Choosing where to give birth can be a real dilemma for some couples, and for others the decision may be easy – for example if there is a financial or locality issue to consider.
For those who are still deciding, here are the main choices for place of birth in Australia.
If you have private health insurance, you might choose to give birth in a private hospital. Most health funds require you to have cover for at least 12 months (waiting period) before claiming any obstetric benefits, so make sure that you have completed the required waiting period and have appropriate obstetric cover. Another thing you'll need to know is if your baby is covered after the birth. If the baby requires to be hospitalised, will you be covered or will you be expected to foot the bill of expensive neo-natal care? Most health funds have a buffer of days/weeks in which the baby is covered, provided you upgrade to family cover within the specified period.
The excess payment you need to pay for the insurance company will depend on your policy, and is usually payable when you are admitted to hospital or more likely, before you leave.
If you don't have private health insurance, you can still attend a private hospital, however you will need to cover the entire cost yourself, which will cost many thousands of dollars and will vary depending on what's needed during the birth and what consumables you use. If you want to give birth in a private hospital, you must be under the care of a private obstetrician, which again will be a bill you will need to cover in the thousands.
You cannot book into a private hospital without a private obstetrician. Even if you bring your own private midwife, you will still need to be under the care of a private obstetrician who is affiliated with that hospital, regardless of any situation.
When booking into a hospital, you will need to either choose a private hospital at which your obstetrician attends (usually they are affiliated with 2-3 hospitals), or if you prefer you can book a hospital first, then ask for a list of obstetricians who attend that hospital. Obstetricians are affiliated with certain hospitals, so you can't choose any hospital and any obstetrician – they need to be affiliated.
Pros for private hospitals
- Your partner can often stay with you
- You are more likely to have a private room and/or double bed (not guaranteed depending on how busy the hospital is)
- The accommodation may be nicer than public care
- The food may be nicer than public care
- You can chose your own obstetrician
- Check-ups are held in the obstetrician's private consulting rooms and not a hospital waiting room
- While the obstetrician doesn't stay with you during your labour (midwives do that bit) your obstetrician will be present at the birth (unless on holidays or doesn't make it in time) and will visit you in hospital afterwards.
“I was really frustrated when I found out that even though i'd been paying for private health insurance, I was still going to be out of pocket a lot of money. The fact is you do end up paying more, but you also get a lot back – so far, we have been out of pocket a bit less than $2,000 by choosing to go private. All up I expect it will be about $3,500. I have to say though, I have been really happy with the decision I have made so far.”
Cons for private hospitals
- They have the highest rate of intervention over all birth options; particularly caesarean sections (see this Victorian report here for 2003-2004). Some private hospitals have in excess of a 50% caesarean section rate.
- Because of the higher interventions that go on in private hospitals, midwives tend to be medical model focused but this is not always the case
- Obstetricians usually don't see you very much during labour. It's the midwives who monitor you in labour and they will likely be unknown to you. There will likely be 2-3 shift changes during your labour, so while you may think you will receive continuity of care with an obstetrician, they aren't around much at the birth at all. If you'd like continuous care and advocacy of your choices during labour, you need to hire a doula or private midwife.
- You will still have additional out-of-pocket costs with most obstetricians which vary from a few hundred to several thousands.
“I would say go public. Not only would private cost you many thousands of dollars, I don't necessarily think that paying for maternity care gets you a better standard of care (unless you are paying for an independent midwife, then it is the best care available in my opinion).” — Kara
Public hospitals are growing in popularity due to the low cost aspect. While you might not be able to choose your own obstetrician, many couples are very happy with the standard of care received in public hospitals, and we aren't going to be offered substandard care in this day and age. Many public hospitals are large teaching hospitals and have great facilities.
Pros for public hospitals
- It doesn't cost you anything and you still get high quality care
- Intervention rates are lower than private hospitals
- Public hospitals often have higher level NICU wards for very sick or premature babies
- Public hospitals usually have staff on around the clock for all requirements, for example anaesthetists and surgery staff. Because they are already present in the hospital, they are not required to be called in, so you can receive faster service. Many private hospitals close for surgery overnight.
- Some public hospitals have ‘know your midwife' type programs where they offer teams of midwives to help you become familiar with a small group of midwives, one of which will support you during your birth. These programs tend to book out quickly though so you'll need to investigate this option as soon as possible. Only a few hospitals offer this sort of program.
“I went public and it was really good actually. I still had easy access to an obststrician, paediatrician, physio during my stay in hospital, even though the ward seemed really busy. In hindsight there was only one thing that annoyed me about my antenatal care and that was how I had to see a different midwife for all of my appointments, but at the hospital I went to, they have changed it so you see the same midwife for all appointments and birth now.” — Karina
Cons for public hospitals
- You get no choice in any of your carers and you will often see different midwives or doctors on each visit; for continuity of care you would need to hire a doula or private midwife.
- Some public hospitals now do not allow elective caesareans on maternal request (without a medical reason), however this does have its benefits also.
“I chose public – I had no reason to believe that I'd have anything other than a normal, natural pregnancy and birth, and midwives specialise in that sort of birth, so it just made sense to me. I was very happy with the care I was given!” — Amy
Birth centres in Australia are currently attached to hospitals and are not free-standing. They accept low risk women and provide a more homely environment for women to give birth in, with a less clinical feel. Most are based in public hospitals so there is no cost involved. If you have had a previous caesarean you wont be able to use a birth centre as none currently allow this.
Pros for birth centres
- Less intervention than private and public hospital, meaning less episiotomies, pain relief, caesareans and assisted deliveries
- Often midwives in the birth centre are low intervention focused
- The birth room is more homely with lots of birth aids to help facilitate a natural, active birth
- Some birth centres allow waterbirth, where as the majority of private and public hospitals do not
- You are more likely to be familiar with the midwives who will be present at your birth, as birth centre midwives often work in small teams and you will meet most of them during pre-natal visits
- Birth centre midwives are often most supportive of doulas and other support people
- If you need to transfer into the main ward, it's usually right next to the birth centre so you wont have far to go at all.
Cons for birth centres
- Being attached to hospitals, birth centres still have to follow hospital policy. While you still have your rights as to what you choose to accept to have done to you, you can't choose to stay in a birth centre if you are deemed to be high risk or if you meet their criteria needing to be transferred to the main maternity ward of the hospital. Check out the transfer rate from the birth centre to the main ward, they vary from 30-50%+ depending on hospital policy.
- If you want a VBAC (vaginal birth after caesarean) no birth centres will accept you
- If you want an epidural you need to be transferred out
- If you require an induction or augmentation (speeding up of labour which has already started) with a syntocinon drip, you will need to be transfered out
Shared Care (GP/Community Midwife + public hospital)
I thought I would add this in which is more of a care option than a place to give birth, but it is something to consider if you don't want to spend a whole lot of time in a hospital and you would like to go public.
Shared care is another option for healthy low risk women. It means that your local GP ‘shares' your care with the midwives and/or doctors at a hospital they are affiliated with. You will have check-ups with your GP in his/her office (which are all the usual pre-natal checks that the hospital would do), then certain visits will be scheduled with the hospital. There is communication between the GP and hospital as to your progress and it's a great option if you have a good relationship with your GP.
The hospital midwives will be present for your labour and birth in the public hospital, then the shared care will continue after birth too.
The main benefit for shared care is seeing the same practitioner throughout your pregnancy, as opposed to going public and not having the same practitioner or one you have chosen.
Women who use birth centres can also access shared care in some hospitals. You can find out more information from your local private hospital.
Pros for Shared Care
- No hospital costs as per public care
- You can see the same carer from pregnancy and into the post-natal period
Cons for Shared Care
- Some shared care providers may charge fees not covered by Medicare (and as per all doctors, the amount may vary), so you will need to check this out with your provider.
For a homebirth, pregnancy care usually takes place in your home by an independent or private midwife (to locate a private midwife, visit the Maternity Coalition website). Most midwives work alone but some work with a back-up midwife or GP.
Many women worry about the safety of giving birth at home, however a midwife will be able to help inform and reassure you with facts and evidence which do show that homebirth is a safe option for low risk women. Many midwives also attend homebirth after caesarean section.
Midwives sometimes have birth pools they can hire to you or have contacts for you to hire one if you are interested in a home waterbirth.
Women who give birth at home find that their labours are more calm, nurturing, shorter and loving compared to being in a hospital environment. Being in a familiar place with familiar smells and people is the perfect mix for labour. Having a private midwife means you will have a well established relationship as she will do all your pre-natal care, be present for your birth and assist with post-natal care and breastfeeding – so you truly have a close and intimate relationship which is so beneficial to both partners. For those who already have children, the children love being involved and the midwife will help them feel involved too.
Midwives bring supplies like an oxygen tank, essential birth equipment and medical supplies, so they do not come unprepared. While they are as keen as you are to help you acheive a wonderful homebirth, midwives will still be extra vigilant for signs that signal a transfer to hospital. They will not try and push for a homebirth at all costs because it is in their best interest to help you achieve the best outcome for you and baby.
If you need to transfer to hospital during the birth, your midwife will come with you, however unless they are accredited by a specific hospital, the midwife may not provide any medical procedures including catching your baby when it's born. She can still advocate and be a second opinion for you which is a great help.
Pros for homebirth
- You see the same provider throughout pregnancy, birth and post-natally, so you are guaranteed to be in the presence of someone you know, trust and like at all stages of your care
- Pre-natal care is in your home, so you could be in your slippers and your midwife will come to you – no waiting for hours in a waiting room for a short visit – no feeling like a number
- Care is more nurturing and you form a close bond with your midwife, which allows you to relax and trust the person who will be there in times of need
- You can give birth in an environment that is comfortable and familiar
- Lowest intervention of all birth places and risk is exactly the same as being in hospital – only with less unnecessary interventions, comes less complications.
- Your whole family can be with you the whole time without visiting hours, and there is no interruption from other women and their visitors
- You are giving birth in an environment that is not prone to infections and full of sick people
- After the birth, you still have an ongoing relationship with your midwife, especially with breastfeeding support, whereas an Obstetrician does not provide this sort of support nor do they have time for it. With your own private midwife, there is no confusion over conflicting advice, which is a big complaint post-natally for many women giving birth in hospitals.
Cons for homebirth
- While there is no cost to be at home, you'll need to pay for your own midwife. Sadly there is no insurance company who will step up to the plate and offer private midwives professional indemnity insurance since it was taken away some years ago, with no rescue package from the government.
- If you want an epidural, you will need to go into hospital
- Most private health insurance companies offer little or nothing to help cover the cost of private midwives. This is because they have no indemnity insurance.
- You really need to surround yourself with support and likeminded people for a homebirth – you will inevitably get demeaning or insensitive comments from uninformed people, however keep your strength up with a cheersquad because a homebirth can be a truly memorable experience.
To read more member experiences, check out our Private or Public forum discussion here.