Do you know your options of care? Do You Know You can choose?
So you’ve just learnt that you are pregnant. Congratulations! Though for many, what comes next can be a minefield to understand. Do I need to see a Doctor? How often do I have appointments? Where do I give birth to my baby? Do I need to do any classes? These questions are perhaps a small sample of many questions that may pop up.
Whether you have been trying to have a baby for a long time or it has been a welcome surprise, knowing what to do next can be so challenging.
Thankfully we now live in a world where information can more easily accessible if you only know where to look.
One of the first decisions to make is to find a care provider that aligns with your beliefs and experiences and will support your choices. Friends and families can be a good source to ask for recommendations locally, but there are other places to look too.
Local hospital page/antenatal clinic
Local medical centre
Social media/internet
GP
Some useful websites to find a care provider are: Homebirth Australia or by State; Maternity Choices Australia, Byron Bay Midwife Services (local to the Northern Rivers NSW).
Did you know you can have different types of care? Or care provider, or a combination? It can be helpful to consider what would make you feel the safest and cared for and then consider how this translates to how and where you would like to have your baby.
For example, do you know if you would like midwifery care or to be with an Obstetrician?
When considering care providers for your pregnancy and birth, it may be useful to understand the different roles that Midwives and Obstetricians have. Midwives are said to be the “specialists in all things physiological for pregnancy, birth and the postnatal period”. And Obstetricians the specialist in the abnormal or when things deviate from normal physiology. However, the roles also intermingle and interplay at different times as needed. For example, you can have an obstetrician or a GP obstetrician as your primary care provider, but at times during the pregnancy you may see a midwife for a pregnancy check-up or they are caring for you during your labour with your doctor coming in to check in and be present for the birth. And for your postpartum; you may have a midwife come to your home and help with postnatal care and see your GP or OB in the first week and then for the six-week check.
Quite simply the training for midwives and obstetricians is different in their underlying philosophy; midwives are physiological and obstetricians biomedical. Though of course both concepts overlap because pregnancy and birth is physiological, but women are not textbooks and medicine does have a place in pregnancy and birth. We are fortunate in this time of living that we have people that have amazing skills and resources when they are needed.
Melanie Jackson provides a fabulous visual example of where pregnancy and birth care may align with provider and location of birth.
Your location where you live can also determine the care models and provider you have access too. Did you know that whilst most women in Australia will have access to a midwife and a doctor in their pregnancy, they may not have access to a particular model of care. Did you know only 8% of women in Australia have access to continuity of care with a midwife (Dawson et al, 2018). Some women may only have access to a GP, no midwives at all, and some women may not have an option to birth in a hospital in their local town if that’s what they would like to choose. Some are then required to leave their homes at 36 weeks and travel to a larger city and await the birth of their baby. This of course means they are away from any support networks they have at home, are in a foreign environment and with limited to no support, and will potentially have added financial strain and are more likely to have an induced labour and possible caesarean birth.
So what are the options of care and care provider?
Midwife as primary care provider. This may be in the form of the local antenatal clinic at the nearest hospital and you may see a different midwife at each appointment and perhaps the public obstetrician for 1 or 2 appointments. During the labour and birth of your baby in the hospital, you will be cared for the midwives rostered on that day and the public obstetrician on call at that time if required. You may stay for 1-2 days to a week on the postnatal ward where rostered midwives will care for before you are discharged home. Once home you may receive 1-3 visits from a different midwife and/or community health nurse in the first 6 weeks postpartum and then see the Gp at six weeks for a postbirth check for you and baby.
Midwifery Group Practice or Caseload Midwifery. In this model a primary midwife is assigned to you as a primary care provider but will perhaps have 1-2 back up midwives as the midwives work in the hospital and to a roster. They will provide care for you in your pregnancy, labour and birth (in the hospital) and postpartum, up to 6 weeks. Variations of this model may be a publicly funded homebirth program or birth centre, so the location of the birth is different to the hospital. Or instead of 1-3 midwives caring for you a team of 6-8 midwives may care for you in Team Midwifery. In all these models you have a form of continuity of carer and access to a known provider 24 hours a day. After your birth if you don’t discharge home within 4-6 hours, you may stay on the postnatal ward and will be cared for by the midwives rostered on. Once discharged you will be cared for by your midwife that you had during your pregnancy and birth and they may see you for home visits as often as needed for up to six weeks, before seeing your GP at 6 weeks.
Private Midwife as primary care provider. You will have a midwife that is Endorsed and has their own business to provide care for your pregnancy, birth and up to 6 weeks postpartum. There is most often an obstetrician that you will be referred to so the midwife has a way of collaborating if anything abnormal or beyond their scop of practice pops up. A hospital can provide this pathway too. Birth is either at home or in the hospital. This is a privately funded model and different costs will be individual to the midwife. You will have access to the midwife 24 hours a day, and visits may often occur in your home.
GP shared care. This model has the GP with obstetric qualifications as the primary care provider in your pregnancy, though some visits may also occur at the public hospital you are referred to for the birth. The birth will occur in the hospital with the midwives and public obstetrician rostered on that day, and you may stay on the postnatal ward cared for by public midwives. Once home you may have 1-2 visits from the hospital midwives and/or community health nurse. You may see your GP in the first 1-2 weeks postpartum in their clinic and then at 6 weeks.
Private obstetrician as primary care provider. You will have a Private obstetrician for your pregnancy care, appointments most often occur in their private clinic, and you may be seen by a midwife that is part of their practice. Birth occurs in the hospital, possible public or private. For the labour; midwives provide the majority of one on one care but the obstetrician comes in regularly for check-ups of progress, decisions of management and the birth. You may stay in the hospital for up to a week. Postnatally you may see your obstetrician in their clinic at 1-2 weeks and at 6 weeks. They may have midwives in their practice that conduct postnatal visits, though this is dependent on the practice.
Of course, there are combinations of more than one care provider and model of care, e.g. Midwife provides antenatal and postnatal care but not any birth care. Some appointments can be via telehealth too or you may choose to have additional education and support with a midwife in person or via telehealth, but they are not your primary care provider. And of course, not all these options are available in the area where you live. You may also choose to freebirth, where you may or may not have care in your pregnancy with a care provider, but you birth at home with no health care professionals present and postnatally may also have no care provided.
Does all of this make sense? Or clear as mud? Is it of any wonder that women and birthing people do not know their options if they have never encountered the pregnancy and birth space before?
And of course, a big thing to remember is that just because you start with one care provider, does not mean you have to stay with that care provider. I have cared for many women that have changed from their care providers to me at differing stages of their journey; recently I commenced care for a woman at 42 weeks! I also frequently provide only antenatal or postnatal care. So remember it is always your choice!
You have to feel safe with the provider you chose, and if at any stage their care is not meeting your needs, you have the choice to enquire about other forms of support or care provider and change to that if needed.
As an Endorsed Midwife and Lactation consultant, I offer and am happy to consider/provide a care model that suits you, so please feel free to give me a call or send an email to discuss the best option of care for you!