Choosing your Healthcare Team.
Congratulations, you are pregnant! So now what?
It is well worth it to take a little time early in your pregnancy to think about the kind of birth you want and to take active steps to increase your chances of getting it.
The more responsibility you take for your pregnancy, health and well being the better the results will be. You will enjoy your pregnancy and birth way more if you are an active participant in your care and use your health team as a resource not authority.
When interviewing your healthcare team members, I suggest you book your appointment for a consultation only and interview several professionals before you make your decision. It is much easier to switch healthcare providers early in the pregnancy than wait until you are 36 weeks into the pregnancy only to discover that your care provider is not on the same page as you.
I always think it is a good idea to get three quotes whenever I am planning any big project and the birth of you baby is no different. I suggest you interview your prospective healthcare providers much the same way as you would interview any professional for an important job.
Make sure your healthcare provider takes the time to answer all your questions. A good working relationship is vital, so use your intuition and ask your self the following:
- Did I feel heard by the doctor or midwife?
- Did the doctor or midwife answer all of my questions directly?
- Did I feel respected and comfortable?
It is also a good idea to ask your prosective healthcare provider what their rates of intervention are. And very importantly to ask how many women have normal births with them? You could consider taking a draft of a birth plan with you can help you clarify what you want and what is achievable with this particular care giver.
If you don’t feel comfortable with your care givers approach you are quite within your rights to get a second opinion.
The Role of the Midwife and Obstetrician
Many people don’t understand the differences in the role of midwives and obstetricians. Often a midwife is thought of as someone who “helps” the obstetrician. When in fact they have very different approaches and philosophies
A midwife is an expert in normal birth. The midwife guides the woman and her chosen support team through the pregnancy and birth and for a period of time after the birth. Midwives believe that pregnancy and birth are normal physiological events and it is the woman’s mind body and soul that needs to be cared for. Good midwifery care means that the midwife learns what motivates a mother, her fears, anxieties, hopes and strengths.
Midwifes are also trained to pick up on things before they go wrong and they know when to call in other experts or obstetricians when they are needed.
Obstetricians are doctors that have special training in pregnancy and birth as well as surgical skills that enable them to take action when pregnancy and birth situations become complicated. They are primarily trained to identify risks and deal with the mechanics of pregnancy and birth.
You have several options and models of care available to you. Below is a basic summary of what you can expect from each option.
- Private Obstetrician.
If you have appropriate health insurance or are willing to pay you can choose a private obstetrician for your prenatal care and delivery. Many women opt for this option as a way of securing continuity of care.
Obstetricians are very busy people and consultation times are short. It is advisable to have all of your questions written down as it can often be the only way you can be sure to be able to ask those things in the time available.
It is also worth noting that once you are in labour you will have no guarantee that you will be cared for by your chosen obstetrician. They usually come into the room just as the baby is ready to be born. Midwives provide all the labour care and will communicate with the obstetrician over the phone. In the postnatal ward the midwives are also the ones who will care for you.
Additionally most obstetricians have their days off covered by another obstetrician in their team so you may well find that midwives and doctors that you have never met anyway will attend most of your care.
Some women love the care they have with a known obstetrician and take comfort in the knowledge that they will have an experienced obstetrician at hand if there are any complications.
However, women do experience more interventions with this model of care. So it is worth finding out about your doctors polices are on how you can give birth while you are in their care. Water birth for example my not be something that your particular obstetrician is comfortable with therefore, that option may not be available to you.
- Private Midwife
Private midwives work for themselves rather than with a health service. So this means that there will be a cost associated with this service. A Medicare rebate may be available if your midwife is eligible and has a Medicare provider number. Some health funds will also give a rebate for midwifery care so it is worthwhile looking into.
If you are planning a home birth with a private midwife and complications occur with the pregnancy or birth you will be advised to go to hospital and in most cases your midwife will go with you.
- Public Patient in a Public Hospital.
The care in public hospitals is free, though you may face some out of pocket costs if you opt to share your care with your General Practitioner (GP). Costs may include, some blood tests, ultrasounds and antenatal classes.
Most of your pregnancy appointments will be with midwives and some with obstetricians.
The hospital midwives will attend the actual birth with the hospital obstetricians being consulted as required. In this model of care you will meet a range of different midwives and obstetricians who are on duty at the time.
Many major public hospitals have clinics run by midwives. These are sometimes located in the community and are called “outreach clinics”.
- Continuity of Midwifery Care.
This model involves a small group of midwifes who work together to provide antenatal, labour, birth and postnatal care to women. This means you get to know your midwife and they will be on call for the birth. If your midwife is not available for the birth another midwife from the team will stand in for her so you may well get to know a couple of midwives
This model of care is associated with the least amount of intervention, have the tendency to be the most satisfying and cost effective for the mothers.
These programs tend to fill quickly so it is advisable to book early if you want to use this model of care.
The women who have experienced this model of care often say that the biggest problem is the sadness they feel when it is time to say “goodbye”.
- General Practitioner Programs
Most hospitals offer women the option of having their pregnancy care shared between a general practitioner and a hospital. You will be asked to come to the hospital for some antenatal visits.
If you develop any complications you will be asked to see the hospital doctors for specialist care. Hospital midwives attend the birth and provide postnatal care.
- Birth Centre care
Birth Centre’s often have beds and furnishings that as designed to create a more home like atmosphere. So, in the Hunter there are some birth centers like Belmont, which are not attached to hospitals and others like the John Hunter that are within the hospital. If there are complications generally the mothers are transferred out into to the delivery suite.
This model of care is also associated with a lower level of intervention rate. Most of the transfers out happen in the prenatal period.
- Publicly funded Home birth.
These models of care is usually attached to a hospital and provide an opportunity of low risk women and their babies to have a home birth without the associated costs of a private midwife. There is usually a set distance or time limit away from a hospital, such as about 30 minutes from Belmont and John Hunter Hospitals for example.
1st August 2016