If I don’t know my options, I don’t have any
Now that you are pregnant, you may be feeling unsure as to what’s ahead of you and where you go to find the best care and support for yourself and your developing baby.
Will you just take your GP’s referral to your local hospital or obstetrician and be led along the conveyor belt like so many, OR will you do your research, look at all your options, and find the best fit for you?
Where do I start in finding Antenatal Care?
Before you start looking at your options of antenatal care, it is important to determine the type of birth you would like. The type of birth experience you want is a very personal decision, as your care should reflect your wishes. Here are some options to consider:
- A natural, instinctive birth in a home setting or birth center, surrounded by experienced midwives, doula and support team
- A pure birth, unassisted in a home setting
- A natural birth in a hospital setting, with an independent midwife or specialist
- A natural birth in a hospital setting, actively managed by the hospital or care providers.
- A surgical birth in a hospital
Once you have an idea on the type of birth you would like, it is important to understand where (birthing place) and who (care provider) will best support you to achieve the type of birth you want.
Your care provider will depend on:
- Where you plan to give birth – in a hospital, a birth center or at home.
- The services available in your area (ask at the antenatal clinic or maternity unit of your local hospital, your Local Health District or your GP, private obstetrician or privately practicing midwife). Ask your midwife or GP about your local maternity services, so you are aware of the range of services available, in the event that requirements for your care, or your baby’s care, become more complex.
- Your health history, or if special circumstances have arisen during pregnancy, you may need specialist care.
Where you birth will determine your birth outcomes
It is not a given, that if you attend your local hospital, that you will be able to birth the way you want. Each hospital and care provider has their own policy’s and philosophy of managing birth. Assuming that it is going to be in-line with your ideals and wishes, and rocking up to your birth expecting complete parent input, may leave you with disappointment. Ensure that you do your research on your choice of birth place. What are their policies? What are their intervention rates & surgical birth rates?
Many parents are unprepared to meet the policy’s and management styles in a less than natural setting or with a provider who subscribes to Active Management of Labour (AML). AML was developed in the late 60’s in Ireland in an attempt to reduce the number of caesareans, but in fact has had the opposite effect. This management style is still used today, and although birthing in a hospital does not mean that your birth has to be a managed birth (not all hospitals, doctors or midwives engage in AML procedures), there is still a large percentage of hospital facilities and care providers using many features of AML rather than exercising patience and allowing labour to play out naturally.
In Marie Mongan’s 4th Edition of her book ‘HypnoBirthing – A Natural Approach to a Safe, Easier and More Comfortable Birthing’, she discusses the importance of being well prepared for your birthing, understanding your options, and choosing the right care for yourselves. Marie talks about 4 Management Models that are available to choose from, and gives a comprehensive comparison for what you can expect with each model of care. This book is a great start to really understanding your options.
Every couple deserves access to high-quality, evidence-based, culturally competent maternity care in a range of settings close to where they live. This unfortunately is not available in all areas, and if you are living in a remote area, your options may be much more limited, so it is vitally important that you do your research early.
Choosing your care provider carefully is going to be the key to getting the input into your birth. Finding a care provider that supports the type of birth you want is going to give you a much greater chance of seeing your birth wishes play out.
Choices of Care for Pregnancy and Birth
Here are your main choices for pregnancy and birth care whether you choose to be cared for in the public health system or the private health system. Your choice may be determined by the health cover that you have, so check with your health fund to find out what aspects of your care and health care services are covered during your pregnancy, birth and postnatal period.
Public Health System
If you choose to receive your antenatal care and give birth in the public health system, you and your baby will receive your care through a midwifery continuity of care program, an antenatal clinic, a midwives’ clinic or with your GP (in partnership with the antenatal clinic). The services offered vary from hospital to hospital and area to area so you might find a number of options open to you.
- Midwifery continuity-of-care – Many public hospitals now offer midwifery continuity-of-care programs. You’ll get to know the midwife or midwives who will look after you through your pregnancy, labour and birth and the postnatal period. You’ll receive consistent information, support and advice from your midwife or midwives. This type of care has been shown to have great outcomes, as women feel well supported and confident. We know from evidence and practice, having a known midwife for pregnancy, birth and postnatal care has best outcomes for mother and baby.
- Your hospital may offer:
• Caseload midwifery or midwifery group practice– If you’re booked in for this kind of care,you’ll have one midwife whom you’ll get to know well over the course of your pregnancy, labour, birth and postnatal care. Your midwife will provide your midwifery care and will have one or two other midwives to back them up if they are not available. Your midwife will also coordinate your care and work in collaboration with the doctors in the maternity service if that’s needed.
• Team midwifery- In a team midwifery practice, a small team of midwives will care for you at a
hospital antenatal clinic during your pregnancy, through your labour and after the birth. The midwives work with doctors in the maternity unit. You will usually get to know all the midwives on the team, and one of them will always be available for your labour and birth care.
- Your hospital may offer:
- An antenatal clinic in a public hospital – The maternity unit at your local hospital usually has an antenatal clinic. Your antenatal visits will be with the clinic midwives, and if it is determined that there may be special circumstances that you require specialist care, you may see one or several doctors during your pregnancy.
- Midwives clinic – Most public hospitals also offer midwives’ clinics. These clinics might be located at
the hospital or birth center, or in the community (for example, at your local Community Health Center). Midwives care for women with normal pregnancies and during their labour and birth in birth centers
or at home (if you’ve chosen to have a home birth). Your midwife will refer you to a doctor if you develop any health concerns during your pregnancy. You will be attended my any midwife for your birth, this option does not give you a choice of midwife.
- GP shared care – If your GP offers shared care, you can choose to continue to see your GP for most of
your antenatal care. You will see your GP for some appointments and attend the clinic for other checkups. Not all GP’s do shared care. If your doctor doesn’t offer shared care, ask at the hospital if it has a shared antenatal care program and they can offer you a list of GP’s in your area who do offer shared care. One of the benefits of GP shared care is that you develop a long-term relationship with a doctor who can continue to look after you and your baby once your baby arrives.
In the Public Health System you are able to birth:
- At home
- In a birth center
- In a hospital
Private Health System
Most women who choose the private health system have private health insurance, so that they have help covering the (varied, but high) cost. Choosing your own ‘private’ care provider definitely has it’s benefits, but it is important to make sure that who you are choosing is supportive of your birth wishes. Some women choose their own care provider to look after them during their pregnancy and birth. This means you book in to see a privately practicing midwife, private obstetrician, or a GP who does antenatal care. You can choose a private practitioner who practices in a private hospital, a public hospital or conducts home birth.
- Privately practicing midwives – support women in home birth and hospital births. There are many privately practicing midwifes and independent groups now available (see our supportive providers list). You must book in early, so if this is an option you are considering, get onto it quickly. A midwife provides a wonderful service of continuity of care, where you have the same midwife supporting you through pregnancy, birth, and after the baby is born. We know from evidence and practice, having a known midwife for pregnancy, birth and postnatal care has best outcomes for mother and baby. Some private midwives (“eligible” midwives) now have a Medicare Provider Number. This means that the services they provide are covered by Medicare although, as with doctors, there may be a “gap”. Ask your midwife for payment details and possible rebates for her services. Your midwife will be able to refer you to an obstetrician or GP obstetrician at any time in your pregnancy, labour or birth if the need arises.
- Private obstetrician and GP obstetrician – With this option you receive care from a private obstetrician and/or a GP. You’ll see them at their offices. Some obstetricians employ a midwife who may also be involved in your antenatal care. Generally, private obstetricians or GP obstetricians deliver babies at a small number of hospitals so you may have to choose between a couple of hospitals. You will be cared for in labour by midwives employed by the hospital but your doctor will be closely involved and will normally be present at
the birth of your baby. Some obstetricians and GP obstetricians may also offer pregnancy care in your home and support home birth. Obstetricians are trained surgeons for complications in birth, so if you have a ‘high risk’ pregnancy, you may want to consider this specialist care.
In the Private Health System you are able to birth:
- At home
- In a birth center
- In a hospital
So now you know your main options of care, how do you ensure that the maternity care you choose will be woman centered, reflecting your needs and wishes with safe and quality practices?
How will you know if the care provider you are choosing is right?
We have put together another post on ‘shopping for maternity care’, and have also put together a list of questions that you can ask when ‘interviewing’ for your care provider. Download your ’40 Questions Checklist’, so that you have covered all bases. Make sure that you listen to their language. If they are speaking in a very medical manner, you may find that they are more likely to subscribe to a medically managed birth (AML).
You are the expert on what is best for you. You deserve to have the best care, and so does your baby. When you are informed, and know your choices, you will find that you have many.
Choosing the Best Antenatal Education for you is the next step in your decision making process. Click here to find out more
Wishing you a happy birthing day!