Pregnancy and birth care options

The pregnancy and birth care options available to you vary according to where you live, the models of care offered by services in your area, your medical history, and risk factors such as weight, age and what happened during previous pregnancies. Your care may come from a midwife, a doctor, an obstetrician, or a combination of these professionals.

It is a good idea to talk to healthcare professionals, family and friends about your options and what to expect from the different types of pregnancy care. The choice you make is personal, and it helps to understand who provides each kind of care.

Who provides your care#

Midwives#

Midwives have special training and skills in caring for women during pregnancy, labour and birth. They also care for newborn babies in the days and weeks after birth, including helping the mother with breastfeeding. Midwives can be women or men.

Obstetricians#

Obstetricians are specialists in pregnancy, birth and women’s reproductive health. In a public hospital antenatal clinic, you may see an obstetrician if one is on duty at the time of your appointment, depending on the hospital and your level of risk. You are more likely to see an obstetrician if your pregnancy is, or becomes, complicated, or if you choose to see one as a private patient.

General practitioners (doctors)#

General practitioners are medical doctors with specialist training in general practice. If they want to care for women during pregnancy and birth, they usually complete further training, such as a diploma in obstetrics. You may want to ask your doctor whether they are accredited to share your pregnancy or birth care at the hospital where you are booked to give birth.

Ideally you will have received care from your doctor before conception, to optimise your health in preparation for pregnancy and reduce any preventable risks. It is also very important for you and your baby to be looked after from the start of your pregnancy until after the birth. Care should include identifying special medical or personal needs that may require extra help from trained professionals.

Making informed decisions#

It is important to make informed decisions about your pregnancy and birth care. When making these decisions, speak with your obstetrician, midwife or doctor. Some options might not be available to you because of where you live. For example, some rural hospitals do not offer antenatal or birth care. In such cases, you would travel to a larger hospital to give birth and then receive postnatal or home visits from local services, while your doctor or a community health clinic might provide shared antenatal care.

Some options may not be desirable to you because of the costs associated with different types of care. Reading, or talking to friends and family about their experiences, can be helpful, but nothing can replace individual advice from healthcare professionals. Every woman is different, and what suits one woman may not be right for another.

Other tips for making informed decisions include:

• Involve your partner or support person in your decision-making. This is particularly important if you need emergency care or are unable to communicate your wishes.

Be wary of online advice from unreliable sources#

Websites endorsed by governments, medical colleges or other recognised peak bodies tend to be the most reliable. Some private hospitals and obstetricians will allow an elective caesarean, where you choose to have a caesarean even though it is not medically necessary. Be sure you understand all the pros and cons before asking your obstetrician to perform this procedure.

During your pregnancy, you will have time to explore all your options with the help of your carers. You can change your mind if the choice you have made turns out not to be right for you and other care options are available.

Public patient care#

Choosing to have a baby as a public patient generally means:

• You go to antenatal check-ups at a hospital outpatient clinic, a community-based health centre, a doctor accredited by the hospital, or through shared care with your own doctor.
• You usually have your baby in the public hospital closest to where you live.
• You may be cared for by doctors or midwives, depending on the level of care you need.

When you are in labour and during birth, you will be cared for by a hospital midwife who will deliver your baby. A doctor will usually only be present at the birth if you need extra medical care. You will not be able to choose the midwife or doctor who attends. If a doctor attends the birth, the hospital midwife will continue to provide care for you.

After leaving hospital, a hospital midwife may visit you once or twice at home, or you may visit your doctor. You are encouraged to see your doctor about six weeks after the birth. If you do not have a doctor, it is a good idea to find one you are comfortable with before you have your baby. Depending on where you live, public hospital maternity care may be partly or fully covered by your public health system.

Private patient care#

Choosing to have a baby as a private patient generally means:

• Your antenatal check-ups take place at your obstetrician’s or doctor’s private consulting rooms. Once you have chosen an obstetrician, your appointments are likely to be with them or another member of their team.
• Many private obstetricians employ a midwife to help with routine checks, organise tests and scans, and give information about pregnancy and childbirth.
• You choose your hospital. You can go to a private hospital, or to a public hospital as a private patient.
• You choose your obstetrician. If you do not have one, you can contact your preferred private hospital and ask for a list of obstetricians who work there. If you already have someone in mind, this usually determines which hospital you go to for the birth. Your doctor can provide a referral.

You will be cared for by a midwife during your labour. The midwife stays in contact with your obstetrician and lets them know when to come in. Your obstetrician will assist with the birth when it is time. You may also choose a privately practising midwife.

Private hospital costs are covered by you and your private health fund, if you have one. You may be out of pocket for some costs, so check with your fund before the birth so you are prepared for any additional fees. It is a good idea to confirm that your insurance provides enough cover for unexpected costs such as an anaesthetist, theatre fees, or being a private patient in a private hospital. Some private hospitals offer home visits once you are discharged. You may also want to check whether your baby is covered, should they need admission to a special care nursery.

Antenatal care#

Your care during pregnancy (antenatal care) can be provided by a midwife, a hospital doctor, your own doctor, an obstetrician, or a combination of these. The type of antenatal care you receive depends on your health, your risk of complications, where you live and the type of care you choose.

Regular antenatal appointments are important to monitor your pregnancy and the wellbeing of both you and your baby. They include asking about your health, checking your blood pressure and monitoring your baby’s growth. Your visits also give you the chance to ask questions and talk about anything that may be worrying you. If your pregnancy is considered low risk, you will usually have between 7 and 10 of these visits over its course.

Specialist pregnancy care is available for women with extra needs or a higher-risk pregnancy. In such cases, your contact with your carers will be tailored to your needs.

Antenatal care options generally include:

• Public clinic care. Depending on the hospital you attend, your antenatal care takes place in a public hospital outpatient clinic or a community clinic, and you go to the same hospital for the birth and postnatal care. Under this model you might see different midwives and doctors at each visit.
• Midwifery clinic care. Care is delivered through a public hospital midwives clinic. You may see the same midwife or group of midwives throughout your pregnancy, and your baby will be delivered by whichever midwives and doctors are on duty in the birthing unit. Many hospitals can offer home visits if you go home early (often within 48 hours after the birth). This model is for women having a healthy, low-risk pregnancy. If complications arise, you will be referred to an obstetrician at the hospital.
• Shared care. Your chosen healthcare professional (doctor, midwife or obstetrician) makes an arrangement with a public hospital to share your antenatal care. You get most of your care from your chosen professional and only attend the hospital for a small number of visits, for the birth, or if there are complications. This lets you be cared for by someone you choose, usually close to home, and can be helpful if you have particular language or cultural needs. In some rural areas, public hospitals provide birth care but no antenatal care, so shared care is the only option. The hospital midwife cares for you during labour and birth, and in some services your own doctor attends the birth as well. Midwives at hospitals and some community health centres also offer childbirth education classes.
• Midwifery group practice. A small group of public hospital midwives care for you during pregnancy, labour, birth and the postnatal period, with most of your care given by one or two primary midwives. This lets you become familiar with a small group who will also be there for your labour and birth.
• Team midwifery care. Similar to midwifery group practice, but with a larger team of up to about eight midwives. This model is often only available in larger urban areas.

Additional and specialist care#

During your pregnancy, you may need additional care that is medical, cultural, social or emotional. For example, you may need support for mental health problems, drug issues or alcohol dependency. If so, you may receive your care from specialised staff in the hospital or in the community. It is important that any problems or complications during pregnancy are looked after.

Public hospitals may offer many different types of specialist care, such as:

• Care for women expecting two or more babies, managed by a group of obstetricians and midwives with expertise in multiple pregnancies.
• Satellite or community clinics, organised by a public hospital, that provide specialist midwifery services in a community venue near your home, such as a community health centre. The midwives and doctors are employed by the hospital and work full- or part-time at the clinic, while birth care takes place in the hospital.
• Culturally appropriate maternity care for women from some communities, which may be provided by a health worker, a midwife, or both, often shared with the local hospital. The health worker supports women during pregnancy and after birth and links them to the care they need.
• Recurrent miscarriage care, for women who have had three or more miscarriages, managed by obstetricians and midwives who are experts in monitoring, preventing and treating recurrent miscarriage.
• Care for women with significant pregnancy complications, with diabetes (gestational or pre-existing), or with other high-risk pregnancies.
• Care for monitoring unborn babies with a medical condition, providing appropriate support for you and your family.
• Care for women planning a vaginal birth after a previous caesarean, supported by obstetricians and midwives experienced in this type of birth.

Care during labour and birth#

The care you receive during labour and birth (intrapartum care) depends on the choices you make about where and how you want to deliver your baby, and who you would like to be present. Earlier in your pregnancy, your antenatal carer may have encouraged you to write a birth plan. A birth plan is a summary of what you would like to happen during labour and birth. It covers things like the position you want to give birth in, the pain relief you prefer, what you would like to avoid where possible, and who you would like with you. It is a good way to tell your carers what is important to you.

However, labour and delivery do not always go to plan. Sometimes unplanned medical interventions are necessary to ensure your safety and the healthy delivery of your baby.

Hospital birth#

Most people choose to have their baby in either a public or private hospital. Where you give birth depends on your location, financial situation, insurance status, choice of obstetrician, and the type and history of your pregnancy. There are many care options in public or private hospitals, as outlined above. Whichever setting you choose, the midwives will help you understand what is happening, support your choices about pain relief, and discuss any medical interventions and special care options with you.

How long you stay in hospital after giving birth depends on the hospital and your care needs. After a vaginal birth in a public hospital you might stay around 24 to 48 hours, or about 72 hours after a caesarean section, while private hospitals may offer a longer stay. In both settings, if you and your baby are well, you may be able to go home sooner.

Birth centre care#

Birth centre care is available in some public and private hospitals. Each birth centre operates differently, but care usually focuses on the whole family. A birth centre is designed to look and feel more like a home, and some have double beds and ensuite bathrooms. As with other parts of the hospital, the centre and its midwives are equipped to handle emergencies.

In a birth centre you are cared for by a team of midwives, and you may also have one to three visits with a doctor who attends the centre. Birth centres work on the basis that pregnancy and birth are healthy life events and that for most women there is little need to intervene. If you have complications during pregnancy or labour, your midwife will arrange a transfer of care. You usually stay in the centre for 24 to 36 hours after the birth, and your partner and family may be able to stay with you. Afterwards, a midwife may visit you once or twice at home, or you may visit your doctor.

Planned home birth#

In some areas, women can choose a planned birth at home under the care of public hospital midwives or private practice midwives. Home birth can be an option for women who are healthy, have a low-risk pregnancy and do not live far from a hospital. It is usually arranged with a private midwife, though some public hospitals offer publicly funded home birth programs.

For a home birth:

• Pregnancy care is provided in your home, or a location chosen by you and your midwife.
• During labour and birth, your midwife cares for you in your home, and a second midwife or a doctor may also attend.
• Your midwife provides postnatal care in your home.

If you need to be transferred to hospital during the birth, your midwife or doctor can come with you, but the hospital staff make the decisions about your care.

Key points#

• It is very important for you and your baby to be looked after from the start of your pregnancy until after the birth.
• It is important to make informed decisions about your pregnancy and birth care.
• Some options may not be available to you because of where you live.
• Some options may not be desirable to you because of the costs associated with different types of care.
• Involving a support person matters most if you need emergency care and are unable to communicate your wishes.

Where to get help#