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Birth Choices Matter

Who you choose to care for you can have a huge impact upon how you birth and the way that you are treated, so it is imperative that you know what is available and what that care might look like.

There are three main paradigms of maternity care

- Technocratic/medical model which sees the body as a machine that should work in an orderly fashion, birth is seen as a medical event that needs technology and assistance

- Humanistic; Mind/body connection, birth as a natural event though incorporates technology and a reliance on an outer source for assistance

- Holistic; Trusts the innate ability for the body to birth, power of the mind/body connection, power and autonomy of birth left with the birthing person, birthing as a traditional and ancient precipitated wisdom

You may also be able to align yourself within one of those paradigms, which should help you to identify the kind of care provider that may be right for you. There are plenty of options for care provision during pregnancy and birth, here is a brief overview of what is available in Perth

Private Obstetrician - Out of pocket (private health rebatable though some gaps differ due to

individual charging models)

Continuity of carer, is a money centred business model. Higher intervention - for not necessarily better outcomes. Consultant Obstetricians are expert surgeons, many don't have faith in women's bodies - plus, it isn't a great money maker if someone just comes in and drops a baby out without any assistance! You will be cared for based upon their individual ideology and they are not accountable for adhering to evidence based care - they can tell you whatever they want you to hear. If you are keen for a managed birth, high induction, CS and instrumental birth rate then just make sure that the double bed and private room is a good enough trade off. There may be limited to zero follow up once discharged (aside from the 'routine' six week check) - often no home visits post discharge from the hospital

GP Obstetrician in public hospital - Out of pocket (partially Medicare rebatable)

Continuity of carer, all appointments with GP. Care based upon their beliefs/ideology. May or may not be qualified surgeons. Labour in public birth suite with staff midwives, with care guided by GP birth ideology (which can vary widely and may not be evidence based). Follow up by home visiting Midwife for a week or two

Public hospital Midwifery clinic - Free

Care mostly by Midwives (who are obligated to provide evidence based practice), occasion Obstetric appointment and consultation if required - any complications of pregnancy or birth and you will receive the necessary care. Birth in public birth suite with Midwife (not necessarily someone you have met before). Follow up by a home visiting Midwife for a week or two

Midwifery Clinic - Care is more women centred, not necessarily the same Midwife at your appointments. Not driven by profit, and Midwives obligated to follow evidence based care. Follow up by home visiting Midwife for a couple of week

Midwifery Teams/Group Practice - free

Care by a small team of Midwives, most likely to be cared for during labour by a known Midwife in a public hospital. Known midwife to follow up at home for up to 6 weeks

Birth Centre - free

Small teams, appointments in clinic, most likely to have known Midwife for birth. Home like birthing environment. Woman centred and evidence based care, belief in the body's abilities. 24 hour discharge then follow up at home with visiting Midwife for a week or two. If any complications arise, care is transferred to main hospital clinics/birth suite

Community Midwifery Program/CMP - free

Birth at home or in hospital with a known Midwife plus a back up/second Midwife. Appointments in clinic and sometimes at home. Women centred and evidence based care. Women need to fit into an inclusion criteria to be eligible for the service (low risk). If complications arise that mean you no longer fit into this criteria for the home birth option, your care is transferred to your back up hospital. Follow up at home and in clinic for up to 6 weeks

Independent Midwife Home Birth - Out of pocket (partially private health and Medicare rebatable) One primary/known Midwife plus a back up for birth. Ideology of empowerment - belief that birth is normal. All appointments at home or can be in clinic. Offering all of the same care and appointments (bloods, ultrasound, urine testing, vital signs etc) that you would be offered in all other settings. Longer appointments. Follow up for almost 7 weeks post birth. Many independent Midwives are Lactation Consultants too

You can also choose to have an independent Midwife support you for all of your antenatal

and Postpartum care, but choose to book into and birth in a hospital. This is an ideal option for those not necessarily wanting to birth at home, but having the incredible one-to-one care you receive with Independent practitioners

Things may have changed slightly or be a bit different to what I have described depending upon who and where. The import take home message here is to do some research, find out about who might be caring for you and make sure they are aligned with your ideas - if they don't it is NEVER too late to switch providers

Where did you birth and did expectation meet with reality for you?

I'm Hayley,

Doula, Birth Educator and Mother of 4. I have been a birth worker for over 10 years and it is my life's work to support you to have your best birth and postpartum possible! Think of me as your constant birth companion and post partum bestie - my mission is to help guide you throughout the incredible experience as you meet your new family member and settle in to life with your baby! Connect with me through - or 0438 188 122

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