Pregnancy-care Options

Midwife caring for pregnant womanDr Manisha Fernando and Dr Katrina Reid look at the different kinds of options available to pregnant women.

Working out the details of your pregnancy care can be confusing, so you might want to consider your preferred model of care before trying to conceive. Your GP is a great source of information about pregnancy services, as are friends and family who have had babies.

Here are some details of pregnancy-care options, however it's important to check what services and options are available in your local area.

Private Maternity Care
This is where you are a private patient of an obstetrician or GP obstetrician (a GP with additional qualifications that allow them to deliver babies). You attend private consulting rooms for care during pregnancy, and are looked after by the same obstetrician/GP obstetrician for labour and postnatal care. Generally you would give birth at a private hospital, although some people's insurance only covers private care in a public hospital.

To access this level of pregnancy care, you generally need private health insurance. It is possible to pay for private maternity care without insurance, but it's an expensive option. Check with your insurance fund first to ensure you are covered for obstetrics, and what waiting periods may apply. As well, this mode of care usually involves out-of-pocket expenses, even with private health insurance, so it is important to check what these will be.

Public-hospital Clinic Care
This model of prenatal care is provided in a public-hospital outpatient clinic. You would attend the same hospital for labour and postnatal care, and pregnancy and labour care is provided under the supervision of medical staff, usually an obstetric registrar. You would usually see a doctor for most of your visits, so women with significant medical issues, or those who develop conditions such as gestational diabetes during pregnancy, would generally have this mode of care. If you have an uncomplicated birth it would usually be attended by midwives, but if complications arise during labour, the midwives would call the obstetric registrar or consultant for help. Generally there are minimal out-of-pocket costs associated with this type of care, as is the case for public-hospital midwives' clinics, and birth-centre care (see below).

Public-hospital Midwives' Clinic
Prenatal care is provided by a public-hospital midwives' clinic, including one or more appointments with an obstetric consultant/GP or obstetric registrar to ensure you are otherwise healthy and don't require transfer to public-hospital clinic care (see above). Labour care is provided under the supervision of medical staff such as an obstetric registrar or consultant, and uncomplicated births are usually attended by midwives.

Team-midwifery Care/Caseload-midwifery Care
In this model, you receive care from a small team of midwives or a single public-hospital midwife throughout your pregnancy, labour, birth and hospital stay. However, if complications arise requiring additional investigation or treatment, an obstetric consultant or registrar will be brought in. This form of care provides great continuity, but is generally only available to otherwise well women with uncomplicated pregnancies. It is also only available at certain hospitals, so you would need to check.

Birth-centre Care
Some women choose pregnancy and delivery focused on the natural process of childbirth in birth centres. The centres are similar to team-midwifery care, but differ because midwives provide prenatal, labour and after-delivery care within a separate section of a hospital, which encourages intervention-free births. Only certain hospitals have birth centres, and women must meet particular criteria to access them. For instance, women with high blood pressure and those who require induction or have had a previous caesarean section may not meet requirements. This mode of care is best suited to healthy women with uncomplicated pregnancies. Water births are also available through birth centres, although you would need to check.

Birth centres often require women to be transferred if they need epidural pain relief, so this needs to be considered by women wanting to attend a birth centre. Again, it is important to check what services are available locally and what circumstances may require you to be transferred out of the birth centre during your labour.

Shared Maternity Care
In this model, the majority of pregnancy care is provided by a local practitioner (usually a GP, but sometimes an obstetrician or midwife), with visits to the hospital at the start of pregnancy and occasionally throughout. Typically these visits are at 28 and 36 weeks, but may vary. Only certain GPs are registered to provide shared care, and if your own GP isn't, they might be able to suggest ones who are. Your hospital also may have a list of registered shared-care providers.

Care during labour will be provided by the public hospital. There may be some small out-of-pocket expenses for the GP visits after claiming through Medicare. The advantage of this mode of care is that you can rely on your trusted GP if they are registered to provide shared care, or build a relationship with a GP who can be a great resource for you after the baby is born.

Planned Homebirths
Some women may want to have their baby at home, but it is important to be aware there are differing opinions among health professionals regarding the safety of this option. In Australia, only a very small percentage of babies are born by planned homebirth. In this model of care, pregnancy check-ups, labour care and postnatal support are usually provided by one midwife. However, transfer to a hospital in the case of complications may be required, so before choosing this option you should consult with your midwife.

To access this care you would generally need to organise a private midwife, although a very small number of hospitals in Australia provide a homebirth program. Private midwives are available via the Homebirth Australia website. Homebirth would generally only be recommended for otherwise well women with uncomplicated pregnancies. Out-of-pocket costs are involved and would need to be discussed with the midwife.

Making A Final Decision
These models of care will vary between different hospitals, States and individual-care providers. Different models depend on your medical and pregnancy history, as well as individual preference. It is important to try to choose the model that seems best for you and your family, but also to be aware that changes may have to be made if your needs or health change. Speak with the different providers of care in your area or visit hospital maternity wards and birthing centres. With a little research, you will be able to find the best maternity-care model for you.

Note: This article provides general health information and in no way constitutes medical advice. Ideas and information expressed may not be suitable for everyone. Readers wishing to obtain medical advice should contact their own doctor.

Dr Manisha Fernando and Dr Katrina Reid are GP mothers who write about prenatal and pregnancy health.



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