childbirth choices
Help I’m Pregnant! Now what?
By Hannah Dahlen
So you’ve done the pregnancy test and it’s
positive. Now what? Who do you see? Where do you go for your care? How do you
find out what is available out there?
When women are pregnant for the
first time it can be a daunting and confusing process trying 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. 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. The only problem with this is, it is usually one view
and it is influenced greatly by individual experience.
Most women have
healthy pregnancies and experience a normal birth. The care received during the
pregnancy, birth and the postnatal period can, however, enhance this experience
and help detect any complications that may develop. In order to meet women’s
choices, a variety of maternity care options have been made available. Depending
on where women live they may be able to choose between receiving their care
primarily from a midwife or a doctor. Women may also be able to choose to have
their baby in a hospital, birth centre or at home. This choice will depend
largely on the health of the individual woman and/or her baby during the
pregnancy. A charge will be associated with some services while others are
covered completely by Medicare. Most women will go and see their general
practitioner when they discover they are pregnant. The general practitioner may
then confirm the pregnancy if this has not already done and they will provide a
referral to the hospital or practitioner of the woman’s choice. They may also do
some initial blood tests and provide some basic information about pregnancy
health related issues.
Public Hospital Care
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 you live, the hospital you chose to attend and your health you may be
able to access several different
options.
Public hospital antenatal clinics (Medicare card only-no extra costs)
Public hospital antenatal clinics are available to all women. These clinics
tend to run Monday to Friday, but not necessarily every weekday. Doctors and
midwives provide the care. You may not see the same health practitioner at each
antenatal visit and it is unlikely they will be the same health practitioners
who attend your birth or care for you postnatally. Women experiencing normal and
complicated pregnancies can access these clinics. As these clinics are very busy
you may find you have to wait a while, despite being given an appointment time.
In some of the larger hospitals several specialised clinics exist to cater for
women experiencing specific pregnancy complications. These clinics, for example,
may specialise in women with blood pressure problems, diabetes or a history of
premature labour. If you are well and your pregnancy is continuing without
complication then other options such as midwives clinics and general
practitioner shared care programs tend to suit women better. The most common
complaints about hospital antenatal clinics are to do with the long waiting
times and meeting different practitioners at each
visit.
Midwives Clinics (Medicare card only-no extra costs)
Many major public hospitals have ‘midwives clinics.’ A midwife or group of
midwives runs these. These clinics are sometimes run 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.
Midwives working in midwives clinics generally provide continuity of antenatal
care for women experiencing normal pregnancies. If any complications develop
then the midwives refer women to a doctor 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. Midwife clinics tend to run on time and
involve less of a wait than the mainstream antenatal clinics. Women also 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. Research has told us that women prefer midwives clinics to mainstream
hospital antenatal clinics, which is why they are being made increasingly
available in public hospitals.
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 are increasingly being set up
in public hospitals. Team midwifery/midwifery group practice involves small
groups 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, which enables the midwife to meet women’s individual
needs. 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. This means your general practitioner may not always be able to
provide your pregnancy 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.
Early Discharge programs (Medicare card only-no extra cost)
Due to the fact that women are staying in hospital for shorter periods of
time, many hospitals have set up ‘early discharge programs.’ This enables women
who choose to go home in the first 48 hours after a normal birth or within 72
hours after a caesarean to have a midwife visit them in their home for up to
week following the birth. If early discharge is part of a team midwife program,
then a midwife you have met during the pregnancy will visit you. This program
suits women who are well and feel they will be more comfortable and rested at
home.
Private Hospital Care (cost associated)
If you have the appropriate private health insurance (or are uninsured and
willing to pay) you can choose a private obstetrician to provide your antenatal
care and attend your birth in a private hospital. You can also have a private
obstetrician attend your birth in a public hospital as long as they have
visiting rights. Obstetricians are doctors specialising in pregnancy and
childbirth. Check with your health fund to see if you are covered for this care.
Costs for private care may not be completely covered by a health fund and you
may have to pay part of the fee. There are enormous variations in obstetricians
and hospital’s fees so explore this carefully as you may well end up paying out
large amounts of money despite being in a private health fund. Choosing an
obstetrician can be difficult depending on the kind of care you want. General
practitioners tend to recommend a few they know but it may well be because they
went to university with them rather than based on their demeanour or skills.
Friends will give you the inside story on obstetricians but this can be coloured
by their own preferences and experiences. It is a good idea to really explore
the obstetrician you are thinking of choosing and ask them a series of questions
that relate to the type of care and birth you want. For example, if you are
after a normal vaginal birth in a birth centre you need to find out up front
whether they deliver in the birth centre as many won’t. Asking obstetricians
what their caesarean section rate is is another good way to discover how
interventionist they are. If you want to give birth on a birth stool or in an
alternative position other than on your back ask the obstetrician if they do
this as well. You will soon get a feeling of how well the two of you will work
together during the pregnancy and birth. It is important that women also realise
that private obstetricians usually come to the delivery ward just before the
birth. Midwives provide all the labour care and communicate on the phone with
the obstetrician. If there are any complications or the birth is imminent then
they will call the obstetrician. In the postnatal ward midwives will also be the
ones to care for you. Research has shown us that if women tend to experience
higher intervention rates under private obstetric care. On the other hand women
tend to like private obstetric care because they experience that continuity that
they regard as so important.
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. Some women choose to have a shared care
arrangement between their general practitioner and the midwives in the birth
centre. Some obstetricians will also assist women to give birth in a birth
centre. If you have chosen an obstetrician for your care, ask them if they will
attend your birth in a birth centre. 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 other medical and midwifery
practitioners 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.
Home Birth Care (cost associated)
Several hundred women each year in Australia choose to give birth at home.
Independent midwives care for these women. These midwives work for themselves
rather than a hospital. This means a cost is associated with this service. Some
private health funds give rebates for midwifery services. The same midwife or
small group of midwives provides pregnancy, birth and postnatal care. If you
choose this option and complications occur during the pregnancy or birth it may
mean you will need to have your baby in hospital. Most midwives will accompany
and support you when this occurs and continue to care for you along with the
hospital doctors and midwives. Intervention rates in birth are low and women’s
satisfaction with care is extremely high when cared for by independent midwives.
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