I’m Pregnant! Now what… - Part 1 Caregiver
First of all, CONGRATULATIONS!
Pregnancy is a wonderful and exciting time, but it is also a very important time, where lots of decisions have to be made.
It can also be a very anxious time, with worry about the baby, pregnancy complications and… birth, which most women don’t even want to begin thinking about because… scary, unknown and painful.
So, I have a few tips and some information to help you navigate the next part of your journey.
Part 1 Choosing your Caregiver
Where to have your baby and who with?
This is a choice for some women and less of a choice for others, depending on location, private health cover and affordability.
In Australia we have 3 main types of care – most people only know about the first 2.
Public Hospital
There are multiple options within the public system, depending on your hospital
o MGP – Midwifery Group Practice
This is a very popular model of care, as you have the same midwife throughout your pregnancy, birth and postpartum. According to evidence continuity of care with a midwife is gold standard for low-risk pregnancies, improving outcomes and lowering intervention rates. (1) Your midwife will possibly even come to your home for your visits. You often gain access to birth centre rooms with more space and options. Some MGP also offers homebirth for low-risk women.
If you would like to access this, I recommend you book in early and ask about MGP.
o Midwifery Clinic
Your appointments will be at the hospital clinic, you may see a different midwife each visit, or you may see the same midwife for multiple visits. Depending on the hospital, they may have a birth centre, or you may birth in the delivery suite. You will usually see different midwifes for birth and postnatally.
Women may also have one or 2 appointments with an obstetrician and then return to midwifery care.
o Obstetricians
If there are any ‘risk factors’ in your pregnancy, you may see doctors/obstetricians for your care, often you will see a different doctor each visit. Usually, you will birth in the delivery suite.
o GP Shared Care
You have many of your appointments with your GP and go into the hospital clinic for a few key appointments.
I often hear of women almost falling into one of these categories without realising different options exist.
Private Hospital with Private Obstetrician
I meet a lot of people who assume a private hospital with a private obstetrician is the best option, especially if they have private health cover. I’ve heard of many GPs referring women to private obstetricians without even asking if this is the type of care they want. This type of care is certainly appropriate for some women but I want you to be informed. Many (not all) private obstetrician have much higher intervention rates than other types of care. According to Australian Government statistics 43% of women had a caesarean section within the private sector, compared to 29% in the public sector in 2021. (2). Rates of induction, epidural, instrumental delivery (forceps or ventous) have all been found to be higher in the private sector as well. (3)
This is not to say all obstetricians will have higher interventions, but it does highlight the importance of choosing your caregiver very carefully. There are absolutely fantastic obstetricians, it is about making sure you find the right caregiver for you.
If you would like care with a private obstetrician and you would like to avoid interventions, be sure to ask your potential caregiver questions about your birth. Questions like: When would you offer induction after my estimated due date? Can I birth in any position I am comfortable? (vs on the bed). And if you really want to get some info, how many low-risk, first-time mums birth without interventions? Plus, come up with your own list of questions about what is important to you.
Take note, not just of the answer but how they answer, do they basically avoid the question? Do they use a lot of medical jargon to give a fancy, meaningless answer? Do they use wording like “I won’t let” or “I don’t allow.” This type of wording gives the idea that they are making the decisions, but remember, you are in control of your body. You are the one hiring them and paying them. You are in charge.
On the topic of paying, many women do not realise in advance how much out-of-pocket they will pay even though they have private health. Every appointment costs money, plus hospital admission, an anaesthetist (epidural or caesarean), it ads up to thousands.
Also, remember, you can change caregiver during your pregnancy. If you start seeing red flags during pregnancy, they will probably only get worse.
Private Midwife (Home or Hospital birth)
Many people don’t realise this option exists. You can have an Endorsed Midwife provide your care during your pregnancy, birth and postnatal period. Many of these midwives provide homebirth, although some do have admitting rights at hospital.
One thing most people don’t realise is the evidence around home birth. A home birth is attended by 2 Endorsed Midwives, with all the appropriate medical equipment. Evidence is clearly showing that homebirth is a safe option for low-risk pregnancies, with significantly lower intervention rates. (4)
There is also the option to have antenatal &/or postnatal care from a private midwife for extra support & care. This is especially great for those in the private system who go home and are not seen again until 6 weeks after having their baby, or women who are only seeing obstetricians during pregnancy who may want some support and education from a midwife.
It is also important to know that different hospitals have different facilities and options. For example, most private hospitals do not facilitate waterbirth, many don’t even have a bath available. Public hospitals may have a limited number and you may need to request this. MGP or birth centres may be more likely to have availability. Public hospitals will usually have a shorter hospital stay but midwives will come out to your home for visits. Private hospitals will often have a longer hospital stay but no visits once you go home until your 6 week check. MGP or Private Midwife and you may have your midwife continue to visit as needed for 4-6 weeks after birth.
So, know your options and as best you can, do some research and find a caregiver who aligns with what you are wanting for your pregnancy, birth and postpartum.
3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27430/
4) https://www.thelancet.com/pdfs/journals/eclinm/PIIS2589-5370(20)30063-8.pdf
