- Your Options for Pregnancy Care in Australia
- The public system
- Public Hospital Care
- Birth Centre Care
- Public Hospital Antenatal Clinics
- Midwife Clinics
- Team Midwifery/Midwifery Groups
- General Practitioner Shared Care Programs
- Private pregnancy care options
- Independent midwives/Home Birth Care
- Doula- Professional BirthSupport Person
- Private Hospital Care
As soon as you’re pregnant, you’ve got decision to make. Being well informed of all your choices can help you to have the most rewarding experience for you and your family.
Two things you will need to make decisions about early in pregnancy are who will provide your care and where you will give birth to your baby. These decisions often go hand in hand since most care providers have a certain place they do deliveries.
Most women base their choices on health histories, personal preference and belief systems, finances and well informed opinions.
Your Options for Pregnancy Care in Australia
The public system
The big advantage of this choice is that it is free to all Medicare card holders.
Public Hospital Care
To go through the public system, you’ll need a referral from your GP to a public hospital before your first antenatal appointment. The midwives booking your care will tell you about the options that are routinely available in that particular hospital. That’s not to say you can’t make choices that are not offered, it’s usually just a matter of discussing your wishes.
If you decide to have your baby in a public hospital, the birth will generally take place in the hospital birthing room. The hospital midwives and doctors will look after you during the birth. As a public patient you have limited opportunity to choose your own midwife or doctor and each hospital has different birthing facilities available. Some have birth pools or spas in each birthing suite, some have only one and its first in best dressed. Some have none. If you have more than one hospital in your area it can pay to shop around.
After the birth, you will be cared for in a postnatal ward. Accommodation arrangements vary from shared rooms to individual rooms. Check with your chosen hospital for details.
Birth Centre Care
Birthing or birth centres are separate from regular hospital care, but located close by the labour wards within the hospital. In a birth centre, midwives usually care for you during your pregnancy, the birth and after the birth. Often the same midwife or midwife team supports you through your pregnancy and birth.
Birthing or birth centres feel more home-like and less clinical than hospital labour wards. However, if there is a problem during labour then an obstetrician or doctor will assist with your birth. Depending on the centre you choose, discharge is usually 24 hours after the birth. After this time, you can either go home or transfer to the hospital’s postnatal ward.
Birthing centres are quite popular and it is a good idea to book in early in your pregnancy. If you are thinking about going to a birthing centre it would be good idea to ask your doctor or midwife about it as early as possible or call the birth centre yourself.
Public Hospital Antenatal Clinics
In public hospital antenatal clinics doctors and midwives provide anti-natal care. You may not see the same health practitioner at each antenatal visit and you are unlikely to have the same health practitioners attend your birth and provide postnatal care.
These clinics can be very busy and you may find you have to wait a while, despite being given an appointment time. Take a book to read!!
Many major public hospitals have ‘midwife clinics,’ run by a midwife or a group of midwives. These clinics are sometimes run in the community and are called ‘out-reach clinics’. Midwives are skilled professionals who are qualified to provide complete care for pregnancy and childbirth. Midwives working in these clinics provide care during the entire pregnancy for women experiencing normal pregnancies. Women get to know their midwife or midwifery team during the pregnancy under this model of antenatal care. If any complications develop then the midwives refer the women to a doctor at the hospital.
Women then give birth in the hospital delivery ward and are attended by the midwives and doctors who are on duty at the time.
After the birth midwives on the postnatal ward provide care for you.
Team Midwifery/Midwifery Groups
Most women want to receive consistent information and care from someone they get to know throughout the pregnancy, birth and after they have their baby. In response to these needs team midwifery programs are progressively being set up in public hospitals. This generally involves small groups of midwives who work together to provide antenatal, labour, birth, and postnatal care to women.
Women are referred to a hospital doctor only if complications develop.
Many of the larger metropolitan hospitals now run team midwife programs or variations of continuity of care programs.
General Practitioner Shared Care Programs
Most hospitals now offer women the option of having their pregnancy care shared between a general practitioner (GP) and a hospital. GPs participating in shared care programs must meet certain criteria before being able to provide antenatal care.
Hospital midwives and doctors mostly attend the birth and give postnatal care. In some cases, particularly in rural areas, GPs may also attend the birth. There are bilingual GPs who can provide shared care. If your GP does not bulk bill or you do not have a Medicare card you will have to pay for this service. You can arrange shared care by contacting your local hospital and finding out if your GP has a shared care arrangement with them.
Women without a Medicare card will have to pay for all of their pregnancy, labour and post-natal care. In this case, shared care between a GP and a public hospital is usually the least expensive option. If you have no Medicare card and payment is a problem, then you can discuss this with your hospital.
Private pregnancy care options
Independent midwives/Home Birth Care
Several hundred women each year in Australia choose to give birth at home. These women are generally cared for by independent midwives, who work for themselves rather than a hospital.
Home birth is a responsible choice for well prepared women with uncomplicated pregnancies and is recognised as such by the World Health Organisation and by Australia ‘s National Health and Medical Research Council.
World wide experience with planned homebirths shows that statistically, outcomes for both mother and baby are as safe as hospital, or safer with much lower rates of medical intervention, faster recovery and a more satisfying birth experience. Women who live almost anywhere in Eastern Australia can have their babies at home under the guidance of midwives.
Traditionally the home has been the usual place for birth. The movement away from the home to hospital has occurred with the advances in hospital based medical care. Almost all Australian births have occurred in hospital since the early years of the 20th century, and homebirth is now generally regarded as unusual.
If you choose a homebirth, the same midwife or a small group of midwives will care for you throughout your pregnancy, birth and after the birth of your baby. If complications occur during the pregnancy or birth it may mean that you will need to have your baby in hospital. Most independent midwives will accompany you and support you if this occurs although due to the fact that they are currently unable to get professional indemnity insurance, they will not be able to participate in your care in any other role than as a support person.
This option is now quite affordable since it is subsidised by medicare. You can claim medicare rebates for visits with an independent midwife before and after birth as well as during the birth provided the birth takes place in a hospital. Your midwife needs to have a visiting rights in place with a hospital and you need to have a Dr approve the care. There are no rebates available for homebirth in Australia at this time. Some private health funds give rebates for midwifery services and if yours doesn’t you may be able to talk them around.
If you are considering or planning a home birth, you may find the Joyous Birth forums a great place to talk with other home birthing families and professionals to help you make your decisions.
Doula- Professional BirthSupport Person
The Doula is a professional birth attendant who understands the needs of the pregnant and labouring woman and is able to support and empower her before, during and after the birth of the baby. The Doulas main focus is to emotionally, physically and spiritually care for the mother and family throughout the birthing process and is employed and paid by the birthing family as a private birth attendant. Worldwide, Doulas have become recognised as legitimate carers and their presence has been shown to increase the safety of birth and enhance the experience for the mother, her partner and the baby.
When Doulas care for birthing women there are reductions in:
- Caesarean birth by 50%
- Length of labour by 25%
- Forceps delivery by 40%
- Requests for epidurals by 60%
- Syntocinon(artifical oxytocin) use by 40%
Typically, a Doula will meet with the family on a number of occasions during the pregnancy to build a strong and trusting relationship. The Doula listens to the mother and empowers her to seek out any relevant information so that she can make informed birth choices. When the woman goes into labour she will contact her Doula and they will arrange to meet at the hospital. The Doula is not responsible for any medical care, this is entrusted to the hospital staff. She will undertake many comfort measures requested by the mother during her antenatal consultations. The Doula will then remain with the woman throughout the labour and into the immediate post-partum period, until the mother feels comfortable and ready to rest with her newborn. The Doula is a professional support person who understands the processes of labour and nurtures the mother, enabling her to have the optimum birth experience.
Private Hospital Care
If you have the appropriate private health insurance (or are uninsured and willing to pay) you can choose a private obstetrician to provide your antenatal care and attend your birth in a private hospital. You can also have a private obstetrician attend your birth in a public hospital that they have visiting rights to. You will need to check with your health fund to see if you are covered for this type of care. Costs for private care may not be completely covered by a health fund and you may have to pay part of the fee.