By Robyn Dempsey
So you’ve found out that you’re pregnant. Congratulations! But what now? You need someone to care for you during pregnancy – and someone to support you when having your baby – but who? You’ll also need to think about where, and how, you want to have your baby. Most women might think that the delivery suite at hospital is the only option, but there are others: birthing centre’s (often associated with hospitals) or even your own home. Homebirth is usually a privately arranged option in Australia, but there are some public hospital schemes. Birth centers and homebirth mean a philosophy of natural birth. Your choice of where to have your baby and how you want to birth will influence who it is that will care for you during pregnancy and at the birth.
So what are the public options? Referral to antenatal care at your local hospital is one option. Different hospitals have different schedules of care and depending on age, health and risk factors you will see a midwife or obstetrician (for more complex care). You won’t pay for your appointments and tests are claimable on Medicare. Ask whether the hospital has a birthing centre as well as a delivery suite and what the obstetricians at the hospital offer regarding these options.
GPs who offer shared care (not all do) alternate their own appointments with those at the antenatal clinic at a hospital, at which the birth ultimately occurs. Some women prefer this as they have a regular GP who they like. Appointment and test costs are claimable on Medicare.
Another option is to choose your own obstetrician (although your health insurer may require you to choose from an approved list). You pay for the care of the obstetrician from start to finish. You see your obstetrician antenatally, for your appointments, at the birth time; midwives will look after you until it is time for the delivery, when they will call the obstetrician. It would be important to check what involvement your obstetrician likes to offer. You may also want to enquire whether they allow any flexibility in where you want to birth and also what their intervention rates are, that is, how often they perform inductions, use instrumentation at birth or Caesarian section. There is some concern that the Caesarian section rate generally is high in Australia. Costs are claimable, but out of pocket expense can add up.
Some women choose a private midwife, who will attend women pursuing all birth options, but this is recommended if you wish to homebirth. This is often the only way to have a homebirth in Australia, since hospital-based schemes are limited. You pay for one-on-one care of a specialist midwife who will take you through from first visit to several weeks after baby is born. Some midwives can offer Medicare rebates and can order blood tests and ultrasounds.
Robyn Dempsey is a mother and midwife in private practice located in Sydney, Australia. Robyn is passionate about facilitating positive birth outcomes for women and their families. Her practice New Beginnings Midwifery (www.homebirthmidwives.com.au) offers a safe, personal approach to child birth.