How cuts are affecting cardio-obstetrics care for pregnant women

Heart disease remains the leading cause of maternal death in Australia, accounting for a significant proportion of pregnancy-related mortality according to data from the Australian Institute of Health and Welfare. As the population of expectant mothers grows older and more women enter pregnancy with pre-existing conditions such as hypertension, diabetes, and congenital heart disease, the demand for specialised cardio-obstetrics care has never been greater.

This emerging field bridges cardiology and obstetrics to manage complex pregnancies where cardiovascular risk is elevated. Yet the infrastructure supporting these services is buckling under financial strain. Recent adjustments to the Medicare Benefits Schedule, including rebate freezes and reductions for specialist consultations, are reshaping how and where this care can be delivered.

For women in metropolitan centres like Sydney, Melbourne, and Brisbane, access to multidisciplinary teams at tertiary hospitals has historically provided a safety net. But as funding tightens, waiting lists lengthen and out-of-pocket costs climb, even these hubs are struggling to maintain the integrated care models that high-risk pregnancies require.

The ripple effects are felt most acutely in regional and remote communities, where specialist services were already scarce. Understanding how policy decisions translate into clinical realities is essential for safeguarding maternal health across the country.

The growing demand for cardio-obstetrics services

Cardiovascular conditions complicate roughly 1-4% of pregnancies in Australia, with higher rates among women from culturally and linguistically diverse backgrounds and those living in lower socioeconomic areas. Hypertensive disorders, including preeclampsia and gestational hypertension, are among the most common reasons for referral to combined cardiac-obstetric clinics. Peripartum cardiomyopathy, though rarer, requires intensive surveillance and coordinated planning around delivery. Acquired conditions such as rheumatic heart disease also remain relevant, particularly in communities where it persists.

The Australian healthcare system has responded to this need through the development of dedicated clinics in major teaching hospitals. These services bring together cardiologists, obstetricians, anaesthetists, and specialised midwives to provide continuity of care. The capacity of these clinics, however, has not kept pace with referrals, and many operate with limited administrative support and fragmented funding streams that limit their ability to scale up.

How rebate changes reshape consultation pathways

Consultations with cardiologists and obstetric physicians are rebated through the Medicare Benefits Schedule, but successive government reviews have resulted in adjustments that practitioners describe as inadequate. When rebate values fail to keep pace with the cost of running a practice, specialists may reduce the number of bulk-billed appointments or limit the time available per patient. Some practitioners report shifting the proportion of complex cases toward the private fee-paying sector simply to keep their practices viable.

For pregnant women requiring multiple reviews throughout gestation, these constraints translate into longer waits and higher out-of-pocket expenses. A single comprehensive cardio-obstetrics assessment can take 45 minutes or longer, far exceeding the standard consultation rebate. Without adequate remuneration, the financial viability of providing this depth of care diminishes, particularly for specialists working outside of hospital outpatient settings.

Geographic inequality and the rural divide

Women living outside major cities face structural barriers that predate recent funding decisions, but the impact of rebate reductions amplifies these inequities. In towns across western New South Wales, the Kimberley region of Western Australia, and Far North Queensland, access to a cardiologist often requires travel of several hours or a wait of months for an outreach visit. When weather events or seasonal flooding limit travel options, scheduled appointments may be cancelled indefinitely.

Telehealth has emerged as a partial solution, with Medicare items introduced during the pandemic becoming permanent fixtures for specialist video consultations. However, MBS rebates for telehealth often fall short of the costs associated with multidisciplinary case conferencing, which is the cornerstone of complex pregnancy management. As a result, rural general practitioners and remote specialists face difficult choices about how to allocate limited clinical time, often absorbing the shortfall themselves.

The cost of multidisciplinary coordination

Effective cardio-obstetrics care relies on collaboration between multiple clinicians, but the current funding model poorly recognises the time invested in team-based planning. Case conferences involving a cardiologist, obstetrician, midwife, and anaesthetist are essential for women with conditions such as mechanical heart valves, aortopathy, or severe valvular disease, yet there is no specific MBS item number that adequately covers this activity.

Hospital-based clinics absorb some of this cost within their operational budgets, but public hospital funding constraints in Australia mean that new initiatives often compete with existing services for resources. The result is a system where the most vulnerable patients rely on the goodwill and commitment of clinicians rather than structured financial support. When staff turnover occurs, the institutional knowledge that sustains these informal networks can disappear with the departing practitioner.

Impact on Aboriginal, Torres Strait Islander and migrant women

Maternal health outcomes for Aboriginal and Torres Strait Islander women remain a national concern, with cardiac complications contributing to the gap in life expectancy. Women from Pacific Island and South Asian backgrounds also experience higher rates of conditions such as rheumatic heart disease and hypertensive disorders. Interpreter access, transport assistance, and culturally appropriate education materials are not luxuries but clinical necessities in these communities.

Language, cultural safety, and transport barriers compound the challenges of accessing specialist care. When funding pressures reduce the availability of dedicated Aboriginal Health Workers or interpreter-supported consultations, the consequences extend beyond convenience to clinical safety. Culturally appropriate cardio-obstetrics programs, such as those piloted in parts of the Northern Territory, require sustained investment to demonstrate their value and to be expanded to other regions where need is high.

Toward sustainable access and policy reform

Preserving access to cardio-obstetrics services requires a coordinated approach that recognises the complexity of the work involved. Sustainable funding must account for the longer consultation times, the need for multidisciplinary input, and the additional costs of providing culturally safe care. Expanding MBS items for complex case conferencing and acknowledging the role of allied health professionals in antenatal cardiac rehabilitation are practical starting points.

Investment in data collection through obstetric medicine registries will strengthen the evidence base for advocacy. Equally important is ensuring that policy discussions include the voices of women who have experienced cardiovascular complications during pregnancy, as their stories illustrate the real-world impact of funding decisions. Clinicians, administrators, and patient advocates must work together to communicate the stakes clearly to decision-makers in Canberra and across state health ministries.

Aspect	Metropolitan tertiary centre	Regional or remote setting
Typical wait for cardiology review	2-6 weeks	6-16 weeks or longer
Access to multidisciplinary clinic	On-site, integrated	Via telehealth or outreach
Bulk-billing availability	Limited for complex cases	Rare; high out-of-pocket costs
Travel requirements	Within city	Often requires long-distance travel
Cultural support services	Established programs	Variable, often limited

Practical steps to safeguard access

• Expand Medicare rebates for extended cardio-obstetrics consultations to reflect the time required for comprehensive assessment.
• Introduce a dedicated MBS item for multidisciplinary case conferencing involving cardiology and obstetric teams.
• Strengthen telehealth funding for complex pregnancy management in rural and remote areas.
• Invest in culturally safe cardio-obstetrics programs for Aboriginal, Torres Strait Islander and migrant women.
• Support national data collection through obstetric medicine registries to inform policy.
• Ensure consumer representation in funding reviews that affect maternal cardiac services.

Join the conversation about protecting cardio-obstetrics care in Australia. Share your story with your local member of parliament, support organisations advocating for maternal heart health, and add your voice to calls for sustainable funding that keeps these vital services accessible for every woman who needs them.