Hannah Dahlen

Pregnancy Choices – Who do you see?Getting pregnant was the easy part – now what?  Who do you see? Where do you go for your care? How do you find out what is available out there and most important of all, what is the best form of care for you.

Joanne said trying find out where to go and who to have care for her was harder than she would have thought. “The GP who did my pregnancy test said, ‘are you privately covered?’ and then he gave me the name of a someone he said was a good obstetrician. I think he might have been a mate from university! It was only after going to the obstetrician and realising I didn’t like his manner and attitude to my questions that I started to ask around. It was then a friend told me about birth centres and midwives and that there were other options. I don’t think it should be like that – there needs to be information out there that women can get hold of. “

When a woman is pregnant for the first time it can be a daunting and confusing process as they try to discover what maternity care options are available and which option will suit them best. The fact that there are an increasing variety of pregnancy and birth options for women to choose from shows how individual this choice is. For some women, however, such as those who live in rural and remote Australia, there may be no choices and only one option. Many women talk to their friends to get information and this can be a great way to get an inside view of what is available but remember it is one view and it is influenced by individual experiences.

Public Hospital Care (75% of births)

Most women who are pregnant, and do not have private health insurance, obtain a referral from their general practitioner (GP) to a public hospital. Depending on where they live, the hospital they choose to attend and their health, they may be able to access several different options.

Midwives Clinics (Medicare card only-no extra costs)

Many major public hospitals have ‘midwives clinics’ which are run by midwives. These clinics are sometimes located in the community and are called ‘outreach clinics’. Midwives are skilled professionals who are qualified to provide complete care for women experiencing normal pregnancy and childbirth and provide continuity of antenatal care for women experiencing normal pregnancies. If any complications develop then the midwives refer women to doctors at the hospital. Women get to know their midwife or midwives during the pregnancy under this model of antenatal care. Women then give birth in the hospital delivery ward and are attended by the midwives and doctors who are on duty at the time. After the birth, midwives on the postnatal ward care them for. Women enjoy seeing the same midwife for their care during pregnancy, as they develop a relationship with them. Midwives focus on more than the physical aspects of the pregnancy. They regard the emotional and psychosocial needs of women as a high priority.

Team Midwifery/Midwifery Group Practice (Medicare card only-no extra cost)

Most women want to receive consistent information and care from someone they get to know throughout the pregnancy, birth and postnatal period. In response to these expressed needs programs like team midwifery and midwifery group practices are increasingly being set up in public hospitals. This involves a small group of midwives that work together to provide antenatal, labour, birth, and postnatal care to women. Many of the larger metropolitan hospitals now run team midwife programs or variations of continuity of care programs. There is now substantial evidence that continuity of midwifery care should be available as a choice for pregnant women. The effectiveness of continuity of midwifery care is largely due to the relationship of trust that is built up during the pregnancy, birth and postnatal period. This form of care results in less intervention and higher long-term breastfeeding rates, as well as lower rates of postnatal depression. Women experiencing this form of care have been shown to feel well prepared for labour, to perceive labour staff as caring, to feel in control during labour and feel well prepared for parenting

General practitioner shared care programs (A cost may be associated)

Most hospitals now offer women the option of having their pregnancy care shared between a general practitioner and a hospital. This provides women with the convenience of accessing their antenatal care in their own local area. They also may have a good relationship with their general practitioner and want to continue this care in their pregnancy. General practitioners participating in shared care programs must meet certain criteria before being able to provide antenatal care. They also will need to refer you to the hospital you will give birth in so you can book in for your care there. You will be asked to return to the hospital for visits with the doctors early in the pregnancy, where they will make sure there are no risk factors in your pregnancy that warrant specialist care. You will then continue to see your general practitioner but you will be asked to return to the hospital for antenatal visits at around 30 weeks, 37 weeks and at around 41 weeks of pregnancy. If you develop any complications you will be asked to see the hospital doctors for specialist care. Hospital midwives and doctors mostly attend the birth and give postnatal care. In some cases, particularly in rural areas, general practitioners may also attend the birth. If your general practitioner does not bulk bill or you do not have a Medicare card you will have to pay for this service. You can arrange general practitioner shared care by contacting your local hospital and finding out if your general practitioner has a shared care arrangement with them or if they run such a program.

Birth Centre Care (no cost for public patients)

Depending on where you live and whether you have any health or pregnancy complications you may be able to choose to have your care through a birth centre. Your general practitioner can refer you directly, or the midwives in the hospital will give you this option when you book in for care. Birth centres are mostly located in hospitals and are staffed and run by midwives with medical back up should complications develop. If you have chosen an obstetrician for your care, ask them if they will attend your birth in a birth centre, as many won’t. Birth centres provide a home like environment where midwives work to care for women through pregnancy, as well as assist them to give birth as actively and naturally as possible. There is a great emphasis in birth centres on empowering women and helping them to feel in control of the whole experience. If there are any complications during the pregnancy or birth then women will be referred to doctors in the hospital. Research exploring women’s birth experiences and outcomes show that women experiencing their care with midwives through a birth centre have lower intervention rates and seem more satisfied than with other forms of care. This is particularly so when midwives work in a team midwifery arrangement in birth centres because women experience even greater continuity of care. Book early though because birth centres are very