Care from a known midwife during pregnancy and birth has many positive benefits.
Women are more likely to experience a positive and empowering birth experience when they have the same person caring for them throughout pregnancy, labour and after childbirth.
Because of the known benefits of midwifery-led care, it’s a good idea to find out from your GP or local hospital early in pregnancy about the availability of primary midwifery care in your area.
Your family doctor may not be aware about this option for care. Some doctors are still not supportive of primary care midwives, despite the research. In either case, if you are choosing to homebirth or wish to add a known midwife to your birth team, contact your local midwife association or organisation for details about privately practicing midwives in your area.
What Is Primary Midwifery Care?
A primary midwifery approach is also referred to as midwifery-led care or midwifery continuity of care. This model of care means a woman has a known midwife providing maternity care during pregnancy, birth and in the postnatal period. Midwifery care is woman-centred care, meaning the focus is on each woman and her individual needs.
This model of care enables women to develop a supportive and trusting relationship with their midwife. Midwives approach maternity care with the view that pregnancy and birth are normal events in a woman’s life. This means that women are afforded resect and nurture in one of the most important and vulnerable times of their life.
What The Research Says
Midwifery continuity of care has been widely studied on a global scale. The Cochrane Review of 13 trials involving over 17,500 women showed that midwifery led care had many benefits with no adverse effects, compared to medical care:
- Reduction in the use of epidurals,
- Fewer episiotomies or instrumental births
- Increased spontaneous vaginal birth
- Less likely to experience preterm birth (less than 37 weeks)
- Less likely to lose their baby before 24 weeks gestation.
An Australian trial, the largest of its kind in the world, confirmed women who have a known midwife have less medical interventions, greater birth satisfaction, and cope better overall with labour and birth. They are also less likely to have a c-section and their babies are not as likely to require admission to special care.
Women who have a primary midwife during pregnancy and labour report they had a positive experience during the birth of their baby. Women who feel satisfied with their labour and birth will often go on to cope well with the challenges of parenting and are more likely to feel positive about having another baby in the future.
Post natal care from their midwife can bring positive benefits too, as women are more likely seek support for breastfeeding or early parenting challenges.
Where Can I Access Primary Midwife Care?
Midwifery led models of care can be accessed through certain maternity programs in hospital settings, birth centres and private practice midwives in home birth settings.
Midwifery-led models of care are offered through some public hospitals and there are a growing number of private practice midwifery groups. In hospital settings this model of care may be referred to as caseload midwifery or midwifery group practice.
Women accessing midwifery-led care through public hospitals are usually screened for risk factors before they are eligible. Most midwifery caseload programs are highly sought after and places on the programs are limited. This means that many women miss out on accessing care shown to improve outcomes for women and babies during labour.
The primary midwifery model of care is not standard practice in the United States but in other countries such as Britain and New Zealand it is more common – especially in the home birth setting. Australia has a number of primary midwife care programs through public hospital settings, while home birth is still a limited option due to cost and lack of support from the government.
Am I Eligible For Primary Midwifery Care?
If you are considered high risk during pregnancy you may not be able to access midwifery programs through your local hospital. High risk pregnancy criteria may include:
- Twins or multiple births
- High blood pressure
- Placenta previa
- Uncontrolled gestational diabetes
- High BMI
Most programs within public hospitals also require women to comply with pregnancy testing such as GBS swabs and testing for gestational diabetes.
Home birth with high risk conditions may or may not be a safe option depending on the condition and the midwife’s experience and choice. While some private midwives will consider twins and higher BMI as variations of normal, placenta previa or preeclampsia are conditions that may require specialist care.
Stories Of Primary Midwifery Care
While evidence is an important part of maternity care, sometimes hearing about personal experiences can help us understand why evidence supports the primary midwifery model of care.
Here are 5 stories of primary midwifery care:
#1: The COSMOS Program – A High Risk Experience
Melinda (name changed for privacy) went through the COSMOS program and says, “They were amazing (I was quite high risk) and really went out to bat for me against the doctors who thought I was too high risk for midwife care. Being in COSMOS meant that during my emergency c-section I was able to keep my baby with me because there were two midwives in theatre with me.”
#2: Feeling Safe During Birth
Kat says about her experience with a known midwife: “Having someone I trusted follow my entire pregnancy and birth helped me to feel safe. Instead of having to advocate for myself and worry about the opinions and practices of different midwives and doctors I was able to let go and just focus on baby and I. I knew that she knew me, my history, health, wishes and fears and that I would have a kind and familiar face in the room when I was at my most vulnerable.”
#3: A Public Funded Homebirth Program
Jessica’s experience of primary midwifery care was through a public funded homebirth program. “Knowing my midwife during pregnancy helped me feel confident, relaxed, informed, supported about birth.”
“I felt respected, supported and actually cared for during labour which was important to me because I wanted a home birth where I knew I would feel relaxed so I could do what my body was telling me to do. Any questions I had even during labour were answered and when my midwife gave suggestions, I was given pros and cons and give time to think. I also knew my midwife was there just for me and my baby, I had her full attention and that made me feel safe.”
#4: Continual Care With Respect
Miranda felt respected and supported during her experience with a primary midwife. “Having continual care with the same midwife helped me feel confident my wishes for birth would be followed and respected as we'd had a chance to talk through and discuss plans in full prior to the birth. As Louise was familiar with my birth plan, my labour was not interrupted by a need to advocate for the birth I wanted.”
#5: A Mother And Experienced Doula
Jennifer is a Melbourne doula who has experienced primary care more than once: “Continuity of care is so important during pregnancy and birth. Having a known midwife as my care provider for my 3rd, 4th and 5th pregnancies and births made me feel comfortable enough to let go and really enjoy birth which in turn created a more natural birthing experience.”
“Having my first primary midwife experience in 2009 was one of the main reasons I am a Doula today, to help bridge the gap and allow women to feel supported by the same provider all the way through pregnancy, birth and beyond. I can't recommend know your midwife programs enough, it's just a shame it's so hard to get in.”