Know Your Pregnancy Care Options
Updated: Dec 17, 2019
Where and with whom to birth your baby.
I'm very lucky in my line of work that I am able to have daily open and honest chats with the many beautiful Mamas and Mamas-to-be at our Paddington studio about all things birth, pregnancy, and motherhood. Lately I've been getting asked where I am planning to have my baby and I’ve realised that a lot of women haven’t heard about all the different options available for where and with whom you can birth your baby, aside from choosing between a public or private hospital. I think knowing your options can be empowering and exciting and can help Mamas have a really positive birth experience. Not just a good outcome which we associate with ensuring healthy Mum and Babe, but also for Mamas and their partners to feel like they were well informed, supported, and able to make their own decisions along the way. And so.. Body and Birth to the rescue!
Having a designated pregnancy health practitioner to guide you through the many decisions and challenges of pregnancy is essential and can be very reassuring. Keep in mind that while this may be your very first time going through these new experiences, these practitioners have cared for many, MANY women through their pregnancies, births and beyond and are very well informed, trained, and experienced.
While you can choose where you want to have your baby, you can also choose what type of care you would like best and who you would like to work with, generally between a more medical model with an Obstetrician (OB) as your main guide, or a midwifery-led model of care where a registered Midwife is your primary carer. Both of these practitioners are specially trained to care for women throughout their pregnancies and births, though they often have different approaches - which is great! As every Mama-to-be will also have different needs and preferences.
I’ve had the privilege to work with hundreds of Mamas over the years and so have had the opportunity to hear lots of different stories, with some wonderful experiences in both public and private hospitals, with private obstetricians and their teams, amazing births with Midwives and some beautiful home births. Of course, I have also heard of very challenging or traumatic experiences in any situations where things don’t go to plan. This post is not intended to sway anyone one way or another, rather just to present the different options available :)
When you are making your own decision, I would highly recommend calling or meeting with potential practitioners to learn more about them. In Australia if you are currently pregnant, most practices (of both private OBs and private Midwives) will bulk-bill (paid for entirely by Medicare) an initial appointment so that you can meet with the Midwife or Obstetrician (or another staff member who works with the OB) to learn more about them and their model of care.
One of the well researched factors of childbirth outcomes is around having continuity of care, that is getting to know your care provider throughout the course of your pregnancy and for them to then guide you during your birth. This helps you feel supported, empowered, and informed throughout your pregnancy and delivery and has been shown to be a key factor for a positive birth experience. Therefore, it is highly worthwhile to find a practitioner or model that you can really connect with, so do your research and enjoy the process of meeting some different practitioners. Different personalities will appeal to different people, some practitioners are more straightforward with the facts while others may be more nurturing and more open to your feelings and suggestions. And if you start with one practitioner but find that you don’t get along or you don’t feel supported, then don’t be afraid to find someone else that suits you better - remember this is YOUR pregnancy and birth journey!
Obstetrician Led Care
A well-known and popular choice for many mamas-to-be, Obstetricians are medically trained surgeons in a combined field of Obstetrics and Gynaecology. They are highly specialised to deal with complex medical conditions that may arise with pregnancy and childbirth and have a wealth of knowledge and skills when it comes to dealing with complications of all types. Of course in the best way possible, we’d always hope that they don’t have to rely on those skills or need to use them, but if concerns do arise then you definitely want them to be around!
As is the case with many medical professions, all practitioners are different with different values and approaches to care during pregnancy, and as such will have different aspects of birth and pregnancy that they deem important or vital. When connecting with them for the first time it is good to know what is important to you, what questions you’d like to ask, and have an idea of your birth plan. For example, if your personal preference is to have a vaginal delivery, then don’t be afraid to ask about the current rate of vaginal vs C-section deliveries of a particular physician or of the hospital at which you are planning to have your birth.
If you do choose to go with an obstetrician throughout your pregnancy, you would still have various appointments with a midwife, and the midwife on shift would be your primary carer during the early stages of your labour, with the obstetrician attending once baby is almost here or if any complications arise.
If the medical model suits you best, then another choice you are able to make is whether you’d like to go through the private system or public hospital system!
Private vs. Public Hospital
Private Obstetrician and Hospital:
Ongoing support and continuity of care
Opportunity to meet with and and choose a particular physician you would like to work with and have the opportunity to get to know them beforehand. In most cases they work in teams, so that if your OB happens to be away or not on call when you go into labour, you’ll be looked after by another member of that team who you will (ideally) already have met.
Can opt to have a C-section delivery if that is your preference
After birth, you will have a private room in the hospital with direct access to medical staff and care for 4-5 days after your delivery.
Postnatally, you will often be able to contact your own obstetrician or their team with any concerns after baby, and your 6-week postnatal check-up will be scheduled with them.
*Just note that to access your private health insurance, you will need to have had top level hospital cover for at least 12 months prior to baby’s due date - so you may need to plan a little in advance* if at all possible.
You will often meet lots of different care providers throughout your journey, both obstetricians and midwives, depending who is rostered to work on the day.
You are not able to request a planned (elective) C-section, unless it is necessary for medical reasons.
Often, the postnatal stay in hospital after delivery is a little shorter depending on how mum and bub are doing, and is sometimes within 24hrs after an uncomplicated delivery (with options for home follow-up from the hospital midwives), or up to 2-3 days.
Your 6-week postnatal check up for Mum and Bub will most likely be with your local family doctor or GP.
Midwifery-led care can take place in several environments: either at a hospital, birth centre, or at home, and can be a great option for women hoping to have a vaginal birth with less medical intervention throughout their labour and delivery. Midwives are often (but not always) trained as nurses first, and provide support, education, and care for both mother and baby during pregnancy and beyond - as with obstetricians, they are able to order blood tests and ultrasounds, and doing routine checks at your appointments like taking your blood pressure and checking in with baby’s heartbeat at appointments and are often scheduled for bit longer than the usual OB appointments (~1hr each visit for MW vs ~20 mins for OBs, practitioner dependent). In the case of more complex medical concerns, midwives will consult with the hospital obstetricians for advice during a woman’s pregnancy, and will transfer care in the event that further medical support or an unplanned C-section is required.
Ongoing support and continuity of care
Great option for women whose preference is for a vaginal birth with less medical intervention
Longer and less rushed prenatal appointments with your care provider
During the early stages of your labour, your midwives will be in contact and (or even with your at home) and continue with you as you progress through to the later stages of labour and as you birth your baby.
If the idea of a water birth or using a warm bath during your labour appeals to you, you are most likely to be able to have that when under the care of a midwife.
Option for a home birth if desired
After a delivery at a Birth Centre or hospital, if all is going well, Mamas are able to go home after 6 hours of having their babe
Usually will have ongoing home visits and support from their midwife, every day for first 10 days, then once a week till your baby is six weeks old with lots of help and guidance for breastfeeding, bathing and baby cares.
Private vs Public Midwife Care
Midwifery care can be accessed from either the public hospitals (all publicly funded), or privately. Typically they work in teams within the hospital, so you get to meet most, if not all, members of the team who will be caring for you when your baby is ready to arrive. To be eligible for the hospital midwifery group practice or Birth Centre programs, you must be referred by your GP and sometimes enter a ballot (luck of the draw!) and meet certain criteria including being a low-risk pregnancy (which takes into account mother’s age, health of baby and other medical concerns), and usually singleton pregnancies (not twins or multiples).
In Brisbane, the options are the Birth Centre at the Royal Brisbane and Women’s Hospital (RBWH) or the Gold Coast University Hospital, and the Midwifery Group Program at the Mater Mother’s Hospital (MMH). The Birth Centres are located within these tertiary hospitals (often just down the hall on the same floor as the other birth suites and operating theatre for C-section deliveries) and medical support is closely available in the case of serious or emergency complications.
Privately practicing midwives can work in groups or individually, and will often have direct access to the Birth Centres within the hospitals (meaning you don’t have to enter the ballot) and you will have most of your prenatal appointments away from the hospital at their practice, or at your home. They can also visit you at home during the early stages of your labour, and even support you through a home birth if you choose to do so. Some health insurance funds will provide rebates for midwifery led care (including pre and postnatal appointments and an in-hospital birth), but not all of them so it is best to check out your options if that is important to you.
Some of the private group midwife practices located in and around Brisbane that our patients at Body and Birth have had good experiences with (or we’ve heard good things about) include My Midwives, Midwives First, New Life Midwifery.
Pregnancy and Birth Doulas like Cheryl Sheriff of Ideal Birth (Brisbane) and Bron from Kindred Birth (Sunshine Coast) can be incredibly helpful if you love the idea of getting to know someone throughout your pregnancy and who will support your decisions in labour - particularly if you are going to be at a public hospital and may not have the option of choosing a pregnancy care provider. While not necessarily medically trained practitioners, experienced doulas have seen many mothers bring their babies into the world and can provide great encouragement and advice when you need it most.
There are also Doulas who specifically provide postpartum care, like Mother Down Under (Brisbane) who help to ‘mother the mother’ when you get home after having your baby, especially after your partner has gone back to work - bringing meals, providing gentle guidance and instilling confidence in new Mamas as they navigate the ups and downs of brand-new-motherhood - such a life saver!
All of this information really just scratches the surface, but hopefully gives you a broader perspective of the different options out there for Mamas-to-be.
Two of the key factors that can help you achieve a positive birth experience include:
Being able to get to know your pregnancy carer throughout your journey and having them present as you bring your baby into the world
Feeling informed and supported by your care provider throughout your pregnancy and delivery
Cheryl Sheriff’s book Stork Talk is a fabulous resource for helping to choose a care provider (among many other things!), including more in-depth information and even what are the best questions to ask when choosing a prospective hospital or practitioner.
If you have any questions, comments, or practitioners you can recommend please leave them in the comments below!
(As we are located in Brisbane, we’re most aware of the practitioners and services in our area, but similar options are available in most major cities and can be found with some research. If you are reading and would like to comment share some other options for your part of the country, please do!)
Women's health and pregnancy physiotherapy is a great compliment to whichever care model you do happen to choose. Our physios will help you prepare you body and pelvic floor for pregnancy, birth, and postpartum and can work in together with your OB or Midwife.
In the Brisbane area and interested in seeing a women's health physio? You can check out our pregnancy services right here!