Our Community Blog

You have recently taken a pregnancy test that has indicated positive and you are wondering what the next steps from here are.

You have options, but the first thing you may like to do see your GP to confirm the pregnancy. Your GP will run a series of serology tests, with one in particular confirming pregnancy (hCG). After your GP confirms pregnancy the GP often leads the way for you, by booking you into a public maternity hospital within your catchment area, or if you have private health cover, your GP may refer you to a private obstetrician they know of. There are quite a few options out there for you and there are things that you may wish to consider before deciding on who you want to look after you when you bring your baby into the world.

‘A caregiver is a qualified person (usually an obstetrician or midwife) who will guide and support you, physically, emotionally and spiritually throughout your pregnancy, labour, birth and in the immediate postpartum.’

Choosing the right caregiver for you is important as you would want to maintain the best experience for yourself throughout your pregnancy for your birth. I have known women to change their caregiver in the last weeks of pregnancy, and in doing so have felt a huge weight lift off their shoulders. ‘Remember that your caregiver works for you, and feeling heard, respected, safe and validated is extremely important.’

Your vision or some may call it birth philosophy is very important in deciding which caregiver is best suited to you. Envisage the birth you would like to have, and by doing this your birth philosophy will flow on in. It is then best to look into which caregivers birth philosophy aligns with yours. You may consider asking yourself the following questions to help you figure this out.

Do you prefer having continuity of carer? This is when the same person looks after you in your pregnancy and will most likely attend your birth.

Do you prefer a mostly hands off approach by caregiver?

Do you prefer more of a hands on approach by caregiver?

Do you feel that the decisions around birthing your baby should lay with you?

Do you prefer to have baby at home?

Do you prefer having regular checks?

Caregivers have different ways of working with women, some are more relaxed, while others are more risk averse, some feel more strongly about keeping birth as a natural physiological process allowing it to unfold as naturally as possible, where others prefer more of a controlled approach during pregnancy, labour and birth. So it really depends on what you want for yourself and your birth, all while taking into account your own individual circumstance surrounding your pregnancy, whether you are high risk or low risk will also depend on your decision for caregiver.

MIDWIFE

‘A midwife has been the traditional carer of child bearing women for many many years. The simple definition of the word midwife is a person, typically a woman who is trained to assist women in childbirth. A midwife specialises in lower risk pregnancy, normal labour and normal birth. And will care for you and baby after baby is born. Midwives are also known to provide holistic care which entails emotional, spiritual and social aspects throughout a woman’s journey.’

If the midwife happens to suspect any issues with woman and her baby, the midwife will refer the woman to an obstetrician for check up. If there are any emotional or social problems detected, the midwife will refer the woman on to the a department that provides help and support. Women tend to have different experiences dependent on the sect they are attached to with the midwifes. For instance more women have greater satisfaction being with the Midwifery Group Practice (MGP) compared to the regulater midwives clinics.

Midwives care for women at:

Midwives Clinics (Public hospital and Private midwifery)

Midwivery Group Practice MGP (Public hospital)

Birth Centres (Public hospital)

At home (Public hospital and private midwifery)

MGP is an amazing well sought after program that support women in the birth centre and in home birth (if your maternity hospital has a home birth program.) Being with the MGP program includes the benefit of continuity of care, it is women centred care with far less intervention and higher satisfaction rates. The woman gets to know her midwife, builds a relationship, receives comfort in knowing that her midwife has her back. The MGP midwife is more flexible and will support in ways that are not received in a regular public hospital. Unfortunately this program is only available to about 8 percent of women. Put your name down for the MGP program at your first midwifes clinic appointment, and fingers crossed you get in. 

PROS

Covered under Medicare.

Managed by a team of midwives, so you may be familiar with them.

Have the option to be looked after by MGP, where the same midwife who looks after you  antenatally and will also be there for your birth. This is very popular and only a small percentage of woman have access to, so be sure to get in quick by putting your name down for the program through the maternity hospital.

In a private hospital you do not have the option of midwifery based pregnancy care however midwives do care for you in labour and postnatally, as they work for the obstetrician looking after you.

Covered under Medicare.

CONS

At the public hospital team midwifery, theres a decent chance you will not know the midwife during labour. Regular midwives clinics are great however you don’t have the same women centred treatment. It is less personable, less flexible and very busy.

depending on when and how long you labour for, you may expect shift change, and may have a new midwife look after you. Unless you are with the MGP/ home birth program. 

Expect shiift change with MGP too however you are more likely to have a known midwive support you at your birth. 

PRIVATE MIDWIFE

This is a great option for many women, especially if you prefer to have a home birth.

You may choose to hire a private midwife to look after you during your pregnancy only and then birth in a hospital or birthing suite with public midwives or you may choose to have a private midwife look after you during your labour and your birth at home and/or to look after you postnatally. The great thing about this service is that the midwife comes to you!

PROS

Continuity of care.

Midwife comes to you at home. 

Flexibility with care, because they work privately they have their own guidelines and do not fall under the stricter hospital guidelines necessarily.

Access to around the clock support.

Partly covered under Medicare.

Attends your birth at home.

Have a reputation for providing holistic care.

CONS

Cannot look after a high risk pregnancy.

Out of pocket $$.

Not many of these gems around so would have to book in as soon as you can.

OBSTETRICIAN

An obstetrician is a doctor who specialises in the area of surgery and medicine that deals with childbirth. (Obstetrics.) They provide care in both public and private hospital settings.

An obstetrician is trained to deal with complicated pregnancies and labours that require or may require caesarian sections or deliveries that require the assisted delivery of forceps/ventouse, or if a woman has any serious pre-existing health concerns such as a heart issue, uncontrolled high blood pressure, auto immune or any other health problem that may cause complication/s to mother and baby during pregnancy, labour and child birth. The obstetrician will closely monitor all that is needed here to ensure the woman and baby are well. Additionally an obstetrician will look after women who are expecting multiple babies (twins triplets, quadruplets).

An obstetrician works privately in a private hospital however some work privately in a public hospital.

An obstetrician is on duty also in a public hospital.

PROS

Regular close monitoring for high risk pregnancies, can perform surgeries and procedures and are specialised to diagnose and medicate.

Continuity of care throughout pregnancy, labour and postnatal period.

Shorter appointment wait times.

Location may be convenient for you.

CONS

May have a higher rate of intervention throughout pregnancy, labour, birth. Before choosing an obstetrician you can find out what their c/section, episiotomy, and assisted delivery percentage is. Finding this out may help you decide on which obstetrician may better suit you. This information can also be found on the Department of Health Website. Additionally you can find out what hospitals the obstetrician works at and how many clients they take on each month.

Can be out of pocket $$ even with your private health cover, depending on what procedure/s were performed by the obstetrician.

Usually a GP will refer the woman to a private obstetrician that they know of, if the woman has private health cover. Women have the option to choose their care, so ask your GP about all options of care to you as a start. Sometimes a GP will not be aware of all the options of care in your area, so this is why research is necessary. Even though you have private health cover, having a private obstetrician may not align with you, or you may decide to choose an obstetrician that you know of rather than going with the one that your GP suggests. You may also feel that because your pregnancy is a healthy low risk one, you prefer a midwife to look after you or you may choose to have a home birth. Having private insurance doesn’t mean you have to be cared for privately.

Usually a GP will refer the woman to a local maternity hospital for care when a woman does not have private health insurance.

GP SHARED CARE

In regional and outback areas you may find that GP’s will deliver babies in the small township hospital. However the public hospital may have a GP shared care program available near you. This is where the GP will look after most of your antenatal checks, rather than visiting the maternity hospital to see an antenatal midwife for the checks. Regardless, you will still need to see an obstetrician a few times throughout your pregnancy. Not all GP’s are qualified to be in the shared care program, so If this is something you may be interested in, ask your maternity hospital for a list of GP shared carers in your area.

PROS

Continuity of carer. antenatally and or if regional possibly in labour too.

Don’t have to drive the long distance to a maternity hospital for antenatal checks.

You may know the GP and have a long standing relationship with them and prefer being cared for by them.

Usually covered under Medicare.

CONS

May have not had a great deal of experience even though they are kept up to date by the maternity hospital they are attached to. You can ask them.

If birthing at the maternity hospital, your GP will not be there For your labour and birth.

When meeting your carer for the first time, your first impression or that immediate feeling you get when meeting them should not be ignored. It is very important to feel happy, comfortable, heard, to have your questions answered respectfully and not be dismissed or brushed off, trust that your caregiver has your back and will respect your wishes. You will always have options, and know that you can change carers throughout your pregnancy even if it is a few weeks before your EDD. 

Sources used:

S. Ross, Birth Righ, A midwives guide to getting the best for you and your baby in pregnancy and birth, 2005, Doubleday. Aus, NZ.