Your antenatal care – Your birth choice
Your decision about how and where to give birth to your baby will be a very personal one.
A century ago, nearly all babies were born at home, usually with a midwife attending the birth. But now, most babies in the West are born in hospitals. A small but growing number of parents choose to have their baby at home or in the more homely setting of a midwife-operated birth centre within a hospital.
The best environment for you to birth your baby is a place in which you feel safe and comfortable – and that will differ for every couple.
You will also need to decide who will provide medical care for you throughout your pregnancy (eg a midwife, doctor or obstetrician) and who will be with you for the birth (including birth attendants such as doulas or family members).
Before deciding what is right for you, it’s important to find out more about the various options available to you (not all are available throughout Australia and New Zealand).
Your birthing options
You might decide to change your choice as your pregnancy progresses; but in some areas, the available resources can be booked up quite early, so it’s a good idea to approach your preferred care provider soon after you discover you are pregnant.
As your pregnancy progresses, you may also find that certain options are less suitable or not available to you, for example if your pregnancy becomes higher-risk due to very high blood pressure, conditions like placenta praevia or concerns about the baby’s health.
However, most pregnancies (more than 85 percent) lead to a normal and straightforward birth, so it is likely that you can stay with your original choice.
Although it is not always possible to ensure that the person who is your health care provider through your pregnancy is also the person that will look after you at the time you deliver your baby, it is really important that you are able to relax and trust the doctor or midwife or team of professionals who will be your main caregiver.
If you have any qualms or discomfort with the person or people involved in your care, it’s a good idea to consider changing to another care provider to make sure you are reducing any potential problems when you are birthing.
It’s also a good idea to get a second opinion if you receive any information that you don’t feel comfortable about.
Do your research thoroughly and be aware that there is disagreement between the experts; no one option is the best for everyone, so be open-minded and be prepared to seek a second opinion if you feel uncomfortable with the options presented to you.
The most common way to access your birth options is through a referral from your General Practitioner; you may also want to discuss birth options with your doctor at the time you seek a referral.
Many local General Practitioners offer ‘shared care’ with hospitals, which means that your own doctor will conduct the regular pregnancy check-ups as your pregnancy progresses, with just a few visits required to the hospital in which you will birth your baby.
The advantage of shared care is that you will have the same trusted doctor with you throughout your pregnancy – and that doctor is likely to be the one who will care for your baby into childhood.
However shared care does mean that the hospital in which you will deliver your baby and the hospital staff who will be involved in the birth may be less familiar to you.
By far the majority of births in Australia (more than 95 percent) take place in the maternity delivery rooms of our public and private hospitals.
Hospitals differ widely in the facilities and options that they offer for maternity patients.
Large public maternity hospitals offer the most facilities; as well as the standard delivery ward, they often offer options like team midwives, birth centres and early discharge home-visit midwife services. Some hospitals also support home-birth midwives.
Public Hospital Delivery Ward
If you agree to accept the hospital-provided doctor, Medicare covers the cost of all pregnancy and birth-related treatment in a public hospital including accommodation for the mother and baby after birth.
You will attend the hospital’s antenatal clinic for your pregnancy care, with the rostered doctors and midwives attending you.
Patients who have private health cover or who choose to pay the cost are also able to use the facilities of a public hospital and choose their own obstetrician (if that doctor is registered with the hospital).
Hospital delivery wards are generally equipped for every eventuality that may occur during a birth including most medical emergencies.
Private Hospital Birth
Many pregnant women choose their obstetrician first and then select from the private hospitals that are visited by their chosen specialist.
However if you prefer, you may first choose the private hospital that suits you best and contact them asking for a list of their obstetricians.
It is a good idea to make this choice early as many obstetricians can be “booked out” quite quickly.
Many large maternity hospitals now offer a Birth Centre, where a small team of midwives are involved in all of the pregnancy care as well as deliveries and postnatal care.
In most instances, only midwives are involved in the prenatal care and delivery, but should assistance be required, obstetricians are readily available.
The birth centres are often set up to emulate a home and they encourage a natural approach to delivery with minimal intervention. Some have rooms with large baths and large double beds and bean bags to make birthing parents feel as comfortable as possible and give more natural options for pain relief.
Once again, birth centres often book out very quickly, so it is a good idea to make this choice as soon as possible.
Around 2.5 percent of births in Australia take place in a Birth Centre.
A small percentage of births in Australia – about 0.5 percent of all births per year – take place in a home setting, with a professional midwife attend the birth. Usually the same midwife who is going to deliver the baby, will monitor the woman throughout the pregnancy.
In a normal healthy pregnancy, most women go into ‘spontaneous labour’ and are often advised to spend the early hours of their labour in the familiar surroundings of their own home before moving to the place where the baby will be delivered.
In a home birth, your attending midwife is contacted when you go into labour and will come to your home, staying until after the baby has arrived.
A lot of freedom and choice is available to mothers birthing at home; you do not need to travel while in labour and remain in familiar surroundings.
There is no pressure to hurry the birth and a natural approach to pain management and delivery is encouraged, although you can arrange a prescription for some pain relief options in advance (such as gas or pethidine) if you wish.
Couples who choose to have their baby at home can join a homebirth support group or simply contact an independent midwife who will guide them through the choices available.
Many women choose to rent a ‘birthing pool’ which can be set up in their home to enable a water birth if desired.
Apart from a small trial in one public hospital, at this stage, homebirth is not publicly funded and are not usually covered by private health insurance, so the midwife fees are paid privately.By Fran Molloy – journalist and mum of 4