Having a baby in Victoria 1989-2000: continuity and change in the decade following the Victorian Ministerial Review of Birthing Services.

OBJECTIVE: To investigate changing patterns in the provision of maternity care in Victoria based on data collected in three statewide surveys conducted in 1989, 1994 and 2000.
METHODS: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth.
RESULTS: 71.4% of women (n = 790) returned completed surveys in 1989, 62.5% (n = 1,336) in 1994, and 67% (n = 1,616) in 2000. The proportion of women receiving public care increased from 41.1% in 1989 to 63.6% in 1999. Simultaneously, the proportion of women attending public hospital antenatal clinics decreased from 16.6% in 1989 to 8.7% in 1999. Shared care (15.8%) and combined care (29.2%), where women attend a GP or specialist obstetrician for all antenatal care and receive standard public intrapartum care in a public hospital, are now the most common models of public maternity care in Victoria. The proportion of women enrolled in public maternity care who had a known midwife caring for them in labour did not change significantly between 1993 and 1999 (34.9% vs. 30.3%, OR = 0.81 [0.7-1.0]). Sixty per cent of women had a midwife home visit after leaving hospital in 1999 compared with 23.8% in 1993.
CONCLUSIONS: The conduct of three population-based surveys at regular intervals over the past 10 years highlights major changes in the organisation of maternity care in Victoria. Comparable information cannot be derived from routine data collections. The Victorian Surveys of Recent Mothers provide an important and unique mechanism for monitoring the impact of shifts in policy and practice over the past decade.