Choosing your Birth Care Provider

Let’s chat about choosing your birth care provider. As a doula, I think this is one of the most important choices you can make for your pregnancy and your birth.

Private OB in private hospital: In this care model you will have your prenatal visits at your obstetrician’s office. The office will let you know the choice of private hospitals that your OB will attend.  When you go into labour you will arrive at the private hospital and they will assign you a midwife. The midwife will be with you and your partner throughout your labour, within her shift hours.

If you have a long labour, there may be a new midwife as the shift change over occurs.

She will liaise with your obstetrician via phone. If your obstetrician is at the hospital, they will pop in from time to time to check on you. Ideally they will be there for the second stage or pushing the stage of labour as baby is born.

In a private hospital you can stay for usually about three to five days and be cared by the postnatal midwives. Once you leave however, there is no postnatal care at home. Your next visit will be with your obstetrician for about a 15 minute visit at the six week mark, postnatally.

Pros:

• Personalised care with one OB.
• private hospital is usually a more luxe environment than a public hospital 
• private rooms are more likely

Cons:

• expensive, even with private health insurance,
• possibly higher rate of intervention in your pregnancy and birth,
• little to no postnatal care or assistance with breastfeeding,
• you won’t know your midwife prior to your labour,
• water birth usually not an option,
• may not be doula friendly

Private OB in a public hospital. Your prenatal visits will be in your OBs office. When you are in labour you will arrive at the public be assigned a midwife. This is very similar to what will occur in the private system. The difference compared with a private hospital is that in a public hospital you will have postnatal care at home.

A midwife will visit you at home for the first four weeks and help you establish things like breastfeeding and checking on your healing and also your mental health. You will then also have your six week check up with your obstetrician.

Public hospital is also likely to have a 24hr theatre available as well as 24hr anaesthetists available. High level care for baby such as NICU is likely to be available in a larger public hospital.

Pros:

• have personalised care of your OB with benefit of postnatal care from midwives postnatally,
• won’t have to wait for anaesthetist to be called in if you want an epidural at midnight as they will be on 24hr in a public hospital,
• NICU avaialble,
• perhaps lower cost than a private hospital depending on level of private health insurance

Cons:

• you won’t know your midwife prior to your labour,
• private OB often have higher rates of interventions (eg induction, Csection etc) than midwifery led care.

Public hospital as a public patient. Your prenatal visits will be held in the hospital antenatal clinic . You will be zoned to a particular hospital based on where you live.  When you arrive in labour you’ll be assigned a midwife who will care for you within her shift times. And you will then have a midwife visit you at home postnatally for 4-6 weeks.

***GP shared care can be an option here too – your early prenatal care can be with a trusted GP, a few visits are at the hospital antenatal clinic then you birth as usual through the public system.

Pros:

• Postnatal care for 4-6 weeks at home,
• waterbirth more likely an option,
• 24hr theatre and anaesthetists available,
• NICU available,

Cons:

• wait time at the antenatal clinic can be lengthy,
• no continuity of care with your provider for both prenatal care and in labour – you will be assigned a midwife and any complications during labour will be managed by the resident / consultant on shift.
• you can not chose your hospital

Midwifery group practice: You are assigned one midwife from a small group who will care for you during your pregnancy. They will attend to you at home for your prenatal care. And then when you are in labour, that midwife will care for you in the public hospital  (you will be zoned to a public hospital based on where you live) or at home (homebirth can be an option for MGP) throughout your labour, again within her shift hours. If she isn’t available, then another known midwife from that group will continue your care.

Postnatal care at home will be with your assigned midwife.

Pros:

• continuity of care from known midwives,
• prenatal visits are at your home which is more convenient,
• homebirth is an option,
• waterbirth is an option,
• postnatal care is for 4-6 weeks at home,
• covered within the public health care system

Cons:

• You may not have your primary midwife attend to you, you may have the back up,
• you may not secure a place as numbers are limited for these programs,
• there can be stricter guidelines to qualify for your homebirth, eg no VBAC, no longer pregnancies beyond 42 weeks, no twin births for example.

Private midwife for a home birth: A private midwife will attend to you at home throughout the duration of your pregnancy, she will be with you for the duration of your labour and birth. A very long labour may have a back up midwife, but she will be known to you. Your midwife will look after you from four to six weeks postnatally, usually with more frequent visits than a public system midwife.

Pros:

• Considered the gold standard of care by many,
• true continuity of care,
• you have less restrictions to qualify for this option, usually and all risk model,
• care is in your home,
• waterbirth is an option.

 Cons:

• out of pocket cost can be expensive although medicare will cover some of the cost.

So you can see there are a number of choices available in Australia on how and with whom and where you can birth. The best way to work out what choice is right for you is to think about what sort of birth you would like. For example, if you have your heart set on a water birth, perhaps don’t choose an OB who works in a private hospital where the rooms don’t have baths. This won’t be an option.

Statistically speaking, pregnancies and births managed by an OB have higher intervention rates: higher induction rates, epidural use and caesareans. If you absolutely want an epidural, then homebirth isn’t an option for you.

Its important you feel safe, listened to and respected as you move through your pregnancy and birth. Find a provider that feels right to you and is aligned with your vision of pregnancy, labour and birth

Best of Luck. Xoxo

***Birthing options may vary depending on where you live. Not all options may be available regionally or in every state.