Actually there is much more out there than those two options and the choice shouldn’t just be dependent on whether or not you have private health but what style of care suits you and your family.
So what are the options?
Private Obstetric Care
Obstetricians are specialists in managing complications in pregnancy and birth, although you can also choose this style of care when you anticipate a normal pregnancy and birth. Obstetricians use a medical model of care which tends to be more interventionist, having an obstetrician does give you some continuity of care. Your obstetrician will see you in their private rooms during pregnancy and can refer you for any tests and procedures you may require. You will often also see their Clinic Midwife at your appointments. They will be involved with your labour and kept informed of your progress by the hospital midwives and they will plan to deliver your baby. They will check on you in the hospital in the immediate postnatal period and you will see them in their rooms for a postnatal appointment. Generally the home visiting midwives from the hospital will also visit you at home for a couple of days after you are discharged. Your out of pocket expenses depend on your level of private health care and the fees charged by your Obstetrician.
Some GPs will provide antenatal, labour and delivery and postnatal care at hospitals and this can give you some continuity of care. This can be in a private or public hospital. You will see your GP in their surgery for your antenatal appointments and they can refer you for any tests and procedures you may require. You will also go for a “booking appointment” at the hospital clinic where you plan to deliver. When labour begins your GP/Obstetrician will be kept informed by the hospital midwives and they will plan to deliver your baby. They will visit you on the ward postnatally and then you can make appointments to see them in their surgery as required. Your out of pocket expenses will depend on your GPs fees, whether you deliver in a public or private hospital and your level of private health insurance.
Public Hospital Care
Public Maternity Hospital Care is also a medical model of care and is often led by hospital policies. You will be referred to the Public Hospital by your GP. Each hospital now has a “catchment area” so unless you have complicated medical issues requiring tertiary level care, ie King Edward Memorial Hospital, the decision of which hospital is now dependent on your postcode. You will attend the Antenatal Clinic at the hospital for your appointments and may be seen by a Midwife, Resident, Registrar or Consultant Obstetrician depending on staffing and medical need. When labour begins you will be assisted by the midwife on duty and reviewed by the medical team on duty periodically. If everything progresses normally the midwife on duty will deliver your baby. If complications arise your baby may be delivered by one of the medical team. Team Midwifery care can be an option at some public hospitals for women anticipating a normal pregnancy and birth. Your care will be provided by one of a team of 12 midwives. This attempts to allow you a higher level of continuity of care and a known caregiver for delivery. You will stay in hospital for approximately 48 hours after a normal delivery and 3-4 days after a caesarean delivery. You will be assisted by the duty midwives and reviewed by the medical team as required. After discharge a midwife may visit you at home. Then you will have follow up with your GP at 6 weeks. The services of the hospital are available to you for 6 weeks if required. This service is fully covered by Medicare.
The Family Birth Centre
The Family Birth Centre is located on the grounds of King Edward Memorial Hospital. It offers a home-like setting for maternity care with the convenience of having the hospital nearby. The care is provided by a team of 8 midwives. The antenatal appointments, labour and delivery occur at the centre and if complications arise transfer to the hospital is arranged. After your baby is born, you stay for up to 24 hours and then your midwives will visit you at home for approximately 4 days. The King Edward hospital services are still available to you for the first 6 weeks. This service is fully covered by Medicare.
The Community Midwifery Program
The Community Midwifery Program offers Midwifery led care and home birth for women anticipating a normal delivery. You will be allocated a primary midwife who will conduct your antenatal appointments in your home and at the clinic. Your primary midwife will plan to be with you during your labour and birth. The midwives work in teams so in the event your primary midwife can not be there the on call midwife will attend. Your midwife will stay with you for several hours after the birth and then visit you at home for up to 4 weeks for postnatal care. If complications arise during pregnancy, labour or postpartum transfer to King Edward will be arranged. The Community Midwifery Program also offer “domino” births where all the pre and post care is the same but the birth is planned for the hospital. This service is fully covered by Medicare.
Independent Midwives offer individualised, flexible midwifery care centred around women and choice. You will choose your midwife and then collaborate with them to achieve the type of care that suits you. Your midwife will come to your home for antenatal appointments, remain with you during labour and birth and for several hours after the birth. Your midwife will then visit you at home postnatally as you require. Some Independent Midwives can order tests and procedures if required, however most will refer you to your GP or back up hospital for tests and prescriptions. Independent Midwives in Western Australia charge between $5000 - $8000 for antenatal, labour and birth and postnatal care. You may be able to claim some of that from Medicare if your midwife is “eligible”.
Now how do you decide?
This decision is all yours but it is an important one. The World Health Organisation recommends that midwives be the caregiver of choice for normal pregnancy and birth and certainly the empowerment that women gain from continuity of care and a known caregiver not only affects their birth but the rest of their lives. Everyone is different - so have a look at yourself, what kind of person are you? What do you believe about birth? What kind of birth do you want? What are you scared of? Then think, where do you want to birth? How do you want to birth? What kind of environment will help you? And then no matter what you decide, be involved in your care, be part of the process. Ask questions, get informed and know that you can always say NO. It doesn’t matter where you are birthing or who your caregiver is, we are here to support you, this is your body, your birth and your family. You always have a choice and it starts with this one – what kind of care do you want?