What!? I Have Birth Options?

By Anna-Maria Boelskov - May 07, 2018

A Guide to Your Birth Options

Yes! You most certainly have options and I recommend you explore them thoroughly and ideally as early as possible once you find out you have a little foetus in your belly. This time can feel very emotional for you and there are layers of thoughts and feelings and logistics that needs your full attention. To help you on your way to find your best birthing team I have listed the most common birthing options here. You can also look at my guide to what to do when you find out you're pregnant. 


What Did I Do When I Got the News I Was Pregnant?

My first pregnancy was unexpected. It came as a big surprise to me. Back then, I had no idea about the different ways you can give birth. Nonetheless what different types of births means for you as a mother and your baby. My head was spinning, and I couldn't think clearly. I saw a general practitioner (GP) I had never seen before as my usual GP was unavailable. Apart from confirming that I was pregnant through a blood test, she told me to get an Obstetrician (OB). She told me to 'hurry up' because my baby's due date was "in the middle of most OB's holidays" - I was due in January. What!? At first, no one told me about all the different birth- and care options available. Nor did I seek out to find alternative ways. I thought these were my only options available... After seeing the GP, I went home and called five different OB's, and only one could fit me in. $7000+ later I was on track, I thought.

Learning About Pregnancy the Hard Way - The Unknown

Like many other things in life I learned the hard way. Halfway throughout my pregnancy I realised that a private OB was not quite right for me. However, I had paid and was locked into a contract. My OB required seemingly endless appointments and ultrasounds, despite my pregnancy being low risk. I asked if I could skimp some. I was told "no". I had to attend due to the way this particular OB worked. It was part of his routines and the agreement we had signed. So I diligently showed up for many, many ultrasounds to see that my baby was doing well. Now, to be clear - the care I got was great. It just wasn't for me. My pregnancy was low risk , and didn't feel the need for extra ultrasounds, or the added expense. Looking back to my two subsequent births and comparing these to the first - a birthing centre would have been a better fit for me. I still wonder to this day why the different options were not laid out to me when I initially rocked up to the GP's office asking the big trembling question "I think I am pregnant - now what?"

Your Birth Options - The Different Ways of Giving Birth

My own three births, years of clinical practice and many doula clients later has made it clear that many women (and couples) are in the dark regarding their birth options. I have had couples ask me why is it so hard to work out what options are available. Why does it seem impossible to get into a birthing centre, and how does one know if a private or public hospital is best?

A few births ago, when I was at a client's final postnatal visit, the new father asked me the question that prompted this blog post: Why didn't they known about the different options available? They had just been told to about one option - full stop. As they reflected on their birth experience (which, by the way, had been a kickass beautiful birth), they felt they would have been more suited in a different hospital setting. But unfortunately, they didn't know that other birth places or options existed until they hired me as their doula 24 weeks into their pregnancy, which can be a little late in pregnancy to change places. 

There is a lack of guidance and a need for clarity on the subject of birthing options. So, how and where to give birth? Here are the most common options available to your to birth your child. Hopefully you will be reading this in time to make the decision that feels right for you.

Private Obstetrician and Private Hospital

An obstetrician (OB) is a specialised doctor in gynaecology, pregnancy, birth, surgical procedures and often high risk pregnancies. Most obstetricians work at one or several private hospitals but are also available in public hospitals. The layout is that your primary care provider in pregnancy is the OB and typically the care involves blood testing and ultrasounds performed at the OBs clinic. The price for a private obstetrician is between $4,000-$9,000 Australian dollars. There may be additional fees for blood tests and scans. An OB is particularly skilled in surgery. Some women choose their OB from word of mouth or by the hospital they wish to give birth in. You will do your prenatal appointments with the OB only and most of your labour with the midwives at the hospital. Typically the OB will arrive once you are close to or in the second stage of labour (when you're pushing). During your labour, the midwives will keep your OB informed of your progress, and although your OB may not be at the hospital, they stay in close contact to advise the midwives. After the birth, the OB will visit you a few times in the postnatal ward of the hospital. You will have your six weeks check up at the OB's office. Private hospitals are typically better funded, and the labour and postnatal rooms may be elegant and more spacious. I advise that you interview your chosen OB to understand their work ethics, their typical approaches to the twists and turns labour may entail, and to discuss your wishes and how your OB can support you in achieving your optimal desired birth outcome. One reason some women and couples choose a private OB is to have the reassurance of knowing who their medical care provider is in case intervention is needed. Another is in case of a high-risk pregnancy where medical intervention may be necessary for the mother or baby.

Public Hospital and Shared Care

What is shared care? Shared care means that you will need to book yourself into the public hospital closest to your home. You will have alternating appointments throughout your pregnancy with your local GP and the midwives at the hospital. The prenatal appointments are generally to check your health and your baby's health and at each visit they will be measuring your tummy and blood pressure. The hospital will offer ultrasound for a dating scan and morphology scan. Most likely these are the only two scans you will have during your pregnancy, and there will be a small cost attached to these. Medicare covers shared care.

As you get closer to your due date, your prenatal visits are only with the midwives at the hospital. You will meet a range of different midwives as there is not one midwife allocated to you, so you may or may not meet a familiar midwife at the birth. During your labour and the birth of your baby, you will be supported by midwives. Depending on the length of your labour you may see a new midwife if there is a shift change. In this care, there is no way of knowing which midwife you will have. In all public hospitals, there are observing obstetricians attached to the public labour wards. Should your labour require specialised medical attention by an OB, there is always one on call to help out, but you don't get to chose who the OB is. Similar to the private care, the OBs on duty are observing your progress remotely once you are admitted to the hospital. The OB on duty will attend to you if you or your baby are showing signs of distress. In case of an emergency, it is the OB that will be assisting you. If your labour goes smoothly and you and your baby are showing signs of thriving you are unlikely to need any other assistance apart from the midwives and your chosen birth support people (e.g. your partner, family members, doula, friends). For first time pregnancies, most people stay for at least 24 hours after the baby is born. All depending on your situation and needs you may need to stay several days.

Birth Centre

What is a birth centre? A birth centre is often attached to the public labour ward (see above) but focuses only on low-risk pregnancies and are run by midwives as a 'group midwifery practice'. That means; if you develop any complications such as pre-eclampsia, gestational diabetes or if you or your baby are showing any signs of distress during labour (meconium, fever or a significant change in heart rate) you will be transferred to the labour ward described above in shared care although your postnatal care will still most likely be with your birth centre midwives. The best description for a birth centre is a "middle-ground between home birth and hospital birth". Giving birth at a birth centre also means that you are cared for by a small group of midwives, whom you are expected to meet at least once before you give birth. The idea is that you know who is there for your labour and delivery and postpartum. The labour room is often different from a labour room in the public and private hospital. The birthing centre rooms are more straightforward in their layout than the hospital rooms. There is often a bath and less hospital equipment to be seen. Some places don't have any medical equipment in the rooms. Other birth centres have everything neatly hidden, so the room seems simpler and calmer in essence. Pain relief options are limited but vary from place to place. Generally the most natural approaches to pain relief at a birthing centre is preferred. These include the shower and a bath tub, nitrous oxide aka gas which works as an anxiolytic as well as heat packs and the tens machine. Should there be a need for medical intervention, the transfer from the birth centre to the hospital is typically only a few steps through to the labour ward. A birth centre is also part of Medicare, and the only cost will be the recommended ultrasounds. Due to the limited number of births each midwife group can take to ensure continuity of care; the spaces fill up quickly. If you want to get into a birth centre, it is best to call your local birth centre as soon as you fall pregnant to get a spot. If you can't get into the birth centre, you will be referred to shared care. The cost? Around $150 out of pocket expenses for ultrasounds. 

Home Birth

What is a home birth? This is a private midwife practice - meaning you plan to give birth at home in the care of a private home birth midwife. Prenatal appointments are all with your midwife at your home or the midwife's practice, and once you're in labour, your midwife will come to your home. She will bring the required equipment which surprisingly (to some) is very little; a tank of nitrous oxide gas (laughing gas), the birth pool and her tools for baby care. The cost for home birth is between $4,000-$6,000 Australian dollars. If the home birth is funded by a hospital program, it will be covered by Medicare. The postnatal care is at your home, and you have direct and frequent contact with your midwife. Should there be complications in labour or the pregnancy, the birth may transfer to the hospital where your midwife will accompany you. Women wanting home births are often keen on a low intervention birth and would for this reason not be wanting an epidural or another type of medical treatment. Another aspect of choosing a home birth is that some women feel safer at home and more comfortable.

Your choice

I have given birth in a public and private hospital, and have been treated well in both places. I have also attended births as a doula in births centres, home births, private and public hospitals all over Sydney, Australia. Each place is ideal for different couples. I have no attachment to what you should choose. I just want you to have the choice. The purpose of this blog post is to give you information and for you to ask yourself (and your partner) what feels best for you, rather than feeling like you have no choice, or worse, regretting how and where you gave birth. I can reassure you that whatever feels best to you IS the right choice for you. Make a conscious decision based on knowledge and research to choose your best care. The essence of a positive birth experience is a supporting, loving and transparent team that respects your care wishes and understands the birth process and options available. Be clear on your wishes, your hopes and your needs. Then seek out the best situation to support you in your pregnancy and birth. The care you choose is essential to a positive experience, and of course, having a doula by your side in any of the places described is a proven way to enhance your experience.


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References: "Melatonin Synergizes with Oxytocin to Enhance Contractility of Human Myometrial Smooth Muscle Cells" | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730229/  | James T. Sharkey, Roopashri Puttaramu, R. Ann Word, and James Olcese



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