Help I’m Pregnant! Now what?
By Hannah Dahlen
So you’ve done the pregnancy test and it’s positive. Now what? Who do you see? Where do you go for your care? How do you find out what is available out there?
When women are pregnant for the first time it can be a daunting and confusing process trying to discover what maternity care options are available and which option will suit them best. The fact that there are an increasing variety of pregnancy and birth options for women to choose from shows how individual this choice is. Many women talk to their friends to get information and this can be a great way to get an inside view of what is available. The only problem with this is, it is usually one view and it is influenced greatly by individual experience.
Most women have healthy pregnancies and experience a normal birth. The care received during the pregnancy, birth and the postnatal period can, however, enhance this experience and help detect any complications that may develop. In order to meet women’s choices, a variety of maternity care options have been made available. Depending on where women live they may be able to choose between receiving their care primarily from a midwife or a doctor. Women may also be able to choose to have their baby in a hospital, birth centre or at home. This choice will depend largely on the health of the individual woman and/or her baby during the pregnancy. A charge will be associated with some services while others are covered completely by Medicare. Most women will go and see their general practitioner when they discover they are pregnant. The general practitioner may then confirm the pregnancy if this has not already done and they will provide a referral to the hospital or practitioner of the woman’s choice. They may also do some initial blood tests and provide some basic information about pregnancy health related issues.
Public Hospital Care
Most women who are pregnant, and do not have private health insurance, obtain a referral from their general practitioner (GP) to a public hospital. Depending on where you live, the hospital you chose to attend and your health you may be able to access several different options.
Public hospital antenatal clinics (Medicare card only-no extra costs)
Public hospital antenatal clinics are available to all women. These clinics tend to run Monday to Friday, but not necessarily every weekday. Doctors and midwives provide the care. You may not see the same health practitioner at each antenatal visit and it is unlikely they will be the same health practitioners who attend your birth or care for you postnatally. Women experiencing normal and complicated pregnancies can access these clinics. As these clinics are very busy you may find you have to wait a while, despite being given an appointment time. In some of the larger hospitals several specialised clinics exist to cater for women experiencing specific pregnancy complications. These clinics, for example, may specialise in women with blood pressure problems, diabetes or a history of premature labour. If you are well and your pregnancy is continuing without complication then other options such as midwives clinics and general practitioner shared care programs tend to suit women better. The most common complaints about hospital antenatal clinics are to do with the long waiting times and meeting different practitioners at each visit.
Midwives Clinics (Medicare card only-no extra costs)
Many major public hospitals have ‘midwives clinics.’ A midwife or group of midwives runs these. These clinics are sometimes run in the community and are called ‘outreach clinics’. Midwives are skilled professionals who are qualified to provide complete care for women experiencing normal pregnancy and childbirth. Midwives working in midwives clinics generally provide continuity of antenatal care for women experiencing normal pregnancies. If any complications develop then the midwives refer women to a doctor at the hospital. Women get to know their midwife or midwives during the pregnancy under this model of antenatal care. Women then give birth in the hospital delivery ward and are attended by the midwives and doctors who are on duty at the time. After the birth midwives on the postnatal ward care them for. Midwife clinics tend to run on time and involve less of a wait than the mainstream antenatal clinics. Women also enjoy seeing the same midwife for their care during pregnancy as they develop a relationship with them. Midwives focus on more than the physical aspects of the pregnancy. They regard the emotional and psychosocial needs of women as a high priority. Research has told us that women prefer midwives clinics to mainstream hospital antenatal clinics, which is why they are being made increasingly available in public hospitals.
Team Midwifery/Midwifery Group Practice (Medicare card only-no extra cost)
Most women want to receive consistent information and care from someone they get to know throughout the pregnancy, birth and postnatal period. In response to these expressed needs programs like team midwifery are increasingly being set up in public hospitals. Team midwifery/midwifery group practice involves small groups of midwives that work together to provide antenatal, labour, birth, and postnatal care to women. Many of the larger metropolitan hospitals now run team midwife programs or variations of continuity of care programs. There is now substantial evidence that continuity of midwifery care should be available as a choice for pregnant women. The effectiveness of continuity of midwifery care is largely due to the relationship of trust that is built up during the pregnancy, birth and postnatal period, which enables the midwife to meet women’s individual needs. This form of care results in less intervention and higher long-term breastfeeding rates, as well as lower rates of postnatal depression. Women experiencing this form of care have been shown to feel well prepared for labour, to perceive labour staff as caring, to feel in control during labour and feel well prepared for parenting
General practitioner shared care programs (A cost may be associated)
Most hospitals now offer women the option of having their pregnancy care shared between a general practitioner and a hospital. This provides women with the convenience of accessing their antenatal care in their own local area. They also may have a good relationship with their general practitioner and want to continue this care in their pregnancy. General practitioners participating in shared care programs must meet certain criteria before being able to provide antenatal care. This means your general practitioner may not always be able to provide your pregnancy care. They also will need to refer you to the hospital you will give birth in so you can book in for your care there. You will be asked to return to the hospital for visits with the doctors early in the pregnancy where they will make sure there are no risk factors in your pregnancy that warrant specialist care. You will then continue to see your general practitioner but you will be asked to return to the hospital for antenatal visits at around 30 weeks, 37 weeks and at around 41 weeks of pregnancy. If you develop any complications you will be asked to see the hospital doctors for specialist care. Hospital midwives and doctors mostly attend the birth and give postnatal care. In some cases, particularly in rural areas, general practitioners may also attend the birth. If your general practitioner does not bulk bill or you do not have a Medicare card you will have to pay for this service. You can arrange general practitioner shared care by contacting your local hospital and finding out if your general practitioner has a shared care arrangement with them or if they run such a program.
Early Discharge programs (Medicare card only-no extra cost)
Due to the fact that women are staying in hospital for shorter periods of time, many hospitals have set up ‘early discharge programs.’ This enables women who choose to go home in the first 48 hours after a normal birth or within 72 hours after a caesarean to have a midwife visit them in their home for up to week following the birth. If early discharge is part of a team midwife program, then a midwife you have met during the pregnancy will visit you. This program suits women who are well and feel they will be more comfortable and rested at home.
Private Hospital Care (cost associated)
If you have the appropriate private health insurance (or are uninsured and willing to pay) you can choose a private obstetrician to provide your antenatal care and attend your birth in a private hospital. You can also have a private obstetrician attend your birth in a public hospital as long as they have visiting rights. Obstetricians are doctors specialising in pregnancy and childbirth. Check with your health fund to see if you are covered for this care. Costs for private care may not be completely covered by a health fund and you may have to pay part of the fee. There are enormous variations in obstetricians and hospital’s fees so explore this carefully as you may well end up paying out large amounts of money despite being in a private health fund. Choosing an obstetrician can be difficult depending on the kind of care you want. General practitioners tend to recommend a few they know but it may well be because they went to university with them rather than based on their demeanour or skills. Friends will give you the inside story on obstetricians but this can be coloured by their own preferences and experiences. It is a good idea to really explore the obstetrician you are thinking of choosing and ask them a series of questions that relate to the type of care and birth you want. For example, if you are after a normal vaginal birth in a birth centre you need to find out up front whether they deliver in the birth centre as many won’t. Asking obstetricians what their caesarean section rate is is another good way to discover how interventionist they are. If you want to give birth on a birth stool or in an alternative position other than on your back ask the obstetrician if they do this as well. You will soon get a feeling of how well the two of you will work together during the pregnancy and birth. It is important that women also realise that private obstetricians usually come to the delivery ward just before the birth. Midwives provide all the labour care and communicate on the phone with the obstetrician. If there are any complications or the birth is imminent then they will call the obstetrician. In the postnatal ward midwives will also be the ones to care for you. Research has shown us that if women tend to experience higher intervention rates under private obstetric care. On the other hand women tend to like private obstetric care because they experience that continuity that they regard as so important.
Birth Centre Care (no cost for public patients)
Depending on where you live and whether you have any health or pregnancy complications you may be able to choose to have your care through a birth centre. Your general practitioner can refer you directly, or the midwives in the hospital will give you this option when you book in for care. Birth centres are mostly located in hospitals and are staffed and run by midwives with medical back up should complications develop. Some women choose to have a shared care arrangement between their general practitioner and the midwives in the birth centre. Some obstetricians will also assist women to give birth in a birth centre. If you have chosen an obstetrician for your care, ask them if they will attend your birth in a birth centre. Birth centres provide a home like environment where midwives work to care for women through pregnancy as well as assist them to give birth as actively and naturally as possible. There is a great emphasis in birth centres on empowering women and helping them to feel in control of the whole experience. If there are any complications during the pregnancy or birth then women will be referred to other medical and midwifery practitioners in the hospital. Research exploring women’s birth experiences and outcomes show that women experiencing their care with midwives through a birth centre have lower intervention rates and seem more satisfied than with other forms of care. This is particularly so when midwives work in a team midwifery arrangement in birth centres because women experience even greater continuity of care.
Home Birth Care (cost associated)
Several hundred women each year in Australia choose to give birth at home. Independent midwives care for these women. These midwives work for themselves rather than a hospital. This means a cost is associated with this service. Some private health funds give rebates for midwifery services. The same midwife or small group of midwives provides pregnancy, birth and postnatal care. If you choose this option and complications occur during the pregnancy or birth it may mean you will need to have your baby in hospital. Most midwives will accompany and support you when this occurs and continue to care for you along with the hospital doctors and midwives. Intervention rates in birth are low and women’s satisfaction with care is extremely high when cared for by independent midwives.
Reproduced with permission http://www.midwives.org.au/ForWomen/childbirthchoices/tabid/322/Default.aspx