How to Choose Your Model of Prenatal Care

How to Choose Your Model of Prenatal Care

By Alexandra Whiting   |  

So you’re pregnant, now what? Time to figure out who’ll care for you in pregnancy and where you’ll give birth.

"Are you public or private?" It’s a question you get asked early in pregnancy, and have to make a decision on, but it isn’t as black and white as the question implies. A more app question (which the health professionals will ask) is, “Model of care?”. In Australia, we’re lucky to have choice when it comes to prenatal care and deciding where we’ll give birth. From free Medicare-covered birth options to private hospitals and obstetricians, you can pay nothing, some, or more to have a baby in Australia. That also means, you need to have a real think about the best option for you. Here we break down the most common modes of care, but as there are variations with different states and areas, be sure to talk to your doctor about what’s right for you.

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Public Hospital Care

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Where: Your local maternity public hospital.

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Cost: Free. Covered by Medicare.

How it works: You are assigned to a maternity hospital based on your home address (they are zoned and have catchment areas just like public schools). Contact the hospital early in your pregnancy to register and get your prenatal program booked. Most often your GP will do this for you and you will be contacted by the hospital, but you can do this independently. You’ll attend the hospital for all your scheduled appointments and prenatal checks. Take part in their birthing classes and contact them with any questions or concerns during your pregnancy and then go there to give birth.

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Pros:

  • It’s free.
  • Australia’s standard of healthcare is very high, our public system offers some of the best care in the world, with skilled staff oh hand around the clock.
  • The public hospitals are where you end up if things get complicated in birth or pregnancy, so if this is the mode of care you choose, it won’t change.

Cons:

  • Unless you are in the midwifery program(see below), there is no continuity of care, meaning you’ll see a different midwife or doctor at every appointment. Depending on the size of the hospital, this might mean you’re seeing a different face every visit, including when you are admitted to give birth and during your postnatal care. This means you won’t have a relationship with the team helping at any stage of the pregnancy and birth. Who delivers your baby will be determined by the hospital roster.
  • Long wait times at appointments. You might have a 2pm appointment but it will depend on the queue ahead. Take a book.
  • Elective C-section, on maternal request, is not allowed without medical reason.
  • You are most likely to be in a shared room after birth.

Private Obstetrician

Where: Your obstetrician’s rooms. Usually in or near the private hospital you’ll go to for birthing.

Cost: Your initial consultation is around $200, and the appointments there after are covered by the obstetrician fees. The cost of an obstetrician varies between $3,000 - $5,000+ and covers their appointments and them being at your labour and birth. Your private hospital stay post-birth may be an additional fee, but private health insurance will cover part or all of this, depending on your cover. It’s also important to note, that if you want to use your private health fund you’ll have to be covered for pregnancy for usually 12 months before you engage your obstetrician.

How it works: If you have a preferred obstetrician, it’s good to contact them as soon as you know you are pregnant as they often have limited availability. Your first appointment with an obstetrician is usually around the 8 week mark. Your obstetrician is a specialist and will guide your pregnancy, labour and birth and be a constant at all your appointments and birth. All your appointments will be with your obstetrician. If you have any questions or worries throughout the pregnancy, you contact your obstetrician. For birth, you will book into the hospital associated with your obstetrician and be attended to by the midwives there until close to birthing time when your obstetrician will arrive and assist in delivery.

Pros: Continuity of care throughout pregnancy. You will likely have your own room after birth and your partner will be able to stay overnight. Elective C-section is an option. Accommodation is generally nicer and more comfortable.

Cons: Like everyone, obstetricians have their own lives and work a roster so there is always a chance your baby will come at a time your obstetrician isn’t available, so a different doctor will deliver your baby. You are unlikely to know the midwives you labour with. Services that are usually free to public patients incur a fee e.g. ultrasounds, blood tests, physiotherapists, anaesthetists, lactation consultants.

Shared Care

Where: Your GP and choice of local maternity hospital or private hospital.

Cost: Depending on your GP, your appointments may be bulk-billed (free, as covered by Medicare) or charged at their usual appointment rates. If the hospital sharing the care with your GP is public then the cost of birth is free, but if it is private the cost will be determined by your level of health cover. Note not all GPs participate in Shared Care.

How it works: You attend your GP for all antenatal appointments and are your contact for any questions you may have about your pregnancy. At 36 weeks pregnant, your care is handed over to your hospital’s doctors and midwives for the remaining weeks of appointments, labour, birth and hospital stay. The hospital or government team handles your home visits and then, you are handed back to your GP for the 6-week postpartum check.

Pros:

  • If you have a GP you already love, it’s comforting to continue seeing them.
  • Your GP is sometimes more conveniently located than the hospital and potentially more prompt so your appointments take up less of your time.

Cons:

  • Some hospitals require some appointments to take place with them prior to 36 weeks, and with your care split across two entities you’re relying on the GP office and hospital to communicate your information back and forth which potentially can become difficult.

Birthing Centre

Where: A birthing centre, usually attached to a public hospital.

Cost: Free as covered by Medicare.

How it works: A model of care managed by midwives, that is made to feel more like a home than a hospital. They are in high demand, so it is best to contact them as soon as you know you are pregnant to secure a spot. These centres aim for minimal medical intervention with fewer pain relief options, so there will be gas and some drugs, but they will provide you with many natural pain relief options like breath work, water and movement.

Pros: If you want to have a minimal intervention birth, the midwives here will support you in that. Less clinical, more comfortable environment. Some continuity of care as there are smaller teams in these centres that you will get to know. More access to private baths for use in labour.

Cons: Only an option for low-risk pregnancies. Not an option for VBAC (vaginal birth after C-section). Epidural and other pain relief options unavailable. In the case of a complication or emergency in birth, you will be moved to the hospital.

Public hospital team midwifery or caseload midwifery

Where: Your local public maternity hospital.

Cost: Free as covered by Medicare.

How it works:

  • These are options available at most public hospitals.
  • Team midwifery shares your prenatal care between a group of 4-6 midwives, one of whom you’ll see at your appointments and will be present while you labour.
  • Group practice or caseload midwifery allows you to be cared for by the same midwife throughout your pregnancy (with a couple of support midwives), and they are also on-call for your birth

Pros:

  • It’s free and high quality care.
  • It’s a model that promotes low intervention, but if emergency medical assistance arises, you’re in the right place.

Cons:

  • Elective c-section, on maternal request, is not allowed without medical reason.
  • You do not choose your midwife or their team, they are assigned.
  • You are most likely to be in a shared room after birth.
  • High demand and only 8 percent of births are this model of care, so you need to apply as soon as you know you are pregnant.

Private Midwife

Where: In your home and choice of local maternity hospital or private hospital or home birth.

Cost: Approximately $4,500 (with the $1,500 Medicare rebate). If the hospital where you’ll birth is public then the cost of birth is free, but if it is private, the cost will be determined by your level of health cover. Cost of additional tests e.g. ultrasounds and neonatal screening.

How it works:

  • Private midwives are in-demand and often booked so this is another option to act fast on.
  • A midwife who works outside the hospital system (but usually has a lot of experience within it) cares for your pregnancy with appointments at your home.
  • They can then attend your birth at a public or private clinic or hospital or help facilitate a home birth, which they are most often engaged for.

Pros:

  • Continuity of care from pregnancy to postpartum, with a secondary midwife arranged if your chosen midwife cannot attend your birth.
  • Midwife comes to you for all your prenatal appointments.
  • They can prescribe medicine, arrange routine tests and will refer you if other specialists are required.
  • If a home birth is the plan, you can set up your birth space how you’d like. More family members and support people can be present.

Cons:

  • Expensive, as not much is covered by Medicare or private health funds.
  • For home birth, epidural isn’t an option, the people present might turn from supportive to stressful, and you need to have a cleanup plan for afterwards.

Doula

Where: In your home.

Cost: Approximately $1,500 to $3,500 though price varies greatly depending on experience and level of support you require.

How it works:

  • A doula is a professional support person who will focus on your needs and desires for your pregnancy, birth and postpartum.
  • They can attend your birth, whether it may be and will advocate for you throughout the labour.
  • They act to help prepare you mentally, physically and emotionally for birth and afterwards support your recovery and the care of a newborn.

Pros:

  • A person in your corner who's been there, done that.

Cons:

  • An additional cost, as you a doula cannot delivery your baby so you still need to be part of another model of care.

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