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23 November, 2009

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Pregnancy - birth choices

When you’re pregnant or planning a baby, you have a number of choices about where to give birth and who you would like to care for you in pregnancy, during labour and after the birth. Carers may include a midwife, a GP or an obstetrician – or a combination of these. It’s a good idea to talk to health professionals, as well as family and friends, about your options and what to expect from the different types of care.

Care in all stages of pregnancy and birth
It’s very important for you and your baby to be looked after from the start of your pregnancy until after the birth of your baby. Care should include providing support and information, monitoring you and your baby’s health and wellbeing, and identifying special medical or personal needs that may require extra help from trained professionals. Care is given:

During pregnancy (antenatal care) – regular appointments are important to monitor your pregnancy and your baby’s growth.
During labour and birth (intrapartum care) – carers will help make you comfortable and help you understand what is happening, assist you in making choices about pain relief, and discuss any medical interventions and special care needs with you.
After the birth (postnatal care) – in most hospitals you will be transferred from the birth suite to the postnatal ward an hour or two after the birth. Midwives will provide most of your postnatal care and a doctor will check on your progress. Carers also offer support for breastfeeding and looking after your new baby. They will discuss with you what you can expect as a new mother and what is normal. Midwives will also visit you at home after you leave hospital.

Choosing the type of care
There are many things to think about when deciding where to have your baby and who should care for you. Things that may affect your decision include where you live (all options may not be available in your district), your health and life circumstances, previous experiences of pregnancy or birth, and your feelings about particular types of care. It may also depend on whether you are a public or privately insured patient. Some rural hospitals do not offer antenatal or birth care; you would go to a larger hospital for the birth and receive postnatal and home visiting care from the rural hospital.

Over the nine months of your pregnancy, you will have time to explore all your options with the help of your carers. You can change your mind if you find the choice you have made is not appropriate for you.

Public hospitals and midwives’ clinics
Choosing to have a baby as a public patient means:

You attend an outpatient clinic at the hospital or a community-based centre organised by the hospital.
You may be cared for by doctors or midwives depending on the care you need.
If a doctor attends the birth, you will not be able to choose the doctor who will deliver your baby.
If a doctor attends the birth, the medical staff of the hospital will provide the care for you during the birth and follow up after.
After leaving hospital, a midwife will probably visit you once or twice at your home, or you may visit your GP.

Private care
Private care means that:

You choose your obstetrician.
Your check-ups take place at their private consulting rooms.
The obstetrician will be present at the birth and will visit you in hospital afterwards.
You can go to a private hospital or to a public hospital as a private patient.
Some private hospitals offer home visits.

Birth centre care
If you are at low risk of complications, you may choose to have your baby in a birthing unit or family birth centre. Birth centre care is available to women in both the public and private systems. Individual birth centres vary in the way they operate but generally emphasise you and your partner’s involvement in decision making. You usually stay at the centre for one to two nights after the birth.

Birth centres operate on the basis that pregnancy and birth are healthy life events and that for most women there is little need to intervene in the birthing process. After the birth, a midwife will probably visit you once or twice at your home, or you may visit your GP.

Shared care
Shared care means that your local GP or a midwife from a community health centre shares your care with the midwives and/or doctors at the maternity hospital.

You visit the hospital at specified routine stages of your pregnancy.
Your GP or midwife cares for you during pregnancy and after the birth.
The hospital midwife will care for you during the labour and birth.
If the doctor attends the birth, the hospital medical staff care for you during the birth.

Midwives at the hospital and some community health centres also offer childbirth education classes.
Planned home birth
A small number of GPs and midwives attend home births. A home birth takes place in familiar surroundings and gives you the most involvement in decisions that affect your care. In Victoria, care is provided by a midwife contracted through Midwives in Private Practice (MIPPS).

Pregnancy care is provided in your home, or a location chosen by you and your midwife.
During labour and birth your contracted midwife cares for you in your home.
You may choose to have a second midwife or an obstetrician/GP attend the birth.
Your contracted midwife provides postnatal care in your home.

If you need to be transferred to hospital during the birth, your GP or midwife will come with you. The GP or specialist will assist with the birth. Midwives must be accredited by a specific hospital if they are to assist with your birth at that hospital.

The costs of having a baby
The costs depend on whether you are a public or private patient:

As a public patient you do not pay for the doctor, midwife or hospital.
Private patients pay for their doctor and hospital – Medicare and private insurance will meet some of the costs of private care.
As there may not be pregnancy care available at some rural hospitals, it may be necessary for you to have your care during pregnancy provided by the local GP. Some GPs will bulk bill – if not, you may have to pay the difference between their fee and the Medicare rebate.
You will have to pay the midwife for a home birth, unless your health fund provides cover for midwifery care. Other home birth costs include attendance of an obstetrician or GP at the birth and fees for ultrasounds and pathology tests.
If you are transferred to hospital during a home birth, you will have to pay for this cost and the hospital costs if you go to a private hospital.

Costs may vary between practitioners when it comes to antenatal care, including ultrasounds and pathology tests. Many of these costs are partially covered by Medicare. There may be an extra cost for antenatal childbirth education classes. Check with your GP, midwife or obstetrician about any services that you may need to pay for.

Care for women with extra needs
During your pregnancy you may need additional care. Your needs may be medical, cultural, social or emotional. If so, you may receive your pregnancy care at a ‘special’ clinic, located at a hospital or community health centre. For example, you may:

Need culturally appropriate care
Need the services of an interpreter
Need support visits at home
Have nowhere to live
Not be able to afford food
Have issues concerning drugs or alcohol.

Where to get help

Your GP
Specialists (obstetricians)
Community health centres
Birthing centres
Hospital maternity units and midwives
Midwives in Private Practice (MIPPS) Tel. (03) 9704 2386
Department of Human Services Information Resource Centre Tel. 1300 650 172 or (03) 9096 0000

Things to remember

The earlier you consider the options for your care in pregnancy and birth, the better.
You must be at low risk of complications to use a birth centre.
The time you spend in hospital after the birth depends on your needs but may be quite short.
There may be extra costs for antenatal investigations and childbirth education classes.
If you need an interpreter, ask the organisation you are dealing with to arrange this.
More information about childbirth is available free from the Department of Human Services Information Resource Centre.

You might also be interested in:
Baby care - safety issues.
Baby due date.
Childbirth - help for women from overseas.
Childbirth - medical interventions.
Childbirth - pain relief options.
Maternal and child health services.
Mercury in fish.
Newborn screening.
Pregnancy - antenatal checks of your baby.
Pregnancy - bleeding problems.
Pregnancy - morning sickness.
Pregnancy - signs and symptoms.
Pregnancy - stages of labour.
Pregnancy - week by week.
Pregnancy - your options.
Pregnancy and diet.
Pregnancy and drugs.
Pregnancy and exercise.
Pregnancy and smoking.
Pregnancy and sport.
Pregnancy and travel.
Pregnancy testing.
Pregnancy tests - chorionic villus sampling.
Pregnancy tests - ultrasound.
Premature babies.

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