Maternity care options - part 2

Maternity care models – Part 2

MGP Care (Midwifery Group Practice)

This is another branch of the public system, whereby you are paired with one primary midwife that is responsible for the majority of your antenatal, labour and postpartum care. It is often seen to be the ideal model of care, due to the special rapport built with the midwife, resulting in more trust, better birth outcomes and overall satisfaction (see study links below). The midwives usually work in a pair or group of three, on an on-call roster, so that if your primary midwife is having a day off, the other midwife will be available. The woman will usually have a ‘meet and greet’ with both/all midwives that she may have caring for her. However, though this option is seen to be the ‘ideal model of care’, only a certain percentage of funds goes towards this model and therefore only a certain percentage of woman can be allotted to it. Beyond this, most hospitals only accept those in the low-risk category and therefore this may exclude those with comorbidities. Note, some hospitals do have an all-risk model and a few MGP programs offer home-birth for low-risk pregnancies. Your midwife will also conduct your postnatal, at home visits.

Private Care

 

Private Obstetric Care

 

This is a model that is similar to a country that does not have a public healthcare system, such as the USA. In this model, you are seen by a private obstetric doctor of your choosing, who is linked in with a private hospital (usually). You would be seen by the same doctor at each visit, and they would be there for the birth. In the postpartum period, you may be put up in a hotel with postnatal midwives available to help you with breastfeeding, education etc, or you may be put in a postnatal ward in a private sector of the hospital.

Some aspects in the private system to consider:

  • You would need to have private health insurance, which has pregnancy included, otherwise, you would have to pay even more out of pocket.
  • Even if you do have private health insurance, you still pay out of pocket expenses for every antenatal appointment, every ultrasound scan, every additional cost-such as an epidural in labour.
  • The approximate out-of-pocket expense is $10,000+
  • You may have more trust and build a rapport with this doctor.
  • They may not be there for most of your labour anyway. Labour can sometimes be long, and each doctor varies on how much contact they will have with you. You will have midwives caring for you in labour that you most likely, have not met prior and then the doctor may come in at the end.
  • Some doctors favour a more medicalised model of care. This may mean that they are very risk averse, have high caesarean section rates, high instrumental birth rates, etc. Please decide what type of care you would like and then do your research accordingly to find a doctor that aligns with your beliefs. For example, if you would like an elective caesarean section, you may prefer to go with a private obstetrician, because it is likely that the public hospital will not agree with this.
  • You need to decide if it is worth the money, especially if this doctor will not be present for your whole labour.
  • You do not get any postnatal visits at home, unless you hire someone privately.

 

Home birth

Home birth is when a woman chooses to give birth in the comfort of her own home with a private midwife. Despite the stigma associated with homebirths, the statistics of birth outcomes compared to hospitals are overwhelmingly positive (see link below), with normal birth being 6 times as likely at home than in a hospital. In Australia, there are very strict standards to get your license as a private midwife. One of these requirements as a homebirth midwife, include being linked in with a hospital, in case something goes wrong. If you have private insurance, you can usually receive some rebates or claim some of the expenses on Medicare or as part of your tax assessment. The cost of a homebirth will usually between $3,500 – $6,000. If your midwife has a Medicare provider number you can claim between $1,000 – $1,800 back. Usually these costs include antenatal, birth and postnatal care of up to 6 weeks post-partum.

Some aspects of homebirth care to consider:

  • If the midwife has a second midwife or a helper for the birth, this may be an additional cost.
  • By having a homebirth, you are opting for a more natural birth and therefore, having an epidural, morphine etc. is not really an option.
  • You may still be transferred to a hospital if your midwife feels that you or your baby may be compromised.
  • The midwife may not agree to care for you if you are in the high-risk category.

 

The other branches and options for care include:

  • A private doula or midwife that may come to your hospital or home birth and provide emotional and physical support throughout your labour;
  • Free birth, which represents a very small percentage of women, who choose to birth without any trained carers at their birth;
  • Birth centres are nearly non-existent in Australia anymore, due to funding being taken away and Australia heading towards a more obstetric-led system. However, this option usually aims for minimal intervention in a ‘home-like’ setting, supported mainly by midwives.

In conclusion, I would like to express my opinion as a midwife and as a woman. It is not true to say that the only important thing about birth is that your baby emerges alive – your experience of going into motherhood is also one of unbelievable significance.

Therefore, it is important to research which model of care most aligns to you and what you feel comfortable with, be that caesarean section or free birth.

In my opinion, and according to the evidence, homebirths are safe, empowering and the most woman-centred for low-risk births. If you do not feel comfortable with this, MGP (Midwifery Group Practice) is a wonderful option. Birth is political. Do not settle only for what media and your loved ones tell you. Though these opinions come with love, they are riddled with intergenerational biases, sexism and stigmas. It is important to take these different options into consideration, to read different studies, opinion pieces, statistics and articles from varied sources, and then decide. It is your body and your birth experience, your baby, your choice.

Remember- You got this, MAMMA!

 

Resources:

 

 

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