In the blog post below, I am going to go through a few scenarios or care preferences, and suggest a care option that may best suit that individual situation. I am going to assume that there are four options, even though others may be available in a woman's local area. The options I am going to choose from are:
Private midwifery care (home or hospital birth)
This is a continuity of carer model where a woman is cared for by one chosen midwife from early pregnancy through to birth and the postnatal period until the baby is 6 weeks old. Where the woman or baby experience complications or risk factors that require a higher level of care, the midwife involves an obstetrician or paediatrician in the care of the woman and / or baby, while the midwife remains the lead care provider and co-ordinator of care. The midwife orders the necessary tests and scans for the woman and baby, as well as prescribing any necessary routine medications.
Private obstetric care (hospital birth)
This is a continuity of care model where the woman's pregnancy care is provided by one chosen obstetrician. The labour is attended by hospital midwives who are not known to the woman before labour starts, and the birth is attended by the obstetrician with whom the woman has a relationship. Postnatal care is provided by hospital midwives who are not known to the woman, with the obstetrician visiting daily and providing a final check at 6 weeks postnatal. This model of care is available in public and private hospitals.
Shared care: either with a GP or a private midwife
This is where a woman attends a private midwife or her GP through her pregnancy (continuity of carer for pregnancy), however the birth is attended by the hospital midwives and obstetricians at the hospital at which the woman is booked, as a public patient. Once the woman is discharged from hospital, she may again be cared for by her private midwife or GP.
Public hospital care
In this model, a woman is cared for entirely by the staff who are employed by the woman's local public hospital. Generally, the woman attends the antenatal clinic for her pregnancy care, where she is seen by the midwives who are on duty that day. From one visit to the next, the woman may be seen by different midwives. Some hospitals have a midwife clinic where it is possible for the woman to be seen by the same midwife for most of her pregnancy (antenatal) appointments. In labour, the woman is cared for by the midwives and obstetricians who are on duty on the day. These midwives and obstetricians will not be known to the woman ahead of time, and they work in shifts. Once the baby is born, the woman moves to the postnatal ward where she is again cared for by midwives she has not met before, who work in shifts. This model of care is absolutely free to Medicare card holders, and in Australia, our public system delivers a very safe standard of care.
I want to build a relationship with the midwife who will be caring for me during birth.
This woman would be best to choose private midwifery care. This is the only model where all of your care is provided by one midwife.
I want to feel prepared, informed and confident as I approach my birth.
This woman would best be cared for with private midwifery care, or with private midwifery shared care. In both models, midwives work very closely with women, through education, preparation, support and lots of time for questions and discussion.
I want basic care: just a quick check and basic education to be safe.
This woman could be cared for with private obstetric care, shared care or public hospital care. It might be best suited to a woman who has had a normal, straightforward birth before, who just wants the basics to be safe.
I want to build a firm relationship with the obstetrician who will be present if something goes wrong.
Private obstetric care might be best here, however there are models of collaborative private midwifery / private obstetric care that might also be helpful.
I am planning an elective caesarean.
Probably private obstetric care will be best. You will get to know your obstetrician well during your pregnancy, and s/he will attend your caesarean. This is very reassuring care for women planning a caesarean.
I want to have home visits from my midwife after my baby is born.
Private midwifery care would be best for the postnatal aspect of the care. Pregnancy and labour care may be provided through a different model, such as public hospital or private obstetric.
I am planning a waterbirth / home birth
Private midwifery care again. Public hospitals generally don't provide homebirth services, and waterbirth rates can be quite low. Private midwives have the highest rates of homebirth and water birth.
I am planning a VBAC
Private midwifery care will give you the best chance of a VBAC (vaginal birth following a previous caesarean).
Melissa Maimann is an endorsed eligible midwife in private practice in Sydney. One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support. Visit Melissa's website to learn more about her services.