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BIRTH / Jun ‘2017

Profile view of a pregnant woman
BIRTH / JUN ‘2017

Having a baby? Before you start shortlisting names or preparing the nursery it is important to work out where you are going to bring your bundle of joy into the world. We look into options to consider when it comes to deciding on the right maternity care option for you and your baby.

Words BROOKE EVANS-BUTLER

When I walked into my GP’s office (positive pregnancy test in-hand) the first questions I was asked was regarding my choice of maternity care. ‘Congratulations! So, do you have health insurance? Do you have a preference of obstetrician and hospital?’ I must admit, my head was spinning…I had found out I was going to be a parent an hour prior, and was already being asked about how and where I wanted to have my baby. However, it is a big decision – and is ideally something that you should research even before you get pregnant. But what is the right decision for you? We look into the options – whether you are considering public or private care or a home birth.

Public or private? Dr Gary Swift, Vice President of National Association of Specialist Obstetricians and Gynaecologists (NASOG), says all who are involved in the area of pregnancy and childbirth strive for optimal care and outcomes – however the public and private models are inherently different.

Private care
If you choose private care, you get to choose an obstetrician to care for you throughout your pregnancy and for the birth of your child.

Dr Swift says private care is based on a one-to-one relationship between the woman and her specialist for antenatal care, detection of problems and ultimately safe and timely delivery. “Personal wishes and concerns are easily addressed when the same clinician is involved at each step,” he says. “This relationship is important equally for the most straightforward and complex of pregnancies. Issues of primary elective Caesarean Section if desired tend to be more easily accommodated in the private sector.”

An advantage of choosing private cover is that you usually have the option of a private room (having a bathroom to yourself after birth is always an added bonus!) and many private hospitals give you the option of having your partner stay with you.  The rooms (and meals) are usually of a higher quality than at a public hospital (some rooms are like lovely hotel rooms) as a general rule, allow new mothers longer stays after birth than public hospitals or some have arrangements with 5 star hotels for part of the post-partum stay.

There is often some out-of-pocket costs associated with private care, so find out your chosen obstetrician’s fee schedule and check with your health cover provider exactly what is covered so you can be prepared.

Note: Most private health providers will have a waiting period for obstetrics (pregnancy) of around 12 months, so if you will need to have this option on your health insurance policy in advance (before you get pregnant) if you want private care. (Check with your health insurance provider about their waiting periods).

Private care pros:

– You have one-on-one care of your chosen obstetrician

– Many private hospitals offer private rooms so your partner can stay overnight with you

– Generally, private hospitals allow new mothers to stay longer after the birth of their baby for recovery.

Private care cons: Having a baby at a private hospital is more expensive than in a public hospital (check with your health fund about what you are covered for).

 

mother breastfeeding her baby

Ultimately it will be a personal choice and for a successful professional relationship, issues of personality, trust, experience and professionalism will be foremost.

Mother-of-three Monique Wilson chose private care for all three of her children and says she would highly recommend this care option. “I chose to have my baby in a private hospital because I had cover and liked the idea of having the same obstetrician through my pregnancy and picking one that I felt comfortable with,” she says. “I ended up having my first child six weeks premmie and it was at my obs appointment that the obstetrician picked up an irregular heartbeat. The bill for his stay in hospital was $15,000 and we didn’t pay a cent. I also enjoyed having my own room and we were given a choice from a buffet for all meals. I loved the treatment we received.”

 

Schwangere Frau liegend betrachtet Ultraschallbilder

"I also did a hypnobirthing course to help me overcome any fear of birth and to empower me to bring my daughter in to the world with the help of my husband and a midwife."

Public care
“Public hospitals fundamentally have to deliver the best service possible to a larger population within the government prescribed budget,” says Dr Swift. “Hence, antenatal care is delivered in a clinic format in which a different attendant is seen on each occasion and varying levels of qualification from intern to specialist. Specialists tend to see the more complex and high risk cases. Long waits are not uncommon in these clinics.

“Labour and delivery management will depend on level of risk and complexity with staff allocated accordingly. Midwives primarily care for low risk women for normal birthing and junior doctors attend for suturing of tears or episiotomies. Trainee specialists provide the majority of services under the supervision of qualified specialists.

“Short stays are the norm with home visit services often covering breast feeding issues as lactation may not have been established before early discharge. Primary elective (maternal request) Caesarean Sections are not usually available in the public system. There is no cost for Public Hospital Services for Australian Medicare Card holders so this will be the only affordable option for many, especially without private health insurance.”

Jodi O’Callaghan decided on a birthing centre (through a public hospital) for the birth of her daughter.  “After falling pregnant I looked in to my options for birthing and decided I wanted to be in control of my birth, with as little intervention as possible,” she says. “I also did a hypnobirthing course to help me overcome any fear of birth and to empower me to bring my daughter in to the world with the help of my husband and a midwife.

“When you go through a Birth Centre you are encouraged to labour at home as much as possible and attempt drug free if the labour progresses as it should be. That coupled with my hypnobirthing techniques to draw on meant that by the time I got to the Birth Centre I was 8cm dilated. Two and a half hours later my daughter Stella was born! I had some tearing and needed surgery, but I had achieved my birth plan goal of being drug free for the birth.

“I was in the Birth Centre for no more than three hours and then spent one hour in surgery, under what I found to be excellent care. I was then transferred to a private room in the maternity ward where I spent five nights being supported by midwives to get the hang of breastfeed and get to know my baby. I had not requested a private room, so it was a lovely surprise. I received excellent care from the public system and was not out of pocket for any expenses. If I have another baby, I would not hesitate to go through the public system again.”

Public care pros:

– There is usually no cost when you have your baby through the public system

– Mothers-to-be with low risk pregnancies may have the option of giving birth at associated birthing centres, adjoined to the hospital

– Public hospitals usually have lower intervention rates (such as caesareans etc).

Public care cons:

– You do not get a choice of carer and often will see many staff throughout your pregnancy and birth

– Often have shared rooms

– Partner cannot stay overnight

– Short hospital stays for the new mother and baby after birth.

Newborn cute infant baby with umbilical cord

"Every child has the right to a safe birth and every mother the right to survive labour and delivery."

Home birth
Some women choose to give birth at home with the support of a midwife – and Cherie Nixon,  coordinator of Homebirth Australia, says being in the comfort of your own home with a good support team  can create a calming birth experience. She says being in familiar surroundings can be good pain relief in itself – and at home women can also use a birth pool, TENS machine, massage and natural therapies like aromatherapy.

Cherie says choosing a home birth offers great one-on-one care – offering support throughout your pregnancy, labour and birth, as well as postnatal care, with some visits until the baby is six weeks old. “You have your own midwife caring for you throughout your pregnancy – your midwife knows your past and your medical history. They come to your house for appointments, which is great if you have other children, and it is a good relationship offering one-on-one care,” she says.  Cherie says that word-of-mouth is the best way to find a midwife – however, you can go to the Homebirth Australia website, www.homebirthaustralia.org and find a midwife using their ‘search for a midwife’ search option.

Cherie says most midwives recommend a woman book into a hospital prior to the birth, so if in the event the woman needs to be transferred to hospital during the labour, the hospital already has the mother-to-be’s details on-hand. It should be noted that a midwife cannot administer an epidural or perform a caesarean section, so if the mother wants pain relief or if complications arise, they will have to be admitted to hospital and their midwife can go to hospital with them as a support person.

Dr Swift says NASOG does not support home birth. “The intrinsic nature of childbirth is that although it is a wonderful event for most, it is intrinsically dangerous and unpredictably so in some women,” he says. “Low risk can become high risk with minimal notice. There are so many potential problems which can occur and lead to the loss of the mother of baby or both which cannot be reliably predicted or catered for in the out of hospital environment. It is possible to understand the desire of women to birth in an environment which is secure and familiar, however the potential for tragedy in NASOG’s view supersedes this.

“Every child has the right to a safe birth and every mother the right to survive labour and delivery. As clinicians we have the responsibility to provide this. We know that despite our best efforts adverse outcome occur in hospitals, but we at least have the opportunity and potential to rescue adverse events and monitor babies to prevent hypoxic injuries. We know from data in countries where out-of-hospital births occur that the maternal and neonatal mortality is more than 10 times higher than it is in hospital births. Ultimately it comes down to compromising the birth environment for safety for the mother and child.”

As a nurse, Jackie says choosing a homebirth was an easy decision. “I guess this has come from my experiences professionally and my knowledge through my profession of all the benefits that come with a homebirth,” she says. “It was really very important to me to have a drug free birth, not because I wanted to be perceived as a superhero or anything other than a woman having a baby, but because of the benefits that a drug-free, natural birth brings.

“There are less bonding and breastfeeding issues with mums who have fully connected with their bodies and babies throughout labour. The best place to have a drug-free birth is at home, as there are no temptations to be had. The gas isn’t in the corner as a constant reminder of what you could have, the doctors and midwives are not in your face saying things like “well the anaesthetist is here now so if you think you might want an epidural later you best have one now so he doesn’t have to come back!”.

“Also at home it is your environment, you are in control of every part of it, you have invited people into your home to help you have your baby, as opposed to hospital where midwives are assigned to you, people wander in and out of the birthing rooms and it can become a bit of a circus at times, this I knew wouldn’t work for me. I knew I needed privacy, quiet and control. And then finally because my partner felt like he could be a bigger part of the experience at home rather than hospital, especially afterwards, he wasn’t going to be rushed out the door because it isn’t visiting hours, he can help care for our new baby in the comfort of our own home and bond with our baby 24/7 like me.

“I personally don’t have anything to compare to as this was my first baby but my homebirth water birth was the best experience of my life. I was never once scared, I never considered transfer to hospital, I never thought I couldn’t do it.”

Home birth pros – You are able to stay in the comfort of your own home – You are under the care of a midwife throughout your pregnancy and birth – You get to choose who is present at your birth.

Home birth cons – Aside from natural measures, pain relief (such as an epidural) is not available if you decide you want it – If there is an emergency you will have to be transferred to a hospital.

 

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A mother, sister or close friend are great options – if you think they are someone who will be a calming influence and be supportive of you.

The power of choice
No matter what care option you choose for you and your baby it is important that you are happy and comfortable, so if you are not happy with your experience you can change hospitals, obstetricians or switch between private and public care for subsequent pregnancies.

You might choose to switch between private and public for subsequent pregnancies if:

1. Your health insurance waiting period is over (you might want to go for private care if the reason you chose public care for a previous pregnancy was because of the waiting period).

2. If you had a caesarean for your first baby and want to try for a vaginal birth after caesarean (a VBAC).  Not all obstetricians will recommend trying for a VBAC, and may recommend you go to a public hospital or to try another obstetrician.

Mother-of-four Angela Davies has experienced private and public care – choosing a private hospital for her children Aiden (6), Charlotte (4) and Bryce (10 months), and a public hospital for her daughter, Elizabeth (2).

“The main reason for my original feeling about wanting to go private was seeing my sisters have their children,” Angela says. “My oldest sister went public for her second child because they couldn’t afford the health insurance and I remember her saying she found sharing a room was not pleasant. While she always went to the feeding room to feed to keep the noise down for her roommate – her roommate wouldn’t and her baby cried a lot.

“So my impression of birthing was that it was amazing and if you wanted you could pay for things that would make it easier to transition in to motherhood such as a private room. I also didn’t like the idea of healing and having boobs out and having to try and be quiet for others if I was sharing a room.  So I paid for private health cover long before I started having children.”

Angela’s first child Aiden, was born via caesarean section at a private hospital. For her second child, Charlotte, she changed doctors (at another private hospital) so she could try for a VBAC. With her third, Elizabeth, she was living rurally and chose to give birth at the local public hospital. For her fourth baby, Bryce, Angela chose to go back to the private hospital where Charlotte was born, so she could be closer to her family.

“All the actual birthing experiences were all pretty much the same,” she says. “I never saw a difference in care at that stage. I preferred private to public after birth though. In the private hospitals there was more ‘luxury’ (bigger rooms, bigger beds, carpeted floors, a small fridge and my own tea making facility). Being able to make my own tea at any time was important. I also felt a bit lost and forgotten at the public.

“At the allocated rest hours the nurses would sit and chat at the nurses’ station, which wouldn’t allow me to sleep. I left the hospital after a day and a half because I felt I would get better care at home with cups of teas from my husband but stayed all my allowed days in the private hospitals. As the birthing experience was no different I would advise women to only go private if the aftercare is important to them. The nursing and medical staff do their best no matter what hospital so that to me isn’t a consideration.”

Your support person
The person you choose to be your support partner during the birth is also an important part of your maternity care choice. Your options include:

Partner or family member/friend: Many women will choose to have their partner as their birth support person. However, if you do not have a partner, if for any reason your partner cannot be there (because of work commitments, travel, illness etc) or if you and your partner feel like you would be better supported with someone else present, you can choose to have someone else at the birth. A mother, sister or close friend are great options – if you think they are someone who will be a calming influence and be supportive of you. Sometimes a woman may want more than one support person (for example her partner and her mother), so check with your hospital about how many support people are able to accompany you (often if you are having a caesarean only one support person will be able to accompany you into theatre).

Midwifery student: This involves a midwifery student attending some antenatal appointments with you, being present at your baby’s birth and seeing you in the days/weeks after the birth. For the midwifery student, attending appointments and the birth offers invaluable experience and, for the mother-to-be, offers another support. You can enquire about having a midwifery student join you for your pregnancy and birth experience, by contacting the School of Nursing and Midwifery at Curtin University, Notre Dame University or Edith Cowan University. If you decide you do not want a student to be present at the birth after all, you can opt out of the program at any time.

Doula: A doula (or birth attendant) is a non-medical person offering support to parents throughout pregnancy and birth. A doula does not give medical advice or perform any medical procedures, but can assist a labouring woman and her partner with non-medical ways to calm and comfort, such as massage and breathing. To find a doula or for more information, go to the Australian Doula College website, www.australiandoulacollege.com.au

Having a baby in Perth? Here are some options:

1. King Edward Memorial Hospital for Women – King Edward Memorial Hospital (public hospital) offers a wide range of care for women, and women considered to have a high risk pregnancy will often be referred here (the hospital is equipped with a neo-natal nursery for sick or premature infants).  There is also a Family Birth Centre on site for women with low-risk pregnancies.

2. Osborne Park Hospital – Osborne Park hospital is a public hospital offering care for women with low to moderate risk pregnancies. A special feature at Osborne Park Hospital is the ‘Snoezelen Room’ for maternity patients, which promotes relaxation through the use of lighting, sound and aromatic oils.

3. St John of God Hospital Mt Lawley – St John of God Hospital Mt Lawley (formerly Mercy Hospital) is a private hospital offering modern birthing suites and home-style accommodation, with double beds in all private rooms, allowing partners to stay together. It also has a level 2 special care nursery if your baby requires.

4. Joondalup Health Campus – Public and private patients are accommodated in this facility, with Joondalup Health Campus (public) and Joondalup Private Hospital located at the same location.

5. St John of God Hospital Subiaco – St John of God Hospital in Subiaco is a private hospital which sees more than 3,500 babies born every year. It features a level 2 neo natal nursery if your baby requires. Take a virtual tour through the website:
http://www.sjog.org.au/hospitals/subiaco_hospital/hospital_services/maternity/virtual_tour.aspx

6. St John of God Murdoch – St John of God Murdoch is a private hospital The St Mary Ward features 29 private suites and three shared suites. A level 2 neo natal nursery is available if your baby requires.  You can take a virtual tour of the facilities by going to the hospital’s website:
http://www.sjog.org.au/hospitals/murdoch_hospital/hospital_services/maternity/facilities.aspx

7. Glengarry Private Hospital – Glengarry Private Hospital features spacious birthing suites and features both family double bed accommodation, as well as single rooms. It also has a level 2 special care nursery if your baby requires.

Other options include: St John of God Hospital in Midland (this hospital offers public and private services) – Fiona Stanley Hospital – Armadale Kelmscott Memorial Hospital – Bentley Hospital – Rockingham General Hospital

Information on public hospitals in Perth can be found at the following website: http://www.healthywa.wa.gov.au/Articles/F_I/Having-a-baby-in-a-public-metropolitan-hospital-in-Perth

Some selected hospitals offer the ‘Look @ My Baby’ service. For a small fee, this service enables you to invite family and friends to see your baby without even coming to the hospital! Your family (even those interstate or overseas) can see the baby via a secure live video stream (straight from a special ‘cot cam’) to capture those first yawns and stretches and special moments. To find out more information go to https://www.lookatmybaby.com/

BROOKE EVANS-BUTLER

Brooke has written for home improvement, bridal and women’s lifestyle publications, but says Offspring enables her to combine writing with her new favourite hobby, being a mum to her boys Caleb and Jonah.