Who Cares? Maternity Care Options For Australian Women

If you’ve just found out you are pregnant, you likely want to choose the very best place to have your baby.

First, you need to know all of your maternity care options. The type of birth you desire will depend on if your pregnancy is low or high risk, as that determines the type of care you will need.

The model of maternity care that you choose during pregnancy will directly impact the options and choices that are available to you during labour and after the birth.

If you wish to have a natural or vaginal birth, you should look at the options available to support you in achieving that.

If you have a medical condition that requires specialist care, choosing a specialist to support you in a positive experience can make a big difference in how you feel about the birth experience.

The information in this article is based on evidence regarding different models of maternity care in Australia. Options for care can vary between states, and within each state there may be slight variations of the choices outlined below. It’s important that you seek the most appropriate care option for your personal needs and circumstances.

What Maternity Care Options Are There In Australia?

While many women do give birth in a hospital, it’s important to understand that pregnancy and birth is not an illness. There are many ways in which a pregnant or labouring woman — and those providing care for her — can either work with or interfere with this natural process. When planning for childbirth, it’s important that you understand how you, and your professional care givers and personal supporters, can act to protect and support spontaneous, uncomplicated birth.

Some key points to understand:

• The wellbeing of the mother and her child is the primary focus of all professional maternity care
• A midwife is the most appropriate primary carer in normal pregnancy and birth
• Continuity of care has been shown to have positive benefits on birth outcomes
• Midwives work collaboratively with doctors, nurses, and other professional care providers in complex birthing situations

There are many things to consider when choosing your care provider and birth setting. Most maternity care in Australia is provided within a hospital/medical setting. But understanding the different models of care offered will help you to make informed choices about your pregnancy and birth.

Maternity Care Option #1: Midwife Primary Care

Midwives are specialists in normal pregnancy and birth. They provide advice, care and support for women and their babies during pregnancy, labour and the early postnatal period.

Public hospitals may offer caseload midwifery or group practice midwifery programs, where you will be cared for by a primary midwife who is supported by a team of other midwives as needed. Private practice midwives offer continuity of care to women planning to birth at home.

Care from a known midwife allows you to develop a relationship and trust in your maternity care giver. This increases your confidence in your ability to birth naturally. Women receiving care from a known midwife are more likely to have normal physiological births with fewer interventions, more positive birth experiences and more satisfaction with her maternity care, and meet her breastfeeding goals. Babies born to mothers receiving care from a known midwife are more likely to be born healthy and at term.

Midwifery care is holistic, which means your care takes into consideration your body, mind and emotions. Your midwife will support during your pregnancy and can undertake all antenatal care, birth education, and your emotional and social needs that you have. Midwives able to detect any complications that may arise with you or your baby and begin emergency care, as well as refer you to specialists and work in collaboration with other maternity health providers.

Maternity Care Option #2: Shared Care

Maternity care can be provided in a number of ways between professional maternity care givers. Models of shared care usually involve midwives and general practitioners (GPs) or obstetricians. These carers work together to provide different aspects of care across pregnancy and birth, usually within a hospital maternity service. In most cases, the GP or obstetrician is the primary care provider.

Some birth centres and hospitals that offer midwifery models of care require medical supervision during pregnancy. You may be required to meet with a doctor at certain stages throughout your pregnancy, and possibly different midwives as well. This lack of continuity in care can lead to fragmentation depending on the setting and the way the shared care model is managed.

While some shared models of care strive to provide a known midwife during labour this is not always possible. If you are considering share care ask how it works in the available setting.

Maternity Care Option #3: Specialist Care (Ob/Gyn)

Obstetricians are specialist doctors (and surgeons) who are experts in the treatment of the complications that can lead to poor outcomes in pregnancy and birth. They are skilled in surgical options for birth.

If you are experiencing a complicated pregnancy, or you have a serious medical condition separate from your pregnancy, it is appropriate to be under specialist care during your pregnancy and birth. Statistics show that the chance of intervention is doubled with private obstetric care, something to take into consideration if you are having a low risk pregnancy and wish to avoid interventions.

Obstetricians provide continuity of care throughout pregnancy if you enter into a private care arrangement, with access to either a private or public hospital for birth. Antenatal care will usually be provided in the doctor’s private rooms. If you are considering private obstetric care you should be aware of their birth philosophy and the practices they prefer to use during labour and birth.

During labour, hospital midwives will monitor your progress and call the obstetrician when birth is imminent. It is not likely you will have met your midwives before labour. Many obstetricians now work in group practices to allow them to have time off. This can mean your doctor may not be available when you give birth and another obstetrician will attend you.

After the birth of your baby, you will be cared for by hospital midwives and your obstetrician will be called if complications arise. If you choose obstetric care you may consider seeking the services of a midwife to work in partnership with you and in collaboration with your obstetrician and other hospital staff.

Choosing the right model of care will be dependent on your birth preferences and goals, your general health and how your pregnancy is progressing. Knowing the available models can help you make an informed decision to help you plan for the birth you desire.

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• Public, Private, Birth Centre or Home?