How is a hospital midwife different to a private midwife?

This is a question I’m asked quite frequently so I’d like to take this opportunity to explain the difference. Hospital midwives are employed by a hospital, either public or private. The majority of hospital midwives work shifts and there are generally 3 shifts in a day, so that each woman will go through 3 different midwives each day, in the provision of her care. Many hospital midwives do not work across the full scope of midwifery practice; instead, they work in one area only, such as postnatal. Because of this, it is unlikely that women would be afforded the opportunity to meet with the midwives who’ll be providing their care in labour and after their baby is born, first because the midwives work in shifts and it’s impossible to know who’ll be rostered on on the big day, and second because the midwives in postnatal, for example, would not work in the antenatal clinics which is where women go for their pregnancy care. The other implication is that antenatal midwives - who do not work with breastfeeding mothers - are not best placed to provide breastfeeding preparation and advice in pregnancy; likewise, delivery suite midwives would also not be best placed to advise about early pregnancy tests.

Another important factor is that hospital-employed midwives are bound by hospital policies. It’s a condition of employment. So that when something props up and the woman wants impartial information or alternative suggestions to explore, the hospital-employed midwife is not able to provide this.

Private midwives run their own businesses and are self-employed. They book their own clients and arrange their work life and hours to meet the needs of their clients. They follow their clients through from pregnancy, birth and afterwards with their new baby, generally for 6 weeks. Private midwives do not work in shifts; we are on call 24/7 for the families in our care. This means that the same midwife is accessible at all times, either by phone or in person.

Families choose their private midwife, whereas there’s no option to choose hospital midwives: you have whoever is rostered on when you’re there. Choice is an important factor of maternity care, and is a driving factor in the success of private obstetric practices where women can interview several obstetricians before choosing the one that best meets their needs.

Private midwives are not bound by hospital policies. We do follow the guidelines of our professional bodies such as the Australian College of Midwives, as well as researched and widely-accepted clinical practice guidelines, as well as legal requirements, but when it comes to exploring all options, private midwifery is the way to go. A common example might be a breech baby. Hospital policy may be to offer to turn the baby manually (ECV) so that it is head down. If this is not successful, caesarean will be encouraged. These options are also given by private midwives, as well as the natural alternatives to turning breech babies, and if the baby decides to remain breech, there is the option of vaginal breech birth and the woman will be able to approach this knowing that she has a skilled professional by her side, on her side.

Women will generally approach private midwives for the one-to-one flexible care that we provide; they want to get to know the midwife who’ll be there on the special day (or night) when their new family member arrives. It’s only natural to want to know that person who’ll be with you during the most life-changing, amazing and special moments of your life.

Generally, satisfaction with private midwifery care is very high, whether the woman birthed at home or in hospital.

Women are generally very satisfied with their care because they have far more control over what does and does not happen to them. Women have greater access to resources that helps them to feel confident with their abilities to birth naturally and fully aware of all options so that they can choose the best one for their needs.

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