Birthing options in Australia
You managed the tricky first stage of pregnancy, doing a wee on a strip the size of a paddle pop stick while not getting any on yourself, and got a positive result! Congratulations! What now?
Most women will still go to a GP for confirmation of pregnancy, and work out their due date. Now you should seek out your care provider who will go on your journey with you. Better outcomes in birth are STRONGLY associated with continued care with a known carer.
If you have complications or are high risk, you will probably receive advice that you should have an obstetrician lead your care.
If all is normal (and most are) you have some more options.
You could contact a private OB of your choosing, who operates in a nominated private hospital, to lead your care during pregnancy: Appointments are conducted in their clinic and they will most likely be there for part of your birth.
During the majority of your labour you would be cared for by the midwives who are on call at that time in the hospital, and the OB will be called when you are nearing second stage to 'deliver' your baby, or if they are needed for a complication earlier.
The midwives on call in the hospital will lead your care after the birth, the doctor will probably see you at least once afterwards as well. Private OBs will charge a fee, which will be covered if you have private insurance, and partly by Medicare.
You could find a private midwife of your choosing to lead your care, who would conduct all your appointments either in their clinic or in your home, refer you for any tests scans, support you for your birth at a public or private hospital, a birthing centre or lead your care for a planned homebirth and 'deliver' your baby.
A private midwife will be there for the entire length of your labour (yes even if it is 2 days), provide your after care in the weeks that follow. They work with partners and you will also have a second midwife whom you will meet during appointments.
If you need an OB it will be whom ever is on call at the time, but your midwife will stay with you as well. Private midwives will charge a fee, (which is only covered by some insurance companies) and may be covered partly by Medicare IF the midwife is considered eligible and is registered with medicare rebate, this rebate covers ante and post natal care, but not the actual birth. (!)
You could do a shared care model with a GP or midwife, booking into a public hospital, having some appointments with the hospital staff, both OB’s and midwives (you may not see the same person twice) and your nominated GP or midwife. This will be covered by Medicare.
Case load midwifery
Some public hospitals have case load programs where you will get to know and have continuity of care with your midwife, some also have a matching system, where although you can't choose your midwife you can be 'matched' to the one that best suits you and request to change during your care. Case load programs endeavor to have your know midwife on call for you labour and lead your after care.
You could book into a birth centre in a public hospital, covered by Medicare, some may have a case load programs where you will get to know (but not choose) your midwife and have them attend your birth, and lead your aftercare. You have to be low risk and there are some rules (like length of labour) which can see you transferred in main hospital wards.
You could book into a homebirth program run through a hospital, this is covered by Medicare. Some of these programs have caseload where you will have two midwives who lead your care, come to appointments in your home and 'deliver' and lead your after care. Some also have a matching system, where although you can't choose your midwife you can be 'matched' to the one that best suits you and request to change during your care. Case load programs endeavor to have your know midwife on call for you labour and lead your after care.
* 'deliver' is in quotations as I have been told by many midwifes that: mothers deliver their babies, Midwifes just catch them!
Will I be supported in my right to choose the type of birth I'd like?
Choice in place of birth isn't a right that is widely supported in Australia, I have listed the options above but not all are as easily or readily available as they should be or as they are in other countries.
There are many very good private OBs in Australia and if you have insurance this option is easily available.
Booking in to a public hospital in your area is an option for all women, there of course are wonderful midwives and OBs working in these hospital, but you wont be able to choose your carer and you wont have continunity of care. (unless they offer case load programs)
Private midwives aren't nearly an numerous, and many have recently been forced to leave the profession because of insurance issues, hostility from hospitals and because of the resistance from GPs and OBs to collaborate with them. Of the private midwives still practicing some have been able to be registered for Medicare rebate and some have not. We need more private midwives and they need to be supported and funded.
We are losing birthing centres in Australia every year. In Melbourne there are only three left! Birthing centres are a wonderful choice for women who don’t want the medical environment of a hospital and would prefer a home like feel where natural birthing is supported, but would still like the back up of a hospital near by. WE need our birth centres back!
Hospital Home birth programs are great but you have to live in the area, there are only two in Melbourne for example, not servicing the majority of the population. Also they have an eligibility selection criteria that doesn't suit everyone.
If I choose homebirthing, will costs be compensated by Medicare?
If you have a homebirth through a hospital home birth program you birth will be covered by Medicare, if you have a private midwives, IF they have been registered for the Medicare rebate you will be covered for Ante and post natal care, but not the birth. If the midwife is not registered for the rebate, you will be out of pocket. A very small number of insurance companies cover home birth (Australian Unity).
What are the risks associated with homebirthing?
There is risk in every birth, in normal birth for low risk women it is very very low, this is true for low risk birth everywhere in Australian. Statistics show that if you are low risk, giving birth at home with a skilled midwife is as safe as a low risk woman giving birth in hospital. Safety in these statistics is defined as an alive and physically healthy mother and baby.
If you are high risk the data shows it may be safer to have you baby in a hospital. But these studies are not taking into account factors beyond alive baby and mother. The emotional and physicological safety of the women and babies. You are less likely to have interventions at home. (in fact it is very, very unlikely), less likely to develop post natal depression.
There is a chance you will need to transfer to hospital from home, this chance is higher if you are a first time labouring mother. You travel by car, or by ambulance depending on the problem, the midwife will advise you and talk you through your options every step of the way.
The most important factor in choosing where to give birth is where and with whom makes you feel the most safe and supported, for most women this is of course a hospital, and for some women hospitals make them feel unsafe.
How does Australia compare?
Australia doesn't really support or offer homebirth to pregnant women. Compared to New Zealand where at confirmation of pregnancy it is explained to women that they can choose hospital birth centre or home birth and that they can change their mind at ANY step in the pregnancy (or even labour!).
They can choose their lead maternity carer and 80 per cent of mothers in New Zealand choose a midwife, this midwife cares for them no matter which delivery environment they choose.
The same is true of the UK and the Netherlands (who have a 30 per cent homebirth rate, the highest in the world) and many other European countries.
Read Bub Hub members' reviews of the movie
Check out the forum threads regarding a mother's choice