For further information, contact Melissa Maimann at Essential Birth Consulting.
The International Definition of a Midwife, as accepted by FIGO, ACMI and the International Confederation of Midwives:
A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
What is a Private / Independent Midwife?
A private (independent) midwife is employed by families, not hospitals. This is a very important distinction for you as a pregnant and birthing woman. As a consumer of midwifery services, having an independent midwife ensures that you have choice and control over your labour and birth.
Independent (private) midwives are accountable to their profession: to the Code of Conduct (ANMC), Code of Ethics (ANMC) and the Nurses and Midwives Board. However, we are not bound by hospital policy. We follow guidelines established by the Australian College of Midwives Inc (ACMI), in consultation with our clients and are guided by the needs of our clients.
Midwives are specialists in normal pregnancy and birth. The World Health Organisation (WHO) recognises midwives as being the most appropriate professionals for healthy pregnant and birthing women. Midwives are educated in all aspects of normal pregnancy, birth and postnatal care, and importantly, we are also educated in detecting complications and accessing obstetric care if needed.
As a private / independent midwife, I value the relationship I develop with you during your pregnancy. I like to spend time with you through your pregnancy so that you feel safe and comfortable with me at your birth. I focus on labour and birth preparation and childbirth education, ensuring that you approach your birth with confidence.
Why have midwifery care?
A recent study presented several advantages to midwifery care. The study was very large, involving 12,276 women. Women who had midwifery care were:
Less likely to be hospitalised during pregnancy
Less likely to have an epidural
Less likely to have an episiotomy
Less likely to require forceps or a ventouse birth
They were more likely to:
Have a normal vaginal birth
Feel in control during labour and birth
Breastfeed
You can have a home birth or a hospital birth with a private / independent midwife.
Fees
You can expect to pay between $4,000 and $5,000 for private midwifery care, whether you are having a home or hospital birth.
Why does it cost so much?
Fees for professional services reflect my qualifications, experience and commitment to you and your family.
I am not of the opinion that private midwifery is expensive. Please consider what other professionals and trades people charge for their services and their level of on-call commitment and responsibility.
Or, to look at it from another angle, how much money may you spend on a holiday? How much does a computer cost? And how long do these last you? Private midwifery is an investment in you and your baby, after all. And you deserve the very best.
Despite this view, some women ask me whether I will provide reduced services such as no postnatal care, one or two antenatal visits, a late booking, and so on, in order to reduce the cost. If I provided less care, I would not be able to maintain a safe record of care: either I would have to book double the number of clients each month (and risk missing your birth) or I may miss signs that things are not going well with your pregnancy or birth. All of this can compromise your care. I prefer to provide a comprehensive service and the women who book with me see the value in this approach. I am in the business of providing a premium service that is also the best value midwifery service in Sydney.
But …. if you want to know how the figures add up ….
Private midwifery consumes a whopping 86 hours of a midwife’s time. And that’s before we include:
On-call – 24 / 7 for 5 weeks around your due date
Phone and email consultations
Research
Administration time
Attending related appointments with clients
Professional consultation on the client’s behalf
Private midwifery services are comprehensive, and private midwives spend many hours with women and their families, building a strong relationship during the pregnancy that carries through to the birth and beyond. This provides an advantage to you during your birth – having a familiar face who knows you, your family, your wishes, your beliefs and so on. As you can see, the service provided by a private / independent midwife does not compare easily with other maternity services in terms of continuity of care, hours of contact, follow-up and availability. When you choose private midwifery, you are choosing gold standard service.
When midwives provide this level of service, it is impossible to book more than two or three clients each month. I could see women in a clinic setting for 30 minute appointments in business hours – that would eliminate travel time and consultation time – but I know that you’re after a service that really meets your needs.
Financial Hardship
I would rather you don’t let money be the deciding factor for getting the support you need. Call me to discuss a flexible arrangement.
Although I will never compromise on the high level of care that I provide, some areas of the service can be modified to reduce the price. I believe you will benefit from a service that gives you what you need, at the right price. Please note there is only one booking per month available to women who are experiencing genuine financial hardship.
Hi Melissa
It will be interesting to see how midwives charge for private services for attending births after November next year, when Medicare rebates will apply. Will we start charging a (small) recommended fee for prenatal and postnatal visits, and put most of the charge into the booking fee, which is what obstetricians do so that most of their fee is covered in the Safety Net?
I would assume that $4000 -$5000 covers approx 10 prenatal checks, two midwives being booked to attend in labour for as long as needed, and the birth plus 3-4 hours post birth, as well as about 5 postnatal home visits and a follow up 6 week visit. Midwives usually charge for the service rather than per hour. Some women will want only one midwife; some will want fewer prenatal checks and postnatal visits.
Dear Joy,
It will be interesting to see how midwives charge for private services after Nov next year – I am not sure how much the medicare rebate will be. Most likely, there’ll be a rebate for antenatal care and postnatal care, but homebirth will not be covered do midwives will have to charge a fee for the actual homebirth. Hospital births will be covered but I’m not sure what the rebate will be. I’ve heard conflicting info – one source said that the rebates will not be more than what a GP would be paid (I think that’s about $30), so in that case we would charge over and above that amount. The other source I spoke to said that the total fee would be around $5000 …. which I can’t see happening.
$4000 -$5000 is the going rate in Sydney …. some women have told me that their midwife charges $6000. I think it relates to the high cost of living in Sydney.
The fee covers visits that are monthly to 28/40, 2-weekly to 36/40 and weekly thereafter (all 2 hours long, all in the woman’s home), attending all hospital / doctor visits and scans with the client, labour and birth (1 midwife …. most midwives work alone), 3-4 hours after the birth, 6-7 postnatal visits (more if needed), care to 6 weeks postnatally, access to books and DVDs etc. I believe Adelaide is the cheapest State for home births, QLD and VIC are in the middle, and NSW is the most expensive …
How does your service work in Melbourne?
Hi Melissa,
This will be very interesting to watch and see how things eventuate. How does indeminty insurance work for you in NSW, are you covered? I am not totally sure of the costs of a private birth in Perth I think it is between $3000 – $4000 per birth all inclusive.
Hi there,
We don’t have PI insurance in NSW … privately practising midwives don’t have PI insurance anywhere in the world, as far as I know. That will cahnge post 2010 when eligible midwives will have insurance, but that insurance will only cover hospital birth. Down the track, it may cover home birth too.
Women in Melbourne have several choices of homebirth ‘models’. There are a couple of group practices which work as businesses and have clear protocols such as two midwives to attend each birth, and pay the midwives a wage. There is one GP who attends homebirth with a midwife. He will do Ventouse if needed. I am one of the few who will be the only midwife in attendance for a birth.
We can make backup bookings at the Women’s hospital by faxing the details in – no visit required. Monash asks the women to come for a checkup at 36 weeks. If women want bookings at other hospitals, or aren’t sure whether they want to give birth at home or hospital they do their checkups with the hospital as well as having visits with their midwife – a shared care arrangement. Occasionally a woman plannning homebirth will make a booking at a private hospital, but no obstetricians are officially giving backup to homebirth, so if the baby is born at home the booking isn’t used.
As a general rule I do prenatal checks in my office approx 6 weekly until 24 weeks, then 28 and 32 weeks, and a home visit at 36 weeks, office visits at 38 and 40 weeks, then weekly until the birth. Postnatally I do 3-5 visits in the first 5 days, then more as arranged with the woman. The total cost is usually $2200-2500.
Hi Joy,
thanks for that insight into midwifery in Melbourne. We don’t have any practices here in Sydney where the midwives are employed and are paid a wage. There are no GPs who attend home births.
Like you, I also work alone and arrange back up if needed by whomever is available at the time. I cover a large area – covering a 2-hour radius around my home, so I wouldn’t be able to arrange back up from just 1 midwife.
Most women book in, but procedures for this vary. Most hospitals require the women to come in for a visit. I always go with them.
We have 2 public homebirth programs in NSW, soon to be 3 or 4. Satisfaction with the services is high provided the woman has met all inclusion criteria. For women who are excluded from the program, bitterness is a common emotion and they usually go and book with an IM.
Joy,
I forgot to ask, when you mentioned that if women are unsure of place of birth, they see the hospital and IM, do they have the option to only see their IM and just go to hospital for a booking visit? The IM is able to provide all the info and history if the woman decides to birth in hospital.