Are you curious about what a Private Midwife does? Did you even know it was an option for you as you plan to have a baby? What difference will it make to your experience of becoming Mother?
One of our Amazing local Private Midwives- Cara McDonald- has graciously answered some questions for me around Private Midwifery and Homebirth. In a bid to clear up misconceptions and highlight what I feel is an incredible service for women and an under-utilised option. I have personally had the pleasure of working with Cara myself (when in the hospital system) and can vouch for the Beautiful person she is and the passion she carries for women and their families being supported and seen in their journey to Motherhood. Private Midwives are special people, their level of enthusiasm in advocating for women is unrivalled, and Cara is no exception.
I hope this a helpful insight.
What services does a private midwife offer?
When you hire a Privately Practising Midwife, you are hiring someone to be focused on providing you with holistic, individualised care throughout pregnancy, birth and beyond.
Privately Practising Midwives offer a range of services, including antenatal care, labour and birth care at home or in hospital, postnatal care, lactation support and childbirth education. Most women choose between having a Private Obstetrician and birthing in a private hospital or having care through a public hospital, most often with midwives. Hiring a private midwife is another choice, but less well known. Private Midwives are able to provide all the care you need if you are a well woman having a normal pregnancy and birth in collaboration with your GP.
How does private midwifery care differ from hospital midwifery care?
All midwives are educated and registered in the same way. We generally all have the same clinical skills. However, to be a midwife in private practice, extra education in pharmacology is required to gain an ‘endorsement’ on our registration, as we are able to write prescriptions for medications and order pathology tests and ultrasounds. In addition, we must have reached a minimum number of hours of practice.
The biggest difference is that by hiring a Private Midwife, you get to choose your care provider and your midwife will be with you throughout pregnancy, birth and up to 6 weeks after the birth. Many public hospitals have Midwifery Group Practice or Caseload programs where you are allocated a midwife, which is great, but these programs can be hard to access for a lot of women as they often have limited numbers, and you don’t get a choice in which midwife you are allocated. The majority of women in the public hospital system will see a different midwife at every appointment and will be cared for during labour and birth by midwives they have not met before. Even if you do have a hospital midwife allocated just for you, they will have rostered days when they are not working, so you may end up with a different midwife at your birth. When choosing a Private Midwife, you can speak to a few and decide which midwife feels right for you. Private Midwives are on call for your birth 24/7.
Most hospital programs that offer postnatal home visits finish by 2 weeks after your birth. Private Midwives usually offer postnatal care for around 6 weeks following the birth of your baby.
Midwives working in the hospital system are bound by hospital policies and procedures, some of which may not be evidence-based, and often women feel that they cannot opt out or choose care that goes against hospital policy (Hint: you always have the right to say no to things that are not right for you!). Private Midwives are self-employed and so not bound by the same policies, although we do work within regulatory frameworks which guide our practice. Many women feel that by hiring a Private Midwife, they have a greater say in their care and more freedom to choose the options that are right for them.
Why is continuity of care so important?
Continuity of care means having the same care provider throughout the continuum of pregnancy, birth and the postnatal period.
There is high quality evidence that continuity of care with a midwife leads to:
- Fewer epidurals
- Fewer episiotomies
- Fewer instrumental births
- More vaginal births
- Fewer premature babies
- Greater satisfaction
- Greater chance of successful breastfeeding
Does having a birth at home present more risk? What if something goes wrong?
Firstly, homebirth is not about having your baby at home at all costs. Homebirth is about having your baby at home as long as it is safe to do so. There are many studies that support homebirth for low-risk, healthy women as just as safe as birthing in a hospital, with women experiencing fewer interventions at planned home births.
A few hospitals, such as Westmead and The Royal Hospital for Women, have started homebirth programs whereby women booked at these hospitals can choose to birth at home with midwives employed by the hospital.
Midwives are highly skilled and trained in recognising when labour is not normal. If we are seeing warning signs in labour, these will be discussed with you and transfer to hospital may be recommended. There are always two midwives present at a homebirth, your primary midwife and a second midwife (usually arranged by your primary midwife).
Midwives carry a birth kit which includes oxygen and resuscitation equipment, medications to control excessive bleeding after birth, suturing equipment, intravenous fluids, and more.
What if I do need to be transferred to hospital?
Sometimes, during your pregnancy, circumstances may arise which means it may be safer to have your baby in a hospital. Your midwife will still be able to provide care during your pregnancy in collaboration with the obstetricians at the hospital, and will accompany you to hospital in labour. Unless your midwife has Visiting Rights at your hospital, she will not be able to act as your midwife in the hospital.
If there are reasons to transfer to hospital during labour, your midwife will discuss them with you so that you can make a decision which is right for you and your baby. If transfer is the best option, your midwife will come with you, handover your history and the situation to hospital staff and support you until after your baby is born.
Transfer to hospital, before, during or after a planned homebirth is often seen as a ‘failure’ or used as an example of why homebirth is risky. However, in reality, if a transfer becomes necessary, it is actually a sign that skilled midwives have successfully recognised that medical help is indicated.
Can I have a private midwife and plan to birth in a hospital?
Yes, you can! A private midwife can perform all of your antenatal care outside of the hospital, and even come to your home in labour. When it is time to go to hospital, they will go with you and support you until after the birth. Once you have discharged from hospital, your midwife can then continue your postnatal care at home. However, unless your midwife has visiting rights at your hospital, they cannot act as your midwife in the hospital. This means during your birth they will be in a support role only. In NSW, the only hospital with visiting rights for midwives right now is Westmead Hospital.
Are there things that may exclude me from private midwifery care? &/or having a home birth?
There is nothing that excludes women from having a private midwife. Often women with high risk pregnancies miss out on midwifery care altogether as their care is mostly overseen by obstetricians. However, even women undergoing high risk pregnancies will benefit from having a Private Midwife to walk with them on their journey through pregnancy in collaboration with an obstetrician.
Sometimes, you may have health issues or complications in your pregnancy which mean giving birth may be safer in a hospital. However, a Private Midwife can still care for you in collaboration with hospital staff.
In general, most women who are otherwise healthy and undergoing normal pregnancies are able to plan a homebirth. If you are unsure whether you are able to birth at home, talk to a Private Midwife about your individual circumstances.
Does Medicare &/Or my private health insurance cover any of the costs of private midwifery care?
There are Medicare rebates available for antenatal care and postnatal care, however there is currently no Medicare rebate for homebirth. Your Private Health Insurer may cover some of the costs of homebirth and/or midwifery care, but not all insurers do. The cost of hiring a Private Midwife may be prohibitive for some women, which is unfortunate, as individualised midwifery care should be a right for all women and not a privilege. In Sydney and surrounds, you can expect to pay between $4000 to $6000 (after Medicare rebates) for Private Midwifery care for your whole pregnancy and birth.
If you are at all interested in talking to Cara more about what this option could mean for you and your family CLICK HERE. You can see what she does, who she is and reach out to ask any questions. I know she would Love to hear from you.
If you are a local Mum in the Blue Mountains and would like more information around all your Maternal Health care options including private midwives CLICK HERE to visit my Pathway to navigate what is available to you. You can find information from midwives, doulas and hospitals to physics and photographers. Then more information about postpartum care for when Baby is here.
There is also a beautiful Home birth Mum community here in the Blue Mountains that meets regularly and has a facebook group that is a beautiful support for mums on many levels- search Blue Mountains Homebirth Community to apply to join this group.
As always, I am happy to help in any way I can. Please do reach out if you think I can lend you strength and direction in any way.
Much Love,
Rachel xx
