Pregnant? Congratulations! Choices, choices, choices ...
Birth choices - navigating the (incomplete) menu
When you first discover you are pregnant, it is a very exciting time! However it can also be a confusing and overwhelming time, with so many decisions to make!
Your first port of call will no doubt have been your GP. My guess is that the conversation went a little like this: "Do you have private health insurance? What obstetrician would you like?" I am guessing that the conversation never went along the lines of "would you like to have midwifery led care?"
Certainly in Perth, where we have the WA Health service The Community Midwifery Program, you can bet that the GP will not have mentioned this to you. In fairness, the GP is a very busy professional and there is an overwhelming amount of information for your GP to be across.
Even so, it is at this part of the pregnancy journey that your choices in childbirth already start to be impacted. After all, how can you make a decision, without all the information? It’s like being offered a menu for lunch, with items not listed, and seeing someone else, who has been there before, knows what is available even if it is not on the menu, being given a delicious looking frittata and salad that you would have loved to have ordered if you had known. You have to be content with your pizza slice, but really, how did she know about the frittata? How could you have known?
There are different facets to your birth experience - where you choose to have your baby, who you choose to provide clinical care and who you choose to have with you as a companion. The first two are intertwined. If you are having your baby in the private system in WA, you are very unlikely to know your midwife when you go into labour.
Midwifery led models of care for women usually live in the public system. Often it is not until a woman arrives at hospital in labour, that she realises her obstetrician will not be there for that very vulnerable time of a first labour. And although midwives do an amazing job at connecting with women quickly, it is a completely different level of support that can be offered by a midwife who knows you, supports your choices and understands how your labour is progressing for you. Continuity of care – knowing your caregiver – has clear benefits to mothers and babies (not to mention partners) yet in WA in particular, our options for having continuity through midwifery led care are limited, and expanding at what seems like a glacial pace.
It is a possibility that new parents to be may put more time into choosing a pram than choosing a model of care. At least with choosing a pram you can access all the information about all the choices and feel like you are making an informed choice! You may have seen the recently released Australian documentary on birth "The Face of Birth" (if you haven't, I strongly recommend that you get hold of it immediately and watch it!). One of the contributors compares her experience of being pregnant in the UK, to being pregnant in Australia. In the UK it is possible to have a look at the statistics of every hospital and health service, checking induction rates, caesarean rates, infection rates etc to see if you can choose a hospital which is local and fits your aspirations for your birth. When she approached an Australian health department to find out similar information, she felt as if she had been attempting to steal state secrets! This information is just not available in Australia, and making decisions about any type of health care, not just maternity care, is always a matter of luck rather than due diligence.
You are just not going to know about that frittata without some extra digging around for information. But there is help, there is information out there. As you are already aware, the internet is your most accessible and democratic source of health information. Our website has a lot of information about birth choices in WA, and there are many other websites across Australia that provide all the information you need to find out what your choices are in your state.
We have also developed a resource called "Questions to Ask your Caregiver" for people who are negotiating their care with a caregiver, as an extra resource for when you are trying to determine who to talk to. Really, when it comes to childbirth education, the biological details are just the beginning. The most important skill you can learn is to feel comfortable negotiating with your caregiver about your care during pregnancy and birth. It is ok to ask questions, it is ok to ask for time to consider your options. It is really important to read up if you want to have some say in your birth experience.
And… it is important to understand that your aspirations for your birth may well be quite different from your caregiver. And that there is such a thing as “directed consent” which could also be called “bullying” where you may be given “choices” that are framed in terms of risk highlighted all out of proportion.
It is ok to ask what the evidence may be for such assertions, and to ask for time to consider. You will remember your child’s birth day forever – each and every year, and on this day you will forever more in one way or another recall your birth. Really, your caregiver is unlikely to have the same recollection of the day – it is well worth asking the hard questions if need be, to ensure that you have the right care giver to support you.
To help parents orientate themselves to the maternity care system and work out which direction to head into, we run a Choices in Childbirth session in Perth twice every month, a free session to help parents orientate to the health system and decide which direction they would like to go in. We run these sessions because we are passionate about women being supported and informed to begin their journey into parenthood. We do belief birth can be a wonderful experience. We also believe that a wonderful birth can take many forms from a natural birth to a caesarean and everything in between.
What is the essential ingredient is for a woman to feel that she is making an informed choice. So don’t be afraid to ask for what you want! Even if it is not on the menu! The act of asking may well increase not just your choice, but the choice of other women, increasing that menu further to accommodate more of women's preferences!