Congratulations on your pregnancy! Whether you've just discovered you’re expecting, well into pregnancy or still just planning, the decisions ahead can feel both exhilarating and daunting. Often, the initial inquiry at your GP's office boils down to a simple question: "public or private hospital?" However, this single query barely scratches the surface of the many choices awaiting you.
The Public Sector:
Public hospital maternity care in Australia offers various models of care and is typically covered entirely by Medicare. This includes antenatal appointments, childbirth hospital visits, and postnatal care, with no out-of-pocket expenses for women. However, except for caseload care, most models within the public system lack continuity of care, resulting in women being seen by different practitioners during antenatal visits and childbirth.
The Private Sector:
The private sector in maternity care offers alternative options to the public sector, including private obstetricians, midwives, and hospitals. While it can provide more personalized care and amenities, it often requires private health insurance or out-of-pocket expenses. Consider the costs and benefits carefully to make the right choice for your needs. The private sector is also associated with higher rates of intervention, induction of labour and cesarean section births.
"Among low risk women, rates of obstetric intervention were highest in private patients in private hospitals, lowest in public patients, and generally intermediate for private patients in public hospitals."
Beyond Public or Private
Beyond the binary of public versus private lies an array of maternity care options, each tailored to different needs, preferences, and circumstances. Yet, many begin this journey without a clear understanding of the diverse models of care available, or what each model entails.
For those who have private health coverage, the default assumption might be to engage a private obstetrician. However, this may not always align with your individual needs or desires for your birthing experience. Truly, the decision about the right model of care extends far beyond insurance status—it's about understanding your unique requirements, preferences, and what brings you a sense of safety, respect and choice throughout this transformative process.
Evidence suggests women using midwife-led continuity of care models are less likely to experience interventions and more likely to be satisfied with their care compared to women using other models of care (Sandall et al. 2016).
In this guide, we'll explore the spectrum of maternity care options, empowering you to make informed decisions that resonate with your values and aspirations. Keep in mind that the availability of these options may vary depending on your location, so it's essential to conduct thorough research or consult with local experts, such as doulas, to explore what's available in your area.
Models of care:
A maternity model of care describes how a group of women are cared for during pregnancy, birth, and the postnatal period.
Midwifery care:
Midwives are skilled health professionals trained to support women through healthy, low-risk pregnancy, birth, and postpartum.
They are experts in facilitating physiological birth and can offer guidance for breastfeeding.
Midwives are adept at recognizing subtle changes that may require specialist attention and are trained to respond to many emergency situations.
If complications arise, your midwife can refer you to obstetricians they work alongside.
This care model does not offer the benefit of continuity of care..
Caseload Midwifery Care:
Caseload midwifery or midwifery group practice programs offer personalized care by assigning an individual (primary midwife) or a small group of midwives to support you throughout your pregnancy, childbirth, and postnatal period.
This continuity of care creates a trusting relationship between the woman and her midwife(s).
Enhanced continuity of care increases the likelihood of satisfactory, low-intervention vaginal births.
Research has shown that this model leads to optimal outcomes, empowering women with a supportive team dedicated to their holistic well-being.
This care may be utilised in a public hospital or birth centre environment.
"Women who received midwife‐led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care."
Collaborative Care:
Collaborative care combines the expertise of both midwives and doctors.
It caters to women who desire midwifery support but may have health concerns or complications during pregnancy.
This model is particularly suited for cases such as VBAC (Vaginal Birth After Cesarean), Gestational Diabetes, concerns about fetal size, or high blood pressure.
Midwives and doctors work together to provide comprehensive care that addresses both the medical and emotional aspects of childbirth.
Obstetric/high risk maternity care:
Public hospital high-risk maternity care involves specialized, multidisciplinary teams providing close monitoring and management for pregnant women with medical or obstetric complications within the public system.
It includes specialized facilities, continuous surveillance, individualized care plans, and comprehensive support to optimize outcomes for both mother and baby.
In this care model, an assessment on intake determines whether obstetrician or midwifery care is best suited to the woman and her baby.
Women in this care model will likely be looked after by different doctors at each visit.
Their birth would be attended by whichever doctor is on shift.
Shared Care:
Shared care involves support shared between a GP/Obstetrician and your chosen hospital. A GP/obstetrician is a General Practitioner who has completed additional training in pregnancy and birth.
Under this model, all your antenatal appointments take place at your GP's clinic, which may incur a fee. However, not all GP/OBs will attend your birth.
Additionally, as part of shared care, you may also be required to attend appointments with midwives at the hospital for booking in and creating a birth plan.
This collaborative approach ensures that you receive comprehensive care throughout your pregnancy journey, combining the expertise of both your GP/Obstetrician and hospital midwives.
Shared care also offers the benefit of continuity of care antenatally, or completely if your GP will also attend your birth.
Private Obstetrician:
Private obstetricians can be consulted in either public or private hospitals, typically requiring a GP referral.
Private obstetric care is suitable for families with private health cover but entails high costs, with out-of-pocket expenses ranging from $3000 to $6000.
Additional costs may arise for services such as anesthetists or pediatricians in a private hospital setting.
Private specialist care offers continuity with consistent appointments throughout pregnancy and attendance at birth.
During labour, support is provided by midwives, with the obstetrician arriving just before the baby's delivery, assuming no complications arise.
It's important to consider preferences and priorities, as women under obstetrician care are more likely to undergo medical interventions, even without complications, compared to other models of maternity care.
“Private patients were significantly more likely to have interventions before birth (epidural, induction or augmentation) but this alone did not account for the increased interventions at birth, particularly the high rates of instrumental births.”
Private/Independent Midwifery Care:
Privately practicing midwives offer independent care to pregnant women, focusing on continuous support throughout pregnancy, birth, and the postpartum period.
Endorsed private midwives can provide complete care to healthy women with uncomplicated pregnancies, including referrals for necessary testing and scans.
Appointments with private midwives typically occur at the client's home, consulting rooms, or another agreed-upon location.
Private midwives are ideal for women opting for home births, ensuring safety with skilled medical professionals and equipment.
Private midwives may be able to offer support for ‘higher risk’ women who would otherwise be ‘risked out’ of a midwifery led continuity of care model through the hospital
These may include VBAC, high BMI, gestational diabetes, suspected ‘large’ baby
Some private midwives provide continuity of care and support women who plan to give birth in a hospital, offering expert prenatal care, support through labour at home and then transfer to hospital
Private midwives can attend your hospital birth as an an advocate and support person however can not offer the same level of care within a hospital due to hospital insurance restrictions
Regulated by the Australian Health Practitioner Regulation Agency (AHPRA), private midwives adhere to professional standards and guidelines.
Hiring a private midwife incurs out-of-pocket expenses ranging from $3,000 to $6,000, partially rebatable through Medicare and sometimes covered by private health funds. Contact your health fund to determine rebate eligibility.
Photo of private midwife Amanda Schmidt from Embracing Birth taken by: Chapter and Song Photography
Which Model of Care is For Me? Understanding Your Needs
By understanding your individual needs and desires, you can make an informed decision about the most suitable model of care for you and your baby
1. Assess Your Individual Needs:
• Consider your unique circumstances, including any medical history, pregnancy risk factors, and personal preferences regarding your birth experience,
2. Define Your Birth Goals:
• Reflect on your ideal birthing scenario, considering factors such as the location you feel most comfortable to give birth, intervention preferences, support during labour, and postpartum care requirements.
3. Prioritise Your Preferences:
• Identify the aspects of maternity care that are most important to you, whether it’s continuity of care, holistic support, pharmaceutical or non pharmaceutical pain relief, access to specific medical interventions, or access to other facilities such as waterbirth etc.
4. Consider Your Financial Capacity:
• Evaluate your budget and determine how much you can invest in your maternity care. Prioritize your needs while being mindful of your financial constraints.
• Do you have private health cover? If so, does it cover more than just a private obstetrician/private hospital? If not, does private obstetric care align with your needs/preferences?
Take Control, Get Educated
Regardless of the model of care you choose, becoming educated about the choices you will face throughout pregnancy, labour, and birth, and knowing your options, as well as the benefits and risks of each, is the key to successfully navigating the system and having an empowering birth experience.
Consider investing in reputable comprehensive childbirth education classes to enhance your understanding of the birthing process and your options. Here are a few well-regarded programs available in Australia:
Hypnobirthing Australia™: Offers courses focused on hypnobirthing techniques to promote calm and positive birthing experiences. Classes are available both in-person and online.
Birth Beat: Provides online childbirth education classes led by qualified midwives, covering topics such as labor, birth, pain relief options, and newborn care.
She Births®: Offers holistic childbirth education programs combining evidence-based information with yoga, relaxation techniques, and acupressure for birth preparation.
The Positive Birth Company: Provides online hypnobirthing courses focusing on relaxation techniques, positive mindset, and informed decision-making during childbirth.
Calmbirth: An Australian childbirth education program designed to empower expecting parents with knowledge and skills for a calm and positive birth experience. Classes focus on relaxation techniques, breathing exercises, and mindfulness practices to manage labor effectively.
You can watch the FREE birth education video series created by midwife Bernadette Lack from Core and Floor Restore here. Bernadette's expertise and insights provide valuable information to support you on your childbirth journey.
How a Doula Could Help
Consider adding a doula to your maternity care team. Doulas provide continuous emotional and physical support throughout your pregnancy, labour, and postpartum period, complementing all models of care. Whether you choose midwifery care, collaborative care, obstetric care, or any other model, a doula can enhance your birthing experience. They are especially valuable in filling in gaps in continuity, ensuring you have consistent support and guidance from pregnancy through childbirth. From providing comfort measures during labour to advocating for your birth preferences, a doula offers personalised care and support. Reach out to learn more about how a doula could enrich your maternity care journey.
Resources
AIHW (Australian Institute of Health and Welfare):
"Maternity models of care" (2023)
"Maternity models of care in Australia, 2023"
Homer CSE, Cheah SL, Rossiter C, et al
Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012: a linked population data study
BMJ Open 2019;9:e029192. doi:10.1136/bmjopen-2019-029192
Roberts CL, Tracy S, Peat B. BMJ. 2000 Jul 15;321(7254):137-41. doi: 10.1136/bmj.321.7254.137. PMID: 10894690; PMCID: PMC27430.
Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, (4), CD004667.
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