As with any big life changing event or large purchase, you're going to want to do your research, understand your options before committing yourself.
Pregnancy and birth is no different!
But more often than not, the decision on where to birth and what provider to go with is usually made spare of the moment based on your GP's recommendation or who a friend went with.
The truth is, most underestimate the impact that this decision will have on their birth experience.
So... in this blog I wanted to give you some food for thought, some questions to ask (yourself and your proposed care provider) so that you can make the right decision for you and your baby.
The Importance of Building an Aligned Birth Team
Knowing what is important to you in your birth, what you want and don't want is pointless if the people who are going to support and advocate for you aren't 100% on board. This needs to be ironed out ahead of time with everyone on your support team to avoid any last minute stress. Here are some tips on how you can do just that...
Ask Questions: If you're talking to someone about their birth, don't take it at face value. Ask some questions and find out what they wanted, what resulted, what they liked, what they didn't, what education they did, what they would change if they could, what were their attitudes and opinions of birth before and afterward. This will help put the information into better contex.
Research : Look for reviews and testimonials of the birth locations and providers you're considering.
Tour the Facilities : Visit the hospitals or birth centers to get a feel of the environment and ask any questions you may have.
Open Communication : Make sure you feel comfortable communicating with your provider about your birth expectations and concerns. Know that it's never too late to change your care provider or hospital if you are feeling uncomfortable where you are.
Provide Your Birth Preferences: Handing your preferences over to your medical care givers as early as possible will ensure you and your providers are on the same page and they support your wishes. If not, you have enough time to discuss, come up with other alternative options OR you can choose to change care providers or hospital.
Get Independent Childbirth Education:Â Â This will ensure you have a good understanding of birthing knowledge, what to expect, techniques for labour and birth, coping strategies and understanding of how to navigate the hospital maternity system.
Questions to Ask Yourself
First, ask yourself these following questions...
Ideally, what type of birth would I like to have? Natural, cesarean, water birth, epidural, drug-free etc.?
Would I prefer a more natural approach to childbirth or am I open to medical interventions?
When I think about my birth, what are my beliefs, ideals and philosophies around birth and parenthood?
What is most important to me during my labour and birth?
Where would I feel most comfortable and safe in my birth? Home, Hospital or Birth Centre?
What kind of personal support would I like to have? Eg. Partner, mother, sister, birth doula?
What kind of medical support would I like to have? eg. a dedicated midwife or obstetrician or am I happy to have who ever is rostered on that day?
Are there specific medical conditions or complications that may affect my birth choices?
What is my insurance coverage and which providers and facilities are included in my network?
What is the reputation of the hospital or birthing center in terms of patient satisfaction and outcomes?
Questions to Ask Your Proposed Care Provider Ahead of Time
What is your philosophy and approach when it comes to childbirth and prenatal care?
What are the costs involved in your care and are there any additional costs involved?
What are your thoughts on Hypnobirthing Childbirth Education or other Independent Childbirth Education Courses? (if they don't support, this is a big fat red flag!)
What are the policies around physiological birth, water birth, labouring positions etc.
What pain relief options are available to me and what are the costs involved?
Statistically how many women do you support to have a natural physiological birth?
Statistically how many women do you support to have an induced labour and birth?
Statistically how many women do you support to have an augmented or medicalised labour and birth?
Statistically how many women do you support to have cesarean birth?
How many high-risk pregnancies and birth do you roughly handle per month?
How do you handle high-risk pregnancies?
How many clients are you covering at a time?
Are you planning on taking annual leave toward the end of my pregnancy?
What is your policy on interventions during labor including vaginal checks?
How often do you attend births personally?
What is your stance on birth plans?
How do you handle emergencies during labor?
What postpartum care do you provide?
Birth Location / Model of Care Pro's and Con's
Public Hospital Birth - Standard Care
Provided in a government funded hospital. Prenatal appointments will be potentially a shared care arrangement with your GP and the midwives (you'll see which ever midwife is on schedule that day). You may or may not have an appointment with an Obstetrician if a special circumstance is raised during your pregnancy.
Pros: Hospitals offer a high level of medical care and intervention if needed during labour. Most costs are government funded in Australia if you are an Australian resident with a medicare card.
Cons: Can feel impersonal as you are seeing someone different at each appointment. Some find it frustrating getting different responses to the same request or question at appointments. Medical interventions can, in some hospitals be very routine.
Public Hospital Birth - Midwifery Continuity of Care
Provided in a government funded hospital you will be assigned a specific midwife along with a backup midwife for prenatal care and birth.
Pros: Same as above plus you'll have the opportunity to form a relationship with your midwife, you can share your hopes and values with them and receive more personalised care. Your midwife (or back up) will attend all of your prenatal appointments and support and advocate for you during your birth. This model of care is financially beneficial as it is usually government funded. Research shows a reduced rate of interventions, increased rates of vaginal birth, increased rates of successful breastfeeding and increased rate of birth satisfaction.
Cons: If you you encounter a risk factor in your pregnancy that could impact your birth, you may be forced out of this model of care and into the public system without an established midwife or obstetrician. Not available in all hospitals and places are limited so harder to be accepted in.
Private Practicing Midwife - Birthing in a Hospital
Receiving care from a chosen midwife in a public or private hospital.
Pros: You have the benefit of having continuity of care from a midwife that you have chosen yourself who has an established relationship with a hospital and is 'sponsored' by an Obstetrician who will provide high risk care if required. Your private midwife will provide you with prenatal care (usually in your own home), you'll have the ability to build a relationship with them where they will be able to get to know and understand your hopes and values for birth so that they can advocate for you during your birth.
Cons: This is a premium service with a price tag. If for some reason your chosen midwife is unable to attend your birth you will be assigned a back up midwife in their place.
Private Obstetric Care
Prenatal, labour and birth care provided by a selected Obstetrician in a private hospital.
Pros: Hospitals offer the highest level of medical care and intervention if needed during pregnancy, labour and birth. All your appointments will be with your chosen Obstetrician so you will have the opportunity to build a relationship with them. Your Obstetrician will sporadically pop into the labour room during your labour and during the birth of your baby and will check in on your whilst in hospital during the post natal period as well as a check up appointment 6 weeks post-partum. Some Obstetricians may offer private prenatal care in a public hospital which will reduce some of the costs.
Cons: Private obstetric care is associated with low rates of normal birth and rather, high rates of medicalised birth interventions eg. induction, augmentation, instrumental birth and cesarean birth. During your labour you will be cared for by which ever midwives are rostered on. This model of care comes at a premium cost.
Birth Centre Midwifery Care
Prenatal, labour and birth care provided by a known midwife or small team of midwives in a birth centre (think birth house, something in between home and hospital). Birth centres are usually located within, attached to or near by a major hospital.
Pros: Birth centres provide a homely environment with less sterility of a hospital. Usually run by a small group of midwives who provide ongoing prenatal care, and a place to birth with continued care. This model of care is associated with higher rates of natural physiological births.
Cons: There is limited access to pain relief like epidurals and should a special circumstance or emergency come up, you will need to be transferred to the closest hospital. There are not so many Birth Centres around these days and they have limited spaces so get in quick!
Home Birth with a Private Midwife
Prenatal care and labour and birth support at home supported by a Private Midwife and a back up Midwife in the role of supporting the lead Midwife.
Pros: Starting and finishing pregnancy, labour and birth in one location without the need to transfer locations. Prenatal appointments usually attended within the birthing womans home. Home is where clients who choose this model of care feel most comfortable and safest. High rates of normal, natural physiological birth with minimal rates of intervention. Higher rates of birth satisfaction.
Cons: Limited access to pain relief and medical interventions. If special circumstances arise transfer to the closest hospital will be required. Hiring a private midwife can be costly.
So what about Doulas then?
It seems silly to write all this without including some information about Doulas.
Doula's are non-medical support companions who provide emotional and physical support during labour and birth. A doula is one way that a birthing woman can 'fill the gap' between continuity of care with a 'known' midwife or obstetrician.
Research has shown that support from a doula is associated with reduced rates of birth intervention, higher rates of normal physiological birth and birth satisfaction.
In Conclusion
Choosing the right birth location and provider is a personal decision that should align with your preferences and desires for labor and delivery. By weighing the pros and cons of each location and asking the right questions, you can ensure that you have a supportive and understanding team by your side on this incredible journey.
Remember, every pregnancy journey is unique, so trust your instincts and choose what feels right for you and your baby!
So, take a deep breath, trust in yourself, and enjoy the process of preparing for the arrival of your little one!
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