Choosing a care provider is one of the most important decisions you will make about your pregnancy and birth.
***Key Points***
Options for Pregnancy, birth and postnatal care includes:
- Public Hospital Offering Maternity Care – This option includes
- Public hospital care
- Public hospital shared care
- Public hospital Midwifery care
- Continuity of Midwifery care
- Birth centre care
- Publicly funded home birth
- Private Obstetric Care
- Private Obstetric care in a private hospital
- Private Obstetric care in a public hospital
- Private Midwifery Care
***Key Points***
***Midwives and Obstetricians***
Midwives are skilled professionals who are qualified in providing pregnancy, birth and postnatal care for women experiencing normal pregnancies. A Midwives role encompasses more than just the physical checks during your pregnancy, they care for your social and emotional needs as well. A Midwife will refer you to an Obstetrician or other specialist if complications develop in your pregnancy
Obstetricians are medical doctors with specialist training in caring for women during pregnancy and childbirth. Their expertise is caring for women with high-risk pregnancies or if complications arise during labour or birth.
In most settings Midwives and Obstetricians will work together to ensure your pregnancy is safe and you are cared for in a way that is individualised and meets your wishes and epectations.
***Midwives and Obstetricians***
***Choosing a care provider***
Throughout your pregnancy, birth and postnatal care, you should be an active participant in your care and provided with options regarding your care and part of all decisions.
Choosing a care provider is one of the most important decisions you will make about your pregnancy and birth. Your provider and place of birth will influence your pregnancy care, your options during labour, and the support available to you after birth.
Different women have different needs in relation to pregnancy and childbirth and you require access to appropriate care for you that aligns with your approach and individual wishes.
The options will include public hospital care, GP shared care, Private Obstetric care and Private Midwifery care. A
The first step for most women is to visit their general practitioner (GP). Your GP will confirm your pregnancy, arrange screening tests, blood tests, and ask about your general health and past pregnancies. The GP can discuss the options in your area and give you a referral to your choice of provider or place of birth.
However, it is helpful to have questions ready for your provider to take part in shared decision making about what is important to you and meets the needs of your individual pregnancy risk factors.
***Choosing a care provider***
***Public hospital***
Public Hospital Offering Maternity Care
Public Hospital Care
Attending a public hospital means you would attend your chosen hospital for all aspects of your pregnancy care which is provided by the hospital Midwives and Doctors.
Women who book for pregnancy care and to give birth at their local hospital maternity unit will have most of their pregnancy appointments with midwives and some with obstetricians. When they give birth, they are attended by the midwives and if required the Obstetrician on duty at the time. They may see a range of different midwives and obstetricians throughout pregnancy and their birth.
Public Hospital – Shared Care
Shared Care means you see your chosen GP throughout pregnancy in consultation with other health practitioners at your chosen public hospital. At key times in your pregnancy, you will see the hospital Midwives, Obstetricians, or other specialists.
If your pregnancy becomes higher risk for you or your baby, you will be asked to see the hospital doctors for specialist care. Hospital midwives attend the birth and provide postnatal care.
Public Hospital – Midwifery Care
Many public hospitals offer Midwifery led clinics. This means a midwife or team of midwives are the primary providers of care during your pregnancy. A team of midwives being responsible for care of a small number of women (team midwifery) or a woman receiving care from one midwife or his/her practice partner (caseload midwifery). At times these clinics may be in the community and may be referred to as ‘outreach’ clinics.
Costs:
Care in public hospitals is free, though there may be some out-of-pocket costs if you opt for shared care with your GP or you may be required to pay for blood tests, ultrasounds and antenatal classes.
Continuity of Midwifery Care
Continuity of midwifery care involves a small group of midwives who work together to provide pregnancy care, labour, birth, and early postnatal care to women and your family. This means you get to know your midwife during pregnancy, and they will be on call for the birth and come to see you in hospital or at home after your baby is born.
The benefits of midwifery continuity of care when providing maternity services are well documented (Sandall et al 2016; Homer 2016). Midwifery continuity of care models are associated with the lowest rates of intervention, including caesarean section, forceps and ventouse delivery. Continuity of carer is when a health professional who is known to you provides all your care, thus enabling the development of a relationship of trust to develop and this model of maternity care has been shown to be the most satisfying for women.
These programs are available at some public hospitals or as a private Midwifery practice. Book early in your pregnancy as these programs get full very early and have waiting lists.
Birth Centre Care
A birth centre looks and feels different to the clinical environment of many hospitals. A birth centre will often have beds and furnishings that create a home-like environment. This is an option you may consider if you have a low-risk pregnancy and if this option is available close to where you live.
Some birth centres are stand-alone birth centres while others are associated with a hospital.
Research shows that women who deliver in a birth centre have lower intervention rates than those who deliver in hospitals and importantly are more satisfied than with other forms of care.
Book early as birth centres are very popular and often have long waiting lists.
Publicly Funded Home Birth
In Australia there are several publicly funded (no cost to you) home birth options attached to public hospitals. These provide the opportunity for low-risk women who don’t live far from the hospital to have a home birth and be attended by the Midwives from the hospital.
Most publicly funded home-birth programs set a restricted distance (time or kilometers) from the hospital. They are free to access if you meet the criteria for booking with the team. Book early!
***Public hospital***
***Private obstetric care***
Private Obstetric Care
Private Obstetricians – Private Hospital
If you have private health insurance and meet the waiting periods for Obstetric care (or are uninsured and willing to pay) you can choose a private obstetrician for your antenatal, childbirth and postnatal care. The Doctor that you choose will provide care at several private hospitals where you can choose to birth your baby. Contact these hospitals to arrange a tour of the facilities and research what is available at each hospital.
Women have continuity of care from their chosen private obstetrician, and they develop a relationship with this carer who will be present during the birth of their baby.
Midwives provide the labour care on a birth suite at a private hospital and will liaise with your Obstetrician closely during labour. In most cases your Obstetrician will be present during the birth of your baby. Midwives provide care on the postnatal ward at a private hospital.
Research shows women experience more intervention in this model of care although it should be noted that Obstetricians vary. It is key to find an Obstetrician whose policies and approach to birth is a philosophical match to yours. See questions to ask your Obstetrician before deciding they are the practitioner to care for you during your pregnancy, birth, and transition to parenthood.
Costs: Contact Obstetricians to ascertain their out-of-pocket costs for pregnancy, birth, and postnatal care. It will vary from $500 – $12 000. Check with your health fund to see if you are covered for this mode of care.
***Private obstetric care***
***Private midwifery care***
Private Midwifery Care
Private Midwives
In some states in Australia, private midwives attend births in hospital, birth centres and as the primary carer at a home birth.
They work for themselves rather than a hospital or health service. This means a cost is associated with this service, which can range between A$3,000 and $7000. You may be able to get a portion reimbursed from Medicare if the midwife is an eligible Midwife with a Medicare provider number.
This continuity of care model allows you to develop a personal relationship with a Midwife during pregnancy, who gets to know you and your family and is closely aligned to your needs and decisions during pregnancy and birth.
If you plan to give birth at home with a private midwife and complications occur during pregnancy or during the birth of your baby, you will be advised to transfer to hospital and your midwife will accompany you as support
As well as these professionals, others may form an integral part of your antenatal care team such as an aboriginal health worker, bilingual or multi-cultural health worker, a perinatal psychologist, nutritionists, obstetric physician, endocrinologist or drug and alcohol worker to name a few.
***Private midwifery care***
***Suggested questions***
Suggested Questions for your care provider
Find out what public maternity services are available in your area?
- What are the timings for antenatal visits, when would you visit for a booking in visit?
- What is the rate of Caesarean section, vaginal births etc in that hospital?
- What models of care are available at this hospital?
- Is there an option for shared care with my GP?
- Is there a continuity of midwifery care model?
- Is there a team midwifery model?
- Is there a multi-disciplinary team available for advice and options?
- If I am high risk, what are my options for specialist obstetric care?
- What are my options in labour, for pain management or water facilities?
- What support is available after the birth of my baby?
- What are the views on others involved in their care – i.e., doulas or extra support people?
- What are their policies regarding skin to skin after the birth of your baby?
- What are their policies regarding optimal cord clamping?
- What are the out-of-pocket costs?
- What options are there for antenatal education? What are the costs involved?
- What specific mental health services are available?
- When does care and support cease after the birth of your baby?
Private Obstetric care or Private Midwifery Care
- What is this Obstetricians rate of Caesarean section, vaginal birth rates and episiotomies?
- What is their philosophy or approach to pregnancy and birth?
- What are their views on post-date pregnancy?
- What are their views of monitoring your baby in labour?
- When will they want to intervene in labour?
- Will they allow you time to talk about decisions in pregnancy?
- Do they work in a multi-disciplinary team for advice and options?
- What are the policies on others involved in their care – i.e., doulas or extra support people?
- What are their views on skin to skin after the birth of your baby?
- What are their views of optimal cord clamping?
- What are the out-of-pocket costs?
- What options are there for antenatal education? What are the costs involved?
- What specific mental health services are available?
- When does care and support cease after the birth of your baby?
Consider this list and add whichever questions are important to you to your notes section of your app. Discuss this with your birth partner and what is important to them.
***Suggested questions***
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