The way in which your primary caregiver views birth, their management style and their degree of commitment to the normal birth process will determine how they care for you during labour and the services they will perform.
Thinking about your goals for the birth can help you to identify which type of care arrangement is going to support you to achieve the kind of birth you are dreaming of. It’s a good idea to shop around for your caregiver in order to give yourself the best chance of fulfilling your goals.
Choosing a Birthplace
The environment in which a woman labours and gives birth has a major effect on the birth. A woman’s physiological responses will be affected by her surroundings and the result can either speed or delay the process. Her main need is to feel safe and protected from danger or harm, since during the hours of labour she will feel particularly vulnerable.
Many expectant parents assume that their baby will need to be born in a hospital. The World Health Organisation states that normal, healthy pregnant women may wish to consider a number of options, and that for these women, giving birth in their own home is a safe option.
The availability of suitable caregivers will also influence where a woman chooses to give birth. And some women choose to arrange several alternatives so that they can make their final decision during labour. For example, a woman may make a booking at the hospital, but choose an independent midwife who can assist her in either her home or at the hospital, depending on how the labour develops and how she feels at the time.
General Statistics for Birth Outcomes in Victoria
| Public Hospital | Private Hospital | Birth Centre | Home | WHO | |
| Normal Birth | 63.3% | 47.1% | 78% | 91% | 80% |
| Forceps | 4.5% | 9.3% | 4% | 0.4%% | |
| Vacuum | 6.1% | 7.9% | 4.5% | 1% | |
| Vaginal Breech | 0.5% | 0.3 | 0.5% | 0.4% | |
| Caesarean | 25.5% | 35.4% | 12% | 6% | 10 -15% |
References:
- Births in Victoria 2003-04. (2005) Perinatal Data Collection Unit. Department of Human Services
- WHO (1985) Appropriate technology for birth. Lancet ii, August 24, 436 - 437
These statistics show that a healthy woman’s chances of experiencing a normal birth are greatest if she chooses to have her baby in a birth centre or in her own home. It also shows that public hospitals support higher rates of normal birth than do private hospitals.
The World Health Organisation recommends that normal birth should be around 80% as it is this percentage of the population who are able to give birth without the need for obstetric intervention. WHO research also shows that countries which have caesarean birth rates of between 10 and 15% also have greater levels of maternal and newborn health.
For more detailed informaion, you can find out how your hospital performed in 2005 - 06 in this online Victorian Government publication Victoria Maternity Service Performance Indicators - Complete set for 2005 - 06 Listed here are statistics for each hospital in regard to Induction of Labour; Caesarean Section; Tearing and VBAC.
Your options for Birth Venue:
Birth Centres
Some hospitals have additional facilities, called Birth Centres, which are designed to be as home-like as possible. These units are usually set up as a separate unit, and have their own staff of midwives to oversee the pre-natal care and the birth. They aim to enable women to give birth with as little intervention as possible.
Benefits
• Care provide by a team of midwives.
• Increased likelihood of achieving a normal birth than in a hospital labour ward.
• If a woman requires medical assistance or the use of pain relieving drugs, transfer to the nearby labour ward is easy.
Risks
• These programs are very popular and often have waiting lists.
• Tension between the philosophy of the birth centre and the Medical institution it sits within, may impact on the facility’s ability to offer true midwifery care.
Melbourne’s Birth Centres
• Monash Family Birth Centre, Clayton. Ph: 9928 8780
• Mercy Family Birth Centre, Heidelberg. Ph: 9270 2222
• Angliss Family Birth Centre, Upper Fern Tree Gully. Ph: 9764 6226
Home Birth
The availability of home birth depends largely on the availability of midwives who provide this service. Details of independent midwives can be found at www.maternitycoalition.org.au
Though doctors rarely provide home birth services, there is one GP, Dr. Peter Lucas who will support a woman to birth in her home. He is based at Wattle Park House, 1138 Riversdale Rd, Box Hill South, ph: 9808 0533
Benefits
• Freedom to labour in your own way, in the privacy of your own home.
• No need to make special arrangements for other children.
• Reduced risks of medical technology or drugs being used routinely – you will be asked to consent to every procedure.
• Reduced risk of infection.
• The baby will be welcomed into its own home and family with little chance of separation or disruption.
• No need for special visits to the hospital with your new baby - your midwife provides post-natal care in your home.
Risks
• Your home must have basic equipment – telephone, hot water, ready access and be within 20 minutes of the nearest hospital.
• If there is a complication with the labour, you will need to transfer to hospital, which can be traumatic. Most independent midwives make a back up booking for you with the closest Level 3 maternity hospital.
• Although midwives will carry basic medical equipment for most situations, if there is a problem with the baby, emergency transfer to the nearest hospital may be necessary.
Hospital Labour ward
The majority of women give birth in a standard hospital labour ward.
Benefits
• Care in public maternity hospitals is free
• Some public hospitals provide midwifery led one-to-one care (Birralee Maternity Service, Box Hill, Sunshine Hospital, Casey Hospital)
Risks
• Facilities vary and may not be conducive to undisturbed birthing. A visit during pregnancy will help you to decide if this is where you want to be for the birth. Prepare for this visit and feel free to ask questions of hospital staff whilst you are there. The hospital tour questionnaire attached might help.
• Though care during pregnancy and labour is provided by midwives, hospital routines are informed by policies based on the medical model of birth, intervention rates in Australia are relatively high.
Your options for caregiver in Australia:
The Midwife:
The World Health Organisation recommends that midwives be seen as the best caregivers for healthy women with normal pregnancies. Midwives are trained in the management of normal pregnancy, birth & newborn care. If problems arise, the midwife is able to recognise them and refer to specialists as necessary. She offers a range of non-medical techniques for promoting safe outcomes for you and your baby and for managing the pain of labour. Public hospital midwifery services are usually free. Different hospitals offer different models of care. The case management model gives you a named midwife who will care for you throughout your pregnancy, labour and birth. In the team midwifery model you are cared for by a team of midwives throughout your pregnancy, labour and birth. Some hospitals offer special midwife run clinics and birth centres.
Controlled trials have been conducted to look at the effects of continuity of care during pregnancy and labour. These trials compared the experiences of women who were cared for by a small team of midwives and women who were cared for by a variety of midwives, obstetricians and GPs. Women who were cared for by a small team of midwives were less likely to be admitted to hospital during their pregnancies; were more able to discuss their worries and feel well prepared for labour; needed less pain relief and experienced fewer interventions during labour. They had fewer babies who required resuscitation at birth.
Independent Midwife:
Independent midwives work on a private basis and so have a range of charges for services. They are sometimes available through outreach programs at local hospitals. Independent midwives may work on their own or with a partner and usually offer homebirth. An independent midwife can also attend you in hospital providing you with continuity of care throughout your pregnancy and labour. Unless they have negotiated visiting rights with the hospital they will not be seen as your primary caregiver by hospital staff. If complications arise in a pregnancy they can refer to an obstetrician. If you are a healthy woman with a normal pregnancy, hiring an independent midwife is one way to ensure that you have a caregiver you know and trust to care for you throughout labour and birth.
Independent midwives do not currently have professional indemnity insurance. If you are considering making a booking with an independent midwife, it is a good idea to discus the implications of this with her before you confirm care arrangements.
Details of independent midwives can be found at www.maternitycoalition.org.au
General Practitioner:
In some communities, GPs offer maternity services. These GPs have additional training in obstetrics and often undertake c-sections. It may be possible to ‘share care’ with a midwife. GPs may provide prenatal care to women planning to birth in hospital, assisted by themselves or by a midwife, and may offer post-natal care – providing continuity of care through pregnancy and birth into the initial postnatal period. Some GPs only provide pregnancy care and will not be present at the birth. GP services are usually available on Medicare.
Obstetricians:
Obstetricians are specially trained in the management of complicated pregnancies and births. Midwives will refer ‘high risk’ clients to obstetricians. Other specialists may be consulted if a woman has an existing condition e.g. diabetes, this will incur additional fees. A private obstetrician provides prenatal care at private rooms. They will be closely involved in your care during labour although they may not be present for all of it. They will plan to be at the birth and will provide care after the birth. Choosing an obstetrician when a normal pregnancy and birth is anticipated does not appear to improve outcomes compared with involving obstetricians when complications arise. It can lead to higher rates of intervention such as Caesarian Sections or forceps. A likely cause of this is that obstetricians follow the Medical Model of birth, which anticipates problems, rather than managing birth as a natural process.
The Active Birthing Workshop can further develop your skills and build your knowledge around:
- The advantages and disadvantages of each choice of birth attendant;
- The advantages and disadvantages of your birth venue options;
- Your rights as a pregnant woman;
- And how to use a birth plan to communicate with your caregiver.
References
- Enkin. M, Keirse. MJNC, Neilson. J, Crowther. C, Hodnett. E, & Hofmeyr.J. (2002) A guide to effective care in pregnancy and childbirth. 3rd Edition. Oxford: Oxford University Press.
- Robertson, A (2002) Preparing for Birth: Mothers – Background notes for Pre-natal Classes. Camperdown: ACE Graphics.