Pregnancy care & birthing options

You may already be thinking about how you want to be cared for during your pregnancy and where you would like to have your baby.

Your choices may be limited by where you live and what options there are in your community.  Alternatively, there may be so many options that it is difficult to make a decision. The various arrangements for care can be quite complex. For example, it is sometimes possible to have a private obstetrician in a public hospital, while some public hospitals make it possible for you to have a homebirth with a midwife. It can also be difficult to understand the costs associated with different care options.  

On this page:

• Making a decision 
• Research about pregnancy care
• About public care
• About private care with an obstetrician
• About private care with a midwife

Making a decision 

Your decision is likely to be informed by your friends and family as well as your own beliefs and values. To find out what care arrangements will suit you: 

• speak to friends and other mothers about their birth experiences
• talk to your local maternity care providers about their services
• ask your GP about your options.

When you are making a decision consider what is important for you and your partner:

• affordability
• having your own obstetrician
• having a single carer (or very few carers) throughout your pregnancy
• access to medical intervention
• access to all pain relief
• having very little intervention
• an active labour
• a home birth
• midwifery care
• seeing your own GP throughout your pregnancy.

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Research about pregnancy care

There is growing evidence that having the same midwife from early pregnancy, through labour and birth until around six weeks after birth has significant and lasting health benefits for women, their babies and families. Some hospitals have responded to this by introducing models of care where women are more likely to see the same midwife or small team of midwives throughout their care. The other option is to employ your own private midwife.

Some studies have also shown increased satisfaction amongst women who have had a private obstetrician, possibly because they are also getting a level of continuity by seeing the one obstetrician throughout. 

About public care

Public maternity hospitals in Australia generally provide very good quality care for women during pregnancy, birth and the postnatal period, as well as caring for babies. Women with healthy pregnancies who want to be cared for as a public patient are usually advised to book in at their closest maternity hospital.

Many hospitals are working towards midwife-led models of care to improve continuity. This is sometimes called  ‘continuity of care’, or ‘continuity of carer’, ‘caseload’ or ‘midwifery group practice’.  With this model women are more likely to have the same carer or small group of carers from early pregnancy, through labour and birth and sometimes up until around six weeks after birth.

There are some models of care – called team midwifery – where a group of midwives, provides care to women. With this model you are less likely to see the same midwife at each visit but each midwife in the team may be more familiar with you and your pregnancy.

When you contact your local public maternity provider, ask them what kind of care they offer. The following are examples of care models that are offered in public settings for women who have uncomplicated pregnancies.

• Shared Care – your pregnancy care is shared between the hospital and a local doctor or midwife who is affiliated with the hospital. Medicare usually covers the cost of the doctor or midwife visits not held at the hospital.
• Team Midwifery – you are placed in the care of a team of midwives so that you are more likely to develop a relationship with them.
• Group Practice or Caseload Midwifery – care provided by two midwives throughout the pregnancy; who are also on call for your birth. Sometimes includes the option of a homebirth.

The Women's provides a range of care options.

Advantages of public care include:

• Different models or types of care are usually available within the hospital.
• You can choose to have care with very little intervention but will still have access to medical back-up if it is needed.
• You have access to other services, including dieticians, social workers and physiotherapists.
• Out-of-hours clinics are often available.
• Childcare is sometimes available on-site.
• Facilities for high-risk pregnancies and very sick babies are usually available in major public hospitals.
• Fees and expenses are low if you have a Medicare card.

Disadvantages of public care include:

• Parking may be difficult.
• Appointment waiting times may vary and may be longer than at a private clinic.
• It is not always possible to see the same doctor or midwife each visit.
• The doctors and midwives you see when you are pregnant will often not be present at your birth, except in the case of Midwife Team Care or Caseload.
• You are more likely to be in a shared room after giving birth.
• Your choice of a male/female practitioner may not always be available.

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About private care with an obstetrician

You may choose to be cared for privately by an obstetrician. Usually, as a private patient, you will have your baby in a private hospital but you can also choose to be a private patient in a public hospital. 

If you choose to be a private patient in a public hospital you will not be guaranteed a single room and you will be responsible for hospital, medical and diagnostic expenses. Health insurance only applies when you are admitted to hospital for the birth of your baby and does not apply to your pregnancy related visits or expenses. However, part of those expenses will be covered by Medicare. Check with your obstetrician about whether you can expect out of pocket fees during your pregnancy care.

Private health funds usually require membership for at least one year before they will cover you for maternity services. Check your policy carefully to understand what is covered and what is not. Usually you can elect the level of cover you want so you may choose to make some changes if you already have a policy in place. Check with your obstetrician about whether you can expect out of pocket fees for the following services:

• hospital admission
• medical fees including anaesthetist and paediatrician costs
• diagnostic fees (ultrasound and blood tests).

If you have a single hospital policy, it won’t cover the cost of dependent children. This is only a problem if your baby needs to be admitted to hospital after they are born in a private hospital. If your baby is born healthy, they will not be formally admitted to hospital, but if they are premature or require some kind of treatment they will be admitted to hospital and this can increase your costs significantly. If you give birth to twins, at least one of the twins will be admitted to hospital and will incur costs in both a public or private hospital.

Speak with your insurance company about the limitations of your policy. Most hospitals also have liaison officers who can help you with any questions you may have.

Your local doctor may help you to choose an obstetrician and can provide a referral. You can also contact the private maternity hospitals directly and ask for a list of their practicing doctors. Alternatively you can search for a doctor by using the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 

Advantages of using a private obstetrician include:

• The doctor of your choosing will provide your care throughout pregnancy, labour and the postnatal period.
• The location of the practice may be more convenient for you.
• Appointment waiting times are usually shorter than in public clinics.

Some disadvantages of using a private obstetrician include:

• It is costly if you have no private health insurance.
• There are usually extra costs not covered by your health insurance.
• Services that are free to public patients may incur a charge, e.g. room accommodation, blood tests, ultrasounds, and access to diabetes educators, physiotherapists, paediatricians and anaesthetists.

Both private and public patients may have to pay for childbirth education.

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About private care with a midwife

Some midwives choose to work privately, rather than being employed by hospitals and other institutions. We refer to these practitioners as Midwife/Midwives in Private Practice (MIPP).

Women may choose to employ a MIPP because they want to be able to choose their care provider, or because the services offered are unique. For example, women may wish to employ a MIPP for continuity of care through the whole pregnancy and have that same midwife support them through labour and birth either at home or hospital, and during their postnatal care. Or they may wish to arrange a ‘once-off’ pre-pregnancy or postnatal consultation. 

Registration, Regulation & Professional Indemnity Insurance (PII)

In Victoria, all midwives, including those in private practice, must have a current annual registration to practice legally. Midwives are required to comply with a range of requirements to meet this annual registration.

One such registration requirement is that ALL midwives must have professional indemnity insurance (PII) to practice. For midwives working in a hospital or health centre this requirement is usually met by their employer. For MIPP there are currently two insurance options, including the government-supported insurance product from MIGA insurance. Private midwives are responsible for arranging and purchasing their own PII.

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