Choosing your pregnancy care provider in Australia
Congratulations, you’re pregnant. Or perhaps trying to conceive? You’re living in Australia and you’re not sure what your options are around medical care providers. This blog post shares my understanding of your choices.
As a Doula, I provide emotional, physical and informational support to my clients around all things pregnancy, birth and their newborn baby. My ongoing continuity of care (including attending your birth) is an important part of ensuring you have the best possible birthing experience. As a non-medical provider, this is simply my understanding of the care options in Australia, and depending on where you live specifically, you may or may not have full access to all these services.
Firstly, you need to see your GP to discuss your options – and it’s great to build a good relationship with a particular GP. My personal recommendation is to do this as soon as you are planning to conceive, and again as soon as you are pregnant. Make sure you feel informed and that your choices are being respected. They may suggest that you start taking prenatal vitamins including iron, folate and iodine. They may also suggest you have a blood test taken to check for things like your immunity to chicken pox or if you’ve ever had the CMV virus. Your GP will give you a referral to act on any of the options below.
Choice 1: go private or public.
If you are an Australian with a Medicare card, then the public system is a free service provided by our government, and you will birth at a public hospital. If you choose to go private, then you are paying your chosen care provider directly (with some subsidy from Medicare) and you have a choice to birth at hospital (public or private) or at home. A private hospital may be covered by your private health insurance (like HCF, BUPA or NIB etc) and you may have to pay an excess directly to the hospital while your health fund often pays the balance. Any additional costs involved with your birth (for example, if you choose to have an epidural which requires an anaesthetist) will be billed to you at a private hospital (again with some rebate available from Medicare or your private health insurer), or if you are a public patient in a public hospital, this will likely be covered by Medicare.
Some women choose to go home after having their baby as soon as possible (often within 24 hours), and if you’ve been in the public system at a hospital then you may have access to a Midwifery service that will come to visit you in your home daily for up to 5 days, and may follow up with phone support too. If you are in a private hospital, women are often encouraged to stay for up to 3-4 days post a vaginal birth and 5-6 days post caesarean birth. This obviously varies from hospital to hospital, and on your personal recovery and circumstance. You may be able to choose a private or shared room. Some private hospitals have luxurious options like serving high tea, or staying in a beachside hotel with room service.
Choice 2: a Midwife or Obstetrician.
Now this can get a little complicated.
In my opinion, Midwives are experts at supporting women to birth vaginally – and where possible, naturally and physiologically. Obstetricians (Ob or Obs) are trained to support women with higher risk and more complicated pregnancies and deliveries that can often include more intervention (like induction, episiotomy and caesarean). That’s not to say that because you see a Midwife your pregnancy and birth will be complication free. However there is often more belief and confidence from the onset of care that women are able to birth their babies, naturally.
If you are a public patient, you can choose GP shared care, which is where you alternate between seeing your GP and an available midwife at the hospital for all your antenatal appointments. At the time of birth, you will be attended to by which ever Midwife is on shift in the delivery suite, and often there can be multiple shift changes during your birth. Or, still as a public patient you may be given the choice to join a Midwifery Group Practice (MGP). This is usually 4-5 Midwives that work together, and over the course of your pregnancy, you will usually meet with all of them at least once. On the day of your birth, one of those Midwives will be on shift and so you will know your care provider at your birth. You may be given the choice to birth in a Birth Centre, which usually promotes natural, physiological and intervention free labours. Sometimes they have a bath or birthing pool too. Or if you’re higher risk (or the Birth Centre isn’t available), you may birth in the delivery unit which has access to things like gas, amongst other interventions for labour. The MGPs usually book out quickly, so if this is your preferred option of care, please book in ASAP.
If you are high risk, the public system will often refer your care to an Ob (whoever is on shift) so you are overseen from a more medical perspective. Then you will likely birth in the delivery unit.
Of course, if there is a complication and you need to have a caesarean section, then an Obstetrician will perform this emergency surgery for you. Even if not an emergency, you may still have the choice to have a caesarean if this is your preference to vaginal birth.
If you are a private patient, you still have the option of a Midwife or Ob. Private Midwives will usually support you in a homebirth, and are considered the gold standard of care you could receive. Less than 1% of Australian women birth at home and this is partly due to increased measures implemented by the government and by insurance companies. For example, these Midwives have to work in teams as two Midwives will be required in your home at the time of birth. They bring with them syntocin (to help prevent postpartum haemorrhage) as well as a resuscitation kits (including oxygen) in case your newborn in non-responsive, vitamin K etc... Many women who choose to birth at home opt in for a water birth, which is not always an option at hospital (as your care provider needs to be trained specifically in this). You may need to be registered at your local hospital as a backup in case of emergency and you have to transfer to hospital. Usually if this happens, it truly is an emergency, and you will likely need a caesarean. Some Midwives have relationships with private Obs and so you may in fact have met them beforehand and know who would be performing your surgery. If your preference is for a private Midwife and a homebirth, you will need to book in as soon as you know you are pregnant as they tend to fill up their books quite quickly. There is, again in my opinion, a shortage of available midwives, which is a pity for women as it can limit their birthing choices.
If you hire a private Ob, then again you can choose from public or private. The Midwives on shift at the time of your birth will be reporting to the Ob who will be making decisions and ‘calling the shots’ for you. You may be consulted in these decisions and hopefully the Ob will be at the hospital with you. There are times where they are consulted over the phone and the Midwives deliver news of such decisions to you. While in many cases Obs are present or pop in during the labour too, sometimes they only make it in time to “catch the baby” – though you will have been attended to by Midwives in the interim. If you are a private patient in a public hospital you will probably be delivering in the delivery unit. To my knowledge, private hospitals only have delivery units and do not offer birth centres.
Is it really a choice? Planning your birth.
Of course, with all births, there is only so much we can “plan” and the above is to help you feel informed and empower you to have a preference. As a birth and postpartum Doula I usually encourage my clients to labour at home as long as possible and I do not support an intentional freebirth (birthing with no medical care provider), although occasionally, with a precipitous labour, babies have been known to come in under 2 hours – sometimes babies are simply in a hurry! If this happens to you, make sure you let your birthing provider know, and I would probably recommend calling an ambulance.
Also note, that you are never locked in to any one chosen method of care and you can change your provider at any time (even at 41 weeks pregnant!). You may have paid a non-refundable service fee, which would be frustrating to lose the money, but changing may impact your birth experience for the better so it’s well worth considering change if you’re unhappy with your chosen provider. It’s so important to feel supported, informed and present for your journey to meet your baby.
I hope this has been helpful and again, the above is simply my understanding of your birthing choices (it is in no way a scientific or researched document). As always, please let me know if you have any questions and feel free to leave a comment below.
About Essential Me
Hi, I'm Amanda. I support women and couples during their pregnancy, birth and postnatal journey as a Doula, Ka Huna massage therapist and Pilates instructor. I'm Based in Sydney and would love to help you. Please check out my Top 10 Tips for the best possible birth experience here. I'd love to meet you for an obligation free interview to see if you feel we're the right fit. Contact me here. Thanks, Amanda x