Midwives & Midwifery | Sunshine Coast | Know Your Midwife

Private  Midwife

Since the changes in legislation Private Midwives are beginning to establish more practices around Australia in general and on the Sunshine Coast too.

Private midwives are often self employed, run their own business and are not tied to the policies or practices of any specific hospital.  They book their own clients and arrange their work life, their family life, and the needs of their clients on a 7/24 basis. There is a backup midwife in most private practices and she is on call for you when your midwife has time off or when she is too long in a labour for safe practice.

A private midwife gives continuity of care throughout the pregnancy, birth and postnatal period up to about 6 weeks. Your private midwife should be accessible 7/24 by phone or in person. She will birth you at home or in the hospital of your choice.

A private midwife follows the guidelines of their professional bodies such as the Australian College of Midwives and the Australian Nursing and Midwifery Council and adhere to the National Guidelines of Referral and of course any legal requirements and best practice guidelines.

Your midwife will discuss medical as well as alternative interventions and she generally works with many other health professions such as chiropractors, homeopaths, osteopaths, naturopaths etc to provide you with the best care.

Families choose their midwife whereas, in private or public care, you have no option in choice of midwives and you will have the Obstetrician on call. This is one of the main reasons women choose private midwives. They want the one on one personalised care that we provide; they want to know and trust who they will experience their most life-changing, amazing and special moment of their life; they want a skilled advocate and professional; they want to feel in control.

In most practices, private midwives will run excellent childbirth workshops to guide you during your pregnancy and prepare you for your birth and journey into parenthood. These antenatal classes are not constrained by hospital policies and guidelines and many techniques and topics are taught that are not touched in those hospital classes.

There are private antenatal classes available on the Sunshine Coast and these are excellent. Any inquires you may have, give Mary Young a call on 0400901437 to discuss your choices in care.

Overall, women find great satisfaction in having their own midwife throughout their journey and research shows all the evidence that this model of maternity care reduces medical interventions such as inductions, forcep and venteuse deliveries; decreases the need for analgesia, reduces caesareans, reduces postnatal depression, and increases successful breastfeeding outcomes. http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview-discussionpaper.

Private Hospital

If you have private health insurance, you might choose to give birth in a private hospital. Most health funds require you to have cover for at least 12 months (waiting period) before claiming any obstetric benefits, so make sure that you have completed the required waiting period and have appropriate obstetric cover. Another thing you’ll need to know is if your baby is covered after the birth. If the baby requires to be hospitalised, will you be covered or will you be expected to foot the bill of expensive neo-natal care? Most health funds have a buffer of days/weeks in which the baby is covered, provided you upgrade to family cover within the specified period.

The excess payment you need to pay for the insurance company will depend on your policy, and is usually payable when you are admitted to hospital or more likely, before you leave.

If you don’t have private health insurance, you can still attend a private hospital, however you will need to cover the entire cost yourself, which will cost many thousands of dollars and will vary depending on what’s needed during the birth and what consumables you use. If you want to give birth in a private hospital, you must be under the care of a private obstetrician, which again will be a bill you will need to cover in the thousands.

You cannot book into a private hospital without a private obstetrician. Even if you bring your own private midwife, you will still need to be under the care of a private obstetrician who is affiliated with that hospital, regardless of any situation.

When booking into a hospital, you will need to either choose a private hospital at which your obstetrician attends, or if you prefer you can book a hospital first, then ask for a list of obstetricians who attend that hospital. Obstetricians are affiliated with certain hospitals, so you can’t choose any hospital and any obstetrician – they need to be affiliated.

Pros for private hospitals

• Your partner can often stay with you
• You are more likely to have a private room and/or double bed (not guaranteed depending on how busy the hospital is)
• The accommodation may be nicer than public care
• The food may be nicer than public care
• You can chose your own obstetrician
• Check-ups are held in the obstetrician’s private consulting rooms and not a hospital waiting room
• While the obstetrician doesn’t stay with you during your labour (midwives do that bit) your obstetrician may be present at the birth (unless on holidays, or it’s his/her weekend off or doesn’t make it in time) and will visit you in hospital afterwards.

“I was really frustrated when I found out that even though I’d been paying for private health insurance, I was still going to be out of pocket a lot of money. The fact is you do end up paying more, but you also get a lot back – so far, we have been out of pocket a bit less than $2,000 by choosing to go private. All up I expect it will be about $3,500. I also didn’t get my Obstetrician, he worked 1:4 weekends. I ended up waiting 40 minutes for an epidural too – the anaesthetist wasn’t around at 2am! I have to say though, I have been really happy with the decision I have made so far.” -  Tara.

Cons for private hospitals

• They have the highest rate of intervention over all birth options; particularly caesarean sections (see this Victorian report here for 2003-2004). Some private hospitals have in excess of a 50% caesarean section rate.
• Because of the higher interventions that go on in private hospitals, midwives tend to be medico/legal model focused but this is not always the case
• Obstetricians usually don’t see you very much during labour. It’s the midwives who monitor you in labour and they will likely be unknown to you. There may be 2-3 shift changes during your labour, so while you may think you will receive continuity of care with an obstetrician, they aren’t around much at the birth at all. If you’d like continuous care and advocacy of your choices during labour, you need to hire a doula or private midwife.
• You will still have additional out-of-pocket costs with most obstetricians which vary from a few hundred to several thousands.
• There is no postnatal support in the home and you are discharged from hospital generally on day 4.

Costs will vary between private hospitals and obstetricians as well as the extras but it certainly pays to shop around – most importantly for the Obstetrician with whom you feel safe and have a great rapport with.

Public Hospital

“I would say go public. Not only would private cost you many thousands of dollars, I don’t necessarily think that paying for maternity care gets you a better standard of care (unless you are paying for an independent midwife, then it is the best care available in my opinion).”—Karen

Public hospitals are growing in popularity due to the low cost aspect. While you might not be able to choose your own obstetrician, many couples are very happy with the standard of care received in public hospitals, and we aren’t going to be offered substandard care in this day and age. Many public hospitals are large teaching hospitals and have great facilities.

Pros for public hospitals

• It doesn’t cost you anything and you still get high quality care
• Intervention rates are lower than private hospitals
• Public hospitals often have higher level NICU wards for very sick or premature babies
• Public hospitals usually have staff on around the clock for all requirements, for example anaesthetists and surgery staff. Because they are already present in the hospital, they are not required to be called in, so you can receive faster service. Many private hospitals close for surgery overnight.
• The Public Hospital has teams of midwives in community clinics to offer you some continuity of pregnancy care, though they don’t have midwives that see you through the pregnancy, birth and postnatal period.

“I went public and it was really good actually. I still had easy access to an obstetrician, paediatrician, physio during my stay in hospital, even though the ward seemed really busy. In hindsight there was only one thing that annoyed me about my antenatal care and that was how I had to see a different midwife for all of my appointments, but at the hospital I went to, they have changed it so you see the same midwife for all appointments and birth now.”—Karina

Cons for public hospitals

• You get no choice in any of your carers and you will often see different midwives or doctors on each visit; for continuity of care you would need to hire a doula or private midwife.
• Some public hospitals now do not allow elective caesareans on maternal request (without a medical reason), however this does have its benefits also.
• There is no postnatal care support in your home and your stay in hospital is 2 – 3 days maximum.

Shared Care (GP/Community Midwife + public hospital)

I thought I would add this in which is more of a care option than a place to give birth, but it is something to consider if you don’t want to spend a whole lot of time in a hospital and you would like to go public.

Shared care is another option for healthy low risk women. It means that your local GP ‘shares’ your care with the midwives and/or doctors at a hospital they are affiliated with. You will have check-ups with your GP in his/her office (which are all the usual pre-natal checks that the hospital would do), then certain visits will be scheduled with the hospital. There is communication between the GP and hospital as to your progress and it’s a great option if you have a good relationship with your GP.

The hospital midwives will be present for your labour and birth. You’ll return to GP care after you return home. There is no postnatal care in the home from the hospital or the GP.

The main benefit for shared care is seeing the same practitioner throughout your pregnancy, as opposed to going public and not having the same practitioner or one you have chosen.

These are your options on the Sunshine Coast, Queensland. Unfortunately we do not have a birthing unit and we have very poor postnatal care followup whether it be public or private. This is such an important time for mother and baby, in fact, the whole family unit. The only 6 week postnatal care available is through private, independent, midwives.

For any further discussion about options of midwifery care on the Sunshine Coast feel free to give Mary Young a call on 0400 901 437