You’ve just found out you’re pregnant! Now what? Public or private? Obstetrician or GP? Birthing centre or home birth?
Not to worry – we’ve put together this article as a summary of the main types of antenatal and childbirth care available in Australia. Although not all regions and states will have all options available.
There are many things to think about when considering your antenatal care and childbirth options. So where to start?
Read through the options below and see which suits you, your needs and your budget.
Who do you want to care for you?
Midwives are health professionals who provide specialist care, education, and support during pregnancy, birth, postnatal, and the early parenting period.
Midwifery care includes the detection of complications in mother and baby, the referral to other specialists, and the initiation of necessary emergency care.
Midwives provide many additional services for complete birth care such as:
- preconception health (preparation for pregnancy)
- all medical antenatal care
- childbirth education
- well-being during pregnancy, such as nutrition, exercise, and support
- information on birthing options and the effects of any drugs which may be used in labour
- postnatal care for mother and child, including infant feeding and settling
- lactation consultants, providing specialised support for mothers, with breastfeeding
In most states, you cannot currently employ a midwife as your main care provider on a private basis unless you wish to consider a home birth. You can employ an independent midwife to go with you to the hospital, but the midwife has no practising rights in the hospital and you will also be attended by hospital appointed midwives and obstetricians as necessary. Because of current public liability insurance issues, home birthing options are limited.
Independent midwives can also be employed privately for any aspect of pre- and post-natal care from childbirth education, to post-natal care of the mother or baby, breastfeeding advice, and sleeping and settling techniques.
Obstetricians are doctors with specialist training in childbirth. Your obstetrician will look after all your medical needs during your pregnancy and can cater for all types of pregnancy from low to high risk.
If you wish to be treated privately and you already have an obstetrician in mind, you will need to contact them to find out which hospitals they have admitting rights to.
If you don’t have a preferred obstetrician, ask your GP for a referral or ask your chosen maternity hospital for details of obstetricians who can practice there.
Will you see the same OB/midwife at each appointment?
Your main antenatal and childbirth care provider will work as a team with others – even doctors and midwives are allowed to sleep and have days off.
When making your final choice, check who else you are likely to see and how often if that is something that is important to you.
For example, if you choose a private obstetrician, you’re likely to have all your antenatal appointments in their private rooms. During labour you will be seen by the midwives at the hospital until delivery is imminent, when your obstetrician will be called to attend. If your obstetrician is not available, it’s likely another member of their practice group will attend in his/her place.
If you attend a midwives clinic in a public hospital and have an uncomplicated pregnancy, you are likely to have each antenatal appointment with any one of the team of midwives or obstetricians available on your clinic day. Your birth will be attended by whichever team of midwives and obstetricians is on duty at the time.
A number of hospitals are also now offering Caseload Midwifery or Midwifery Group Practice. This is where the pregnant woman is cared for by the same midwife, supported by a small team of other midwives, during their pregnancy, birth, and early weeks at home. Ask if it is an option at your hospital.
At the Royal Hospital for Women in Sydney expectant mothers can join a Pregnancy Centred Care Program – where they participate in four group sessions with up to 12 women due in the same month.
Private hospital facilities (cost involved)
If you wish to have your baby as a private patient, you get to choose where you give birth and who your main care provider will be. You can choose your obstetrician first – and then find out which hospitals he/she has admitting rights too – or you can select your maternity hospital and find out which private obstetricians work there.
Once you are booked in with an obstetrician, you will have all your antenatal appointments with him/her at their private practice. Your obstetrician will conduct all antenatal tests, or make arrangements or recommendations for tests and scans with specialist providers.
You will have no need to go to the hospital at which you will give birth until the time arrives to have your baby. However, many obstetricians and hospitals will arrange for a familiarisation visit beforehand so that you can have a quick look around before the big day.
If you wish to use private medical insurance, ensure that you check your policy carefully for the services covered before undertaking any costly consultations. Some policies have exemption clauses for cover for pregnancy in the first year (or more) of membership. Check also what private cover you would have for your child once born. Family cover often includes the child automatically, but this may not be the case if you have individual cover. Check your policy carefully. If all is well and your insurance will cover you, select your preferred venue and speak to your health insurance provider about what steps to take from there.
If you wish to be treated as a private patient, but do not have private medical insurance, you will be required to pay all costs yourself. Check payment terms and conditions with your care provider and chosen maternity hospital before undertaking any consultations.
Public facilities (generally no cost for eligible patients)
For care as a public patient under Medicare you will need a referral by your local GP. Call your local maternity hospital for details of their booking-in procedure. The birth should take place at the hospital and there are usually no out-of-pocket expenses providing you have valid Medicare cover.
After ‘booking in’ and an initial assessment, you may then have the following options for continuing care, providing your pregnancy is low risk and no complications develop …
Hospital maternity clinic
If you elect to have your antenatal care through the hospital maternity clinic, you are likely to have all your antenatal appointments at the hospital with your care being provided by a team of midwives and obstetricians. Who you see on your appointment day will depend upon who is on duty on the day.
On the downside, there can be long waiting times for appointments, but on the positive side, the hospital will arrange for all your tests, scans, and other care – which, in most cases, will take place in the hospital itself at no cost to you. Hospitals often offer additional services such a pregnancy exercise classes, postnatal education, and specialist physiotherapy services.
The birth should take place at your chosen hospital where you will be seen on the day by the midwifery team and obstetricians on duty at the time. Postnatal care will often be in shared wards and you can elect for an early discharge if staff feel that you are coping well (particularly if it is not your first baby).
Midwife-managed birthing centre
Midwife-managed ‘birthing centres’ and free standing childbirth units provide for more natural ‘at-home’ style antenatal care, labour, and birth. Places are limited and are only available to pregnancies considered low risk. Early enrollment is advised.
Midwives take primary professional responsibility for care. Since teams and patient numbers are smaller, you have a much higher chance of seeing the same midwife more often during your antenatal appointments and the birth.
During labour and birth, medical services, including obstetric, neonatal, and anaesthetic care, are available if needed, sometimes from a separate site. Most centres are within hospitals so more intensive medical care is available should an emergency arise.
Community midwifery programs
Community midwifery programs usually operate through a local health service or maternity hospital providing publicly funded antenatal care at local community facilities or even homebirth care. CMPs usually operate with small teams of midwives following a ‘continuity of care’ model.
This option is available at some city public hospitals – although the number is increasing. It is more widely available in regional areas where community facilities ease the burden of having to travel long distances to the nearest maternity hospital.
Check with your local maternity hospital or GP to see if this option is available in your local area and if you would be suitable for this type of program, which is usually only for low-risk pregnancies.
GP – shared care (may be some costs)
Under the ‘shared-care’ scheme, you split your check-ups between your GP and the maternity clinic at the hospital. After an initial assessment at the hospital, the scheme allows you to visit your GP for regular check-ups, while you visit the hospital for scans, antenatal classes, and any tests above and beyond those that can be carried out by the GP.
Regular checks after approximately the 36th week (depending on your maternity facility) will usually take place at the hospital. If you are interested in shared care, check that your GP is willing and able to provide this service. Any fees due to your GP will depend upon your GP’s individual fee scale and billing policy.
Home birth (costs involved in most cases)
A home birth option is only available to low-risk pregnancies. It is available on a private basis anywhere in Australia but homebirth in the public system is only available in very limited areas.
For all the above options, specialist tests, such as ultrasounds, will usually be carried out at a hospital.
If you are considered to be at risk of a more complicated pregnancy, you are likely to be requested to visit the hospital for all your check-ups.
Other childbirth services
There are a number of additional private and community services to assist you with antenatal care and childbirth preparation, offering assistance from parenting antenatal classes to hypnobirthing, birthing partners (doulas) and more.