Continuity, choice and control in the private system

There have been some interesting articles in the media today in response to yesterday’s articles about the incredibly high rates of (possibly unnecessary) intervention with private obstetric care. Rob Buist, a respected obstetrician in Sydney’s Eastern Suburbs , quite rightly points out that women seek private care to access “the renowned "Three Cs" of maternity care – choice, control and continuity.” These are certainly features of the private system. Women choosing private care are able to choose their care provider and hospital, they have the continuity of one known care provider overseeing or providing all of their care, and they have a degree of choice (so long as their choices can be supported / provided for by their care provider). However, other women experience that the private obstetric system offers little choice and support for a normal birth, particularly in the face of risk factors such as VBAC, VBAMC, vaginal twin birth and vaginal breech birth. Let alone in the water without continuous monitoring! This lack of support is to the extent that some women feel that they need to bring private midwives with them to the hospital to act as qualified advocates for their wishes.

My experience is that the Three Cs are the most important factors that an informed woman considers when she makes choices about her care, yet our maternity system does not seem to offer women true choice. By and large, women with private health insurance have choice of private obstetrician and hospital, but do they have choice of a private midwife in hospital? Homebirth under the care of a private midwife with the backing of the hospital or a supportive private obstetrician? A hospital waterbirth with twins or a breech baby? How different would things look if women were able to access this care? Would our intervention rates be as high as they are currently? Certainly, there needs to be a balance between safety and the exercising of choice in birth because the point of pregnancy and birth is to deliver a healthy baby, but it is time to look at our rates of intervention and ask ourselves if womens’ and babies’ needs are best served by these high rates of intervention, or if there are better ways of delivering care in the private system that genuinely incorporate continuity, choice and control.