August 2019)
        • Government of South Australia SA Health
        Pregnancy Outcome Unit Pregnancy Outcome in South Australia 2016. Government of South Australia, Adelaide SA2018
        • Donnolley N.
        Maternity Care Classification System: Maternity Model of Care Data Set Specification National Pilot Report November 2014—National Maternity Data Development Project Stage 2.
        in: Australian Institute of Health and Welfare AIHW, Canberra2016 (Cat. no. PER 74)
        • Dawson K.
        • McLachlan H.
        • Newton M.
        • Forster D.
        Implementing caseload midwifery: exploring the views of maternity managers in Australia — a national cross-sectional survey.
        Women Birth. 2016; 29: 214-222
        • Middleton P.F.
        • Brown S.J.
        • Bubner T.K.
        • Glover K.
        • Rumbold A.
        • Weetra D.
        The SA Aboriginal family birthing program-a success story.
        J. Paediatr. Child Health. 2015; 1: 127
        • Homer C.S.
        • Thornton C.
        • Scarf V.L.
        • et al.
        Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data.
        BMC Pregnancy Childbirth. 2014; 14: 206
        • Dahlen H.
        • Jackson M.
        • Schmied V.
        • Tracy S.
        • Priddis H.
        Birth centres and the national maternity services review: Response to consumer demand or compromise?.
        Women Birth. 2011; 24: 165-172
        • Chan A.S.J.
        • Nguyen A.M.
        • Sage L.
        South Australian Department of Health Pregnancy Outcome in South Australia 2004. South Australia Department of Health, Adelaide2006
        • Borquez H.A.
        • Wiegers T.A.
        A comparison of labour and birth experiences of women delivering in a birthing centre and at home in the Netherlands.
        Midwifery. 2006; 22: 339-347
        • Newman L.
        The health care system as a social determinant of health: qualitative insights from South Australian maternity consumers.
        Aust. Health Rev. 2009; 33
        • Dahlen H.G.
        • Dowling H.
        • Tracy M.
        • Schmied V.
        • Tracy S.
        Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years.
        Midwifery. 2013; 29: 759-764
        • Steel A.
        • Adams J.
        • Frawley J.
        • Broom A.
        • Sibbritt D.
        The characteristics of women who birth at home, in a birth centre or in a hospital labour ward: a study of a nationally-representative sample of 1835 pregnant women.
        Sex. Reprod. Healthc. 2015; 6: 132-137
        • Ministry of Health and Family Welfare
        Midwifery Services in India. Government of India, India2018
        • Beake S.
        • Acosta L.
        • Cooke P.
        • McCourt C.
        Caseload midwifery in a multi-ethnic community: the women’s experiences.
        Midwifery. 2013; 29: 996-1002
        • Laws P.J.
        • Lim C.
        • Tracy S.K.
        • Dahlen H.
        • Sullivan E.A.
        Changes to booking, transfer criteria and procedures in birth centres in Australia from 1997–2007: a national survey.
        J. Clin. Nurs. 2011; 20: 2812-2821
        • Sweet L.P.
        • Boon V.A.
        • Brinkworth V.
        • Sutton S.
        • Werner A.F.
        Birthing in rural South Australia: the changing landscape over 20 years.
        Aust. J. Rural Health. 2015; 23: 332-338
        • Waldenstrom U.
        • Turnbull D.
        A systematic review comparing continuity of midwifery care with standard maternity services.
        Br. J. Obstet. Gynaecol. 1998; 105: 1160-1170
        • Turnbull D.
        • Holmes A.
        • Shields N.
        • Cheyne H.
        • et al.
        Randomised, controlled trial of efficacy of midwife-managed care.
        Lancet. 1996; 348: 213-218
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016; 4CD004667
        • McLachlan H.L.
        • Forster D.A.
        • Davey M.A.
        • et al.
        The effect of primary midwife‐led care on women’s experience of childbirth: results from the COSMOS randomised controlled trial.
        BJOG Int. J. Obstet. Gynaecol. 2016; 123: 465-474
        • Donnolley N.R.
        • Chambers G.M.
        • Butler-Henderson K.A.
        • Chapman M.G.
        • Sullivan E.
        A validation study of the Australian maternity care classification system.
        Women Birth. 2019; 32: 204-212
        • Vedam S.
        • Rossiter C.
        • Homer C.S.E.
        • Stoll K.
        • Scarf V.L.
        The ResQu Index: a new instrument to appraise the quality of research on birth place.
        PLoS One. 2017; 12e0182991
        • Scarf V.
        • Catling C.
        • Viney R.
        • Homer C.
        Costing alternative birth settings for women at low risk of complications: a systematic review.
        PLoS One. 2016; 11
        • Scarf V.
        Micro-costing vaginal birth at home, in a birth centre and in a hospital in New South Wales for women at low risk of complications.
        Women Birth. 2019; 32: S13
        • Hermus M.A.A.
        • Wiegers T.A.
        • Hitzert M.F.
        • et al.
        The Dutch Birth Centre Study: study design of a programmatic evaluation of the effect of birth centre care in the Netherlands.
        BMC Pregnancy Childbirth. 2015; 15: 148
        • Hermus M.A.A.
        • Boesveld I.C.
        • Hitzert M.
        • et al.
        Defining and describing birth centres in the Netherlands-a component study of the Dutch Birth Centre Study.
        BMC Pregnancy Childbirth. 2017; 17: 210
        • Caughey A.B.
        • Cheyney M.
        Home and birth center birth in the United States: time for greater collaboration across models of care.
        Obstet. Gynecol. 2019; 133: 1033-1050
        • Seymour L.
        • Stewart A.
        The decline of birth centres and the resultant effect on maternity services.
        Women Birth. 2017; 30: 4