So you’re pregnant... now what?! Stepping into the world of unknown territory, with new lingo and jargon being thrown around, in a society full of fear mongering and negativity around birth. So, with all that looming around how can you make a clear decision around your care model, particularly with the BIG misconception that I hear again and again, and again “well private is better isn’t it?” So let’s just nip that one in the bud ladies and birth partners, just because something is paid for doesn’t mean you get a “better service”.
Some options to consider; midwifery care through a public hospital, where you see generally a different midwife each visit and the same goes for birth. Midwifery continuity of care which is generally through group practice, which in Newcastle the two options for low risk pregnancies are through Belmont Midwifery Group Practice and Hunter Midwifery Group Practice which with that you are assigned your own personal midwife and sometimes a secondary one to be familiar with for all of your care and birth. In Newcastle/Lake Macquarie this also means if you choose to birth through either center the option of the beautiful birth baths. With group practice there is then the option to birth at home, which studies show this option is perfectly safe if not safer than being in a hospital setting for low risk women as the chances of unnecessary medical intervention is reduced not to mention the general comfort of being in your own space (if that’s what make you feel most comfortable for birthing). Another option if you are wanting a home birth, and again this is area dependent, but seeking out a private midwife who is Medicare endorsed, so again you have the benefit of continuity of care. In order to birth through a private hospital you need to find an OB, or there is an option to have a private OB and birth through the public system.
When choosing your model of care, firstly, consider what is important to you, and what does a positive birth experience look like? With that, you may even need to shift some of your conditioned beliefs around birth which can be such an array of things, but generally you’ll find your biggest influence will come from family members and people closest to you that have told the same story to you or used the same dialogue around birth for years and years. For example, if someone you know has shared their experience of birth trauma etc, you may be conditioned to think that being in a private hospital with all the medical supplies, staff and interventions available on hand means you are therefore choosing the “safest” option, however if you are at low risk with no medical concerns, this generally means the possibility for higher intervention rates. When it comes to choice of place of birth, there are also impacts on how “normal” your birth experience will be. Recent stats evaluating Australian specific data showed that the chances of having a normal labour and birth experience in a birth centre or planned home birth compared with that in a hospital were double and almost six fold respectively. Some of the latest Newcastle stats (the latest are 2017) show that John Hunter’s C-section rate is 32.6% and Newcastle Private 44.7% and the WHO recommendation is that C-section rates should be between 10 and 15% and anything higher than that is of no benefit to mum or baby. The most recent National Core Maternity Indicators Report (2017) showed that 40.5% of labours are induced and the included women in this study were first pregnancy, with one baby, from 37-41 weeks, aged 20-35 with no medical health concerns in a head down position only, so once we begin to add back in other factors like women going “post dates” over 41 weeks or over the age of 35 etc. The recent Reuters Health report showed that having midwifery care for low risk women reduced C-section rates by up to 30%, however with the ample studies and research out around this topic the idea of continuity of care is still slow to catch on.
Regardless of which model you choose, there are some important considerations that I believe all women should be aware of; What are your care providers beliefs on natural physiological birth? Because if they believe that you are a “patient” then chances are you’ll be treated like a sick person, rather than a pregnant woman. What are your providers intervention rates particularly around episiotomy, assisted birth (ventouse and forceps) and C-section rates. If your care provider tells you they use episiotomy routinely... ALARM BELLS!! When talking statistics if your provider has a high rate of any of these interventions and you choose them as your provider, then keeping in mind you can be easily mislead or directed down a path you did not intend your birth to take. Does your care provider support physiological third stage? For first time mums, we’re talking birthing your placenta naturally all things going well, as opposed to having an injection of Syntocinon (synthetic oxytocin) and your provider manually compressing your tummy while putting traction on the cord (this is a whole other post topic altogether). Does your provider support your birth preferences? Now this is getting a little more into your pregnancy most likely before these things are discussed for most women. However, it’s important to note that your care provider actually works for you. So, if you go through your preferences and you are told “you can’t do something” or eyes are being rolled, then chances are they won’t support you. The power is in your hands, you can “fire” and change care providers at any time, even during labour. Be sure to note though, as language is important, and I hear all too many times that “I wasn’t allowed to”... you are your own person, with rights, and according to the Australian Medical Associations report on the rights of a birthing woman, the power of choice is with you (link below)!
So, when it comes to the complexities of choosing a care model; Do the research, ask the questions, listen to your intuition, and know, you can always change!