Choosing your Pregnancy: Birth and Postpartum Care

So, you’re pregnant. Now what? Thinking about where you will give birth and who will support you during your pregnancy is an important decision and raises a number of questions. How do you approach it? What are the options available for me? What are my values around this birth? I want to spend the next two blogs trying to shed some light on these questions.

What are my options?

This may differ depending on where you live, but these are the basic options:

  • Hospital (Public or Private)
  • Birthing Centre
  • Private/Homebirth Midwives

What are the differences?

Public Hospital

A public hospital is usually the most accessible and affordable option. It’s also the most popular and most utilised. You will receive antenatal care and routine appointments with both midwives and doctors, depending on your needs. You also have access to Allied Health services like physio, dieticians, and counselling (should your care require these additional services). Some hospitals will also offer continuity of care models, which is where you will see the same midwife (as much as possible) throughout your pregnancy, but you will need to ask about this. Finally, the larger hospitals are likely to see both low and high-risk women, whereas smaller hospitals will generally only look after low-risk. They will assess you when you book in and continue to review as your pregnancy progresses.

When it comes to the birth, a public hospital usually has a variety of options in terms of pain relief and intervention—if required. This will be provided by the doctor rostered on at the time (who you won’t know); there is generally little choice in who your care providers are. If you are a private patient, you can also choose to birth at the public hospital—assuming your obstetrician has practising rights there.

Once your baby is born, postnatal care is generally provided on the ward. The duration of your postnatal stay may be shorter in the public hospital due to how busy it can become. Discharge is usually at or just after 24 hours for a normal vaginal birth, and 48 hours for a caesarean or birth with complications. Most hospitals should offer you a postnatal midwife home visit, so make sure you take advantage of that.

Private Hospital

A key difference with private hospitals is the option to choose your obstetrician. Your private hospital may have several obstetricians practicing there, so get a list of them and do some research. Ask others about their experience with that practitioner and make sure you feel comfortable with the one you have chosen. During your pregnancy, you will go directly to their rooms for care. They should also stay with you throughout your pregnancy and ideally at your birth (they do, of course, have days off and holidays, so they will discuss with you who will be on call should they be unavailable when you go into labour).

Private hospitals are also well equipped with pain relief options, both natural and medical. However, statistics show that they tend to have much higher intervention rates, so it is important to keep open communication with your doctor as to what you hope to achieve with your birth.

After your baby is born, you will likely spend some time in the postnatal ward, which is staffed with midwives. Your obstetrician will follow up with you there. It is often the case that you are not discharged as early as in a public hospital. Then, depending on when you leave and the services of the hospital, you may also have the option of maternity care at home.

Birthing Centre

A birthing centre is run primarily by midwives for women with low risk pregnancies (your risk level is assessed at booking and monitored throughout your pregnancy). These are popular, so you need to book in early. The reason they are popular is because they are midway between home and hospital. That is, they offer the comfort and relaxation of a home environment without being at home. Antenatal appointments are done with midwives, often in a continuity model. This way, you can build a relationship with your midwife/midwives.

The driving philosophy of a birthing centre is that birth is a normal, natural experience. This translates into a low intervention/interference birth. While they are equipped with emergency equipment and midwives well trained in using it, the priority is towards natural birth. In fact, when you birth here, your pain relief is natural—there is no medical management like epidurals available. If, however, your midwives become concerned during the pregnancy or the labour, they will transfer you to the hospital where medical management can be offered.

After your baby is born, because you have had a normal, natural birth, you are likely to be discharged at or just after 24 hours. You will also have midwifery visits offered to you, ideally from the same midwife/midwives you have already built a relationship with.

Home Birth

Home birth is as it sounds: you give birth at home. But your antenatal care is also provided at home; where this is not feasible, it is done in a relaxed, home clinic setting. Home birth is usually run by private-practice midwives and available to low-risk women who want an intervention-free birth in their own homes. If, at some stage, you become high risk, your midwife will give you hospital options that potentially include your private midwife continuing your care.

The real attraction to home birth is that, when you go into labour, your midwife comes to you at your home. You are then supported all the way to birth. The midwife will also have emergency equipment, should they need it once the baby is born. If, however, there are complications throughout, you may be transferred to your local hospital.

Your postnatal care also happens at home. Your midwife will usually stay with you after your birth to support you with feeding and ensure there are no postnatal complications. They will then continue to visit and offer ongoing support while you recover at home.

CLICK HERE  to Read a blog specifically around Private Midwifery Care and cover some of the additional questions that you might have.

-For Blue Mountains Families…

CLICK HERE to search the options for where you can choose to birth-

Additional considerations with Maternity Care

If the place you have chosen to birth doesn’t tick all the boxes, there are other options you can explore to complement and enhance your care.

Continuity of Care

If the place you have chosen to birth does not allow for this, you can consider incorporating continuity in these ways:

  • Doula: this is a person who is there purely to support and advocate for you. You most often engage with them during your pregnancy and build a relationship that allows them to be a trusted part of your birthing team. They will often extend into postnatal support services as well.
  • Student Midwives: Large hospitals will often play a role in training up student midwives. As part of their training, they need to “follow through” with a certain number of women during their pregnancy, birth, and postpartum experience. Volunteering to have a student midwife can be a lovely way to have a trusted face throughout your care. They are, of course, always supervised but are typically very passionate about you and your experience.
  • Shared GP care: Some GPs will offer antenatal care services, so if you have a good relationship with your GP and wish to see them for all your routine checks, you can enquire about that possibility.

Antenatal Education

You must not assume that you will be given all the information that you need to know during your antenatal appointments. There is so much information that it simply won’t fit into your appointments. If you have engaged with a private midwife or doula, then you will find more education incorporated in those appointments. Childbirth classes are a fantastic option, which I highly recommend. These are usually 10-12 hours of education and practical skills and will help you to feel confident and empowered about your birth and parenting journey. If your chosen practitioner doesn’t offer further education, be sure to ask them for recommendations of where to find it.

For Blue Mountains Families…

CLICK HERE to search your local Doula Services,

CLICK HERE to search where you can book in for Antenatal Education

 

In the next Blog I hope to help you consider your own Values and Objectives, to help you make a choice that is good for you. CLICK HERE TO READ PART 2

It is important to note that there is no right or wrong, but there is likely to be a better fit for you and your family. Id like to help you work out what that is.

 

I have created a pathway for women that are pregnant in the Blue Mountains…

CLICK HERE to get some guidance on how to navigate local services in pregnancy, birth and beyond.

Never Hesitate to reach out, if I can help you and/or point you in the right direction Id love to do so.

 

Blessings,

Rachel xx

Rachel

Author Rachel

I am Mum to 3 little ones, aged 6,3 and almost 1, Wife to my high school crush, Midwife at our local hospital and Creator of 'Out of the Nest'. I hope more than anything to do all these things well and maybe empower and encourage others along the way. Though its quite the juggling act, and balls do drop ALOT, so I am happy to talk about that too. xx

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