Models of Care
There are several services and care providers that women may be able to access for their pregnancy care. The services available are known as ‘models of care’. In Australia, the National Maternity Services Review identified the range of maternity care models currently available. They reported that 92.7% of women in Australia receive care through one of four primary models: private maternity care, combined maternity care, public hospital care and shared maternity care (3).
In 2007, most Australian women gave birth in the conventional hospital setting, with a small percentage accessing birth centres or opting for a planned home birth. There was also a small number who birthed before they reached the hospital. Of the women birthing in the hospital setting, 7/10 chose the public system (3).
Continuity of care is crucial for women. In recognition of this, the demand for the midwifery continuity model has been increasing. However, many women choose continuity of care from general practitioners (GPs) and specialist obstetricians. Regardless of who provides this care, continuity is still recognised to be the most beneficial option.
Standard Midwifery Care – You will have most antenatal visits with a hospital-based midwife; however, some of these may be in your community. A midwife will care for you in labour. You will then go to the postnatal ward where you will have one midwife each shift caring for you as well as a few other women and babies. A midwife will still be there to support you and your family throughout your journey. However, this care can be fragmented.
Continuity of Midwifery Care – You will have the same midwife (or team) throughout pregnancy, birth, and the postnatal period. You can access this through a hospital (may have inclusion/exclusion criteria), or an eligible privately practising midwife. These midwives practice independently but usually have agreements in place if their client wishes to birth in a hospital or needs to transfer from home to hospital during labour. Medicare* reimburses most of the fees that apply. Continuity of care reduces the rates of caesarean section and induction of labour. It improves newborn outcomes and women’s satisfaction with their care when compared to other models (4-6).
To read more about the benefits of midwifery continuity of care, please click here.
*Please note Medicare is the Australian equivalent of universal healthcare so this rebate may differ from country to country.
Private – If your health insurance covers it, or you can afford to pay for it outright, you can hire a private obstetrician. Your obstetrician will care for you during your pregnancy, attend your birth and check on you after your baby is born. Fees are involved.
Public – An obstetrician will need to be responsible for your care during pregnancy if you have pre-existing complications or develop complications in your pregnancy. You will often have the option of additional visits with a hospital midwife. Fees do not apply in this case.
GP Shared Care
Some women have a good, longstanding relationship with their family doctor, and would like this relationship to extend into their pregnancy. Your GP will look after most of your antenatal care, with some appointments with the doctors and midwives at your local hospital. You can ask your hospital for extra midwifery appointments. This way, you can ensure you receive all the information and support you need.
Choosing where to give birth
You can give birth at home, in a hospital, or a birth centre. These places may have guidelines and criteria as to who would provide care to you.
Midwife-led units (including hospital-based birth centres) are staffed by midwives (core staff and continuity of care midwives) with a focus on normalising childbirth. However, there are emergency facilities available if required. Obstetric doctors are often available 24/7 and will be close by if they are needed.
Midwives also staff obstetric-led units. They will care for you for your labour and birth. However, there will be obstetric doctors on call and the birthing unit floor. They will look at each labouring woman’s history and labour progress and intervene if necessary. Women deemed ‘high risk’ usually give birth in this type of unit.
You will likely give birth in a private hospital if you engage the services of a private obstetrician. A midwife will care for you in labour and will call your obstetrician when you are close to birthing. You will pay for what you receive (e.g. epidural) along with a flat rate for care.
Your options for homebirth will vary greatly depending on where you live, access to a skilled midwife, whether your local hospital will provide this care, and fees. Research suggests that for low-risk women cared for by trained midwives, home birth is as safe as giving birth in a hospital and can reduce unnecessary interventions (7).
Free-Standing Birth Centre/Community Maternity Unit
These are centres located on their own – separate to the hospital. Some countries don’t have them, while these are the main places of birth for other countries. These free-standing models mimic a home environment that promotes natural birth. Midwives staff these centres and transfer to hospital is available if complications arise.
Hayley Moyes (MMid), Clinical Midwife
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