Maternity care

If you are pregnant or planning to become pregnant, there are many different options for care and support during pregnancy and birth. This article gives options for pregnancy care, where you can give birth and the costs involved so you can make the choices that are best for you.

If you have just found out that you are pregnant, it’s important to see your doctor (GP) or midwife to start your antenatal care.

Who will I see during my pregnancy?

There are 3 types of health professionals who can look after you during your pregnancy, depending on your health needs and where you plan to have your baby.

A midwife has special training to support and care for you during pregnancy, labour and birth. Midwives work in public and private hospitals, with obstetricians and in the community. They help you to stay healthy in pregnancy. If there are no complications, they can also help you give birth. Midwives also care for you and your baby in the first few weeks after the birth.

An obstetrician is a doctor who has had special training to look after you and your baby during pregnancy, birth and straight after birth. You might choose to have an obstetrician look after you throughout your pregnancy and to deliver your baby. If you are having your baby in a public hospital, you might only see an obstetrician if there is a medical need.

General practitioners (GPs) are doctors who promote general health and treat many different health problems. Often your GP will be the first health professional you see if you think you are pregnant.

GP obstetricians are GPs who have additional training in women’s health. They offer shared care. This is where you see your GP as well as midwives or obstetricians for your pregnancy care. If you live in a rural or remote area, your GP might provide all of your pregnancy care and deliver your baby.

What is antenatal care?

Antenatal care is the care you receive during pregnancy. You will have antenatal appointments throughout your pregnancy. Most females who have uncomplicated pregnancies have about 8 to 10 appointments. If you’ve had a previous pregnancy with no complications, you may have about 7 to 10 appointments.

Antenatal appointments are important even if you are healthy and your pregnancy is going well. They allow your midwife or doctor to check your health and your baby’s health so they can find and manage any problems early on. These appointments are also a good opportunity for you to ask questions and talk about any concerns you have.

When should I make an appointment?

It’s best to make your first antenatal appointment when you are about 6 to 8 weeks pregnant (usually, this is 6 to 8 weeks after your last period started). This appointment can be with a midwife, your doctor or at a clinic or hospital. Typically this appointment will be with your GP.

At this appointment, the doctor or midwife will confirm that you are pregnant. They will do a thorough health check. This will include asking about your medical history and your family’s medical history.

They will discuss your pregnancy care with you, including:

• where you plan to give birth
• where you will go for antenatal care appointments and which health professionals you will see
• how many appointments you will most likely have
• where you can go for antenatal classes

They may also offer you tests to check for health conditions that may cause problems during pregnancy or labour. You can decide whether to have the tests or not.

How often will I have antenatal appointments?

You will have regular appointments throughout your pregnancy. At these appointments your doctor or midwife will check yours and your baby’s health, and offer you tests that are available at your stage of pregnancy. Many people start off having appointments every 4 to 6 weeks. From about 24 weeks of pregnancy, your appointments will become more frequent. Most people who have uncomplicated pregnancies usually have about 7 to 10 appointments in total. If you or your baby develop a health risk during your pregnancy, you may need extra appointments or tests.

You can also go to antenatal classes to help you and your partner, if you have one, get ready for the birth. Many hospitals run antenatal classes. You can ask your doctor or midwife what they recommend.

Where can I give birth?

There are several options for where you can have your baby. The options available to you depend on whether there are complications and where you live.

Making the best choice for you depends on what’s important for you and your partner. For example:

• What can you afford?
• Do you want to see the same doctor or midwife at every visit?
• Would you like your GP to look after you through your pregnancy?
• What kind of medical intervention or pain relief would you like during birth?

Your GP can discuss your options and help you decide what’s best for you. You may also choose to talk to your friends and family about their experiences. Keep in mind, pregnancy and birth preferences and experiences are different for everyone.

Public hospital

If you choose to give birth in a public hospital and your pregnancy is low-risk, you will most likely book in at the local maternity hospital for your area.

The hospital may offer several models of antenatal care that you can choose from, such as seeing midwives at the hospital’s antenatal clinic or shared care between the hospital and a GP. Many hospitals offer a service where you can see the same midwife or group of midwives throughout your pregnancy. You will be referred to a doctor if there are complications.

The first step is to see your GP who will discuss the options at different hospitals in your area and give you a referral.

Some advantages of public hospital care are:

• You may be able to choose your model of antenatal care.
• You can have minimal intervention during birth if you choose, while still having access to medical intervention if you need.
• Medicare covers most of the cost of care during the pregnancy and birth.
• Most major public hospitals can care for you and your baby if there are complications.
• You may be able to see allied health professionals if needed.

Some disadvantages are:

• You might not be able to see the same midwife or doctor throughout your pregnancy.
• The midwives or doctors you see during pregnancy might not be at the birth.
• You won’t be able to choose which midwife or doctor you see.
• After the birth, you’re more likely to be in a shared hospital room.

Private hospital

If you decide to give birth in a private hospital, you will be cared for by a private obstetrician or GP obstetrician. You will need to book in at one of the hospitals where your doctor works.

You will see the same doctor throughout your pregnancy and develop a relationship with them. The hospital midwives will look after you during your labour and your doctor will usually be there for the birth. The hospital midwives and your doctor will look after you after the birth. Most people who choose a private hospital pay for it with their private health insurance.

The first step is to see your GP for a referral to an obstetrician, who will then book you into the private hospital.

Some advantages of private hospital care are:

• You can choose the doctor who will care for you throughout pregnancy, labour and after birth.
• You might be able to choose a more convenient location for your care.
• You will have the option to stay in hospital for a few days after birth.

Some disadvantages are:

• It’s expensive if you don’t have private health insurance.

There are usually extra costs that your insurance doesn’t cover. This may include a fee for an anaesthetist or paediatrician if you need one.

Birth centre

Birth centres provide a more home-like environment to give birth than a hospital. They are an option if your pregnancy is low-risk and your birth is expected to be uncomplicated. A midwife or team of midwives will care for you during pregnancy, labour and birth. You might also see an obstetrician if there are any complications during your pregnancy. Birth centres usually don’t offer epidurals.

You’ll probably go home within 24 hours after birth, with care from midwives at home afterwards.

Birthing centres are often attached to hospitals. If a problem develops during your labour, you may need to move to the hospital for medical care.

See your doctor as soon as possible to find out what’s in your area and book in.

Homebirth

You can choose to have your baby at home as long as your pregnancy is low risk. You might still be transferred to hospital during the birth if there are any complications.

If you want to have a homebirth, you can choose to have your antenatal care with a private midwife or through a public hospital that has a homebirth service, if this is available in your area. If any problems develop, you may need to see an obstetrician.

You will need a referral from your doctor for a public homebirth service. You can find a private midwife on the Homebirth Australia website. You can book in to your local hospital as well, just in case complications arise.

It’s important to make sure that your midwife is registered and qualified for homebirths. Check that they have procedures in place to refer you to an obstetrician if you need this and to transfer you quickly and safely to hospital if a problem arises during your pregnancy or birth.

You will also need to make sure that your baby get any treatments they need after birth, and that your midwife or doctor will care for you after birth, examine your baby within the first week and refer your baby for standard newborn tests.

What is shared care?

Shared care is when your pregnancy care is shared by your GP and the hospital or birth centre. You see your own doctor throughout your pregnancy and go to the hospital for some appointments and to give birth. This is an option if your pregnancy is low risk.

If your GP doesn’t offer shared care, your hospital can give you a list of GPs who do. Some hospitals offer shared care with midwives or obstetricians.

How long after the birth will I come home?

After the birth, you might go home the next day, or you might need to stay in hospital for several days. Some people can go home from 6 hours after giving birth. How long you stay will depend on your recovery, where you give birth, whether you have had a caesarean birth, and whether you or your baby have any complications.

How much does it cost?

The cost of having a baby will vary depending on whether you give birth in the public or private system. There are advantages and disadvantages to both.

In Australia, pregnancy care in a public hospital or birth centre costs very little because it is mostly covered by Medicare, which covers Australian citizens and some visitors to Australia. In the private system, you will need to pay for your care or take out private health insurance. Medicare and your health fund will cover some of the costs of a private hospital stay, but you may still have to pay extra fees (known as ‘out-of-pocket’ costs).

Be sure to check that your private health insurance covers maternity care, and whether there is a waiting time before you can claim.