Hello! We've made it to the third and final post of the 3-part series "How to Choose your Maternity Care Provider." Thanks for reading so far! If you missed the previous posts, click back and have a read about how defining your birth vision (Part 1) and deciding WHERE you'd like to have your baby, and WHAT model of maternity care is best for you (Part 2) will be key in your decision process.
Also in the second post, we discussed your public options for care in the Australian maternity health care system. This last post focuses entirely on private care providers: Private Practicing Midwives (PPMs) and Private Obstetricians (OBs).
The main reason you would choose a private care provider (whether that be PPM or OB) would be to have continuity-of-care. You will meet with them throughout your pregnancy. They agree to be with you for your birth. And they will follow you throughout 6 weeks of your postpartum period. You usually pay their pregnancy management fee in advance. This timing can vary per provider but usually you would pay a deposit and then final amount between 28-32 weeks. That's about where the similarities end between Private Midwives and Private OBs. Read on to understand their main differences.
Private Practising Midwife (PPM)
If you desire to have a low-intervention physiological birth at home, and are (1) unable to get a MGP placement due to their lack of availability or (2) ineligible due to your personal risk factors or history or (3) don't want to be constrained to a particular hospital's policies, you may want to hire a Private Practising Midwife (PPM). PPMs will provide personalised care throughout your pregnancy, birth and postnatal period. They are champions of physiological birth, and believe it to be a normal life process, instead of an obstetric medical event.
PPMs are midwives that have completed a postgraduate degree and have worked at least 5,000 hours within 6 years at a hospital. They are endorsed by the Nursing and Midwifery Board of Australia to prescribe medications, order diagnostic tests including blood tests and ultrasounds. They must also complete 30 hours of continuing professional development every year. They are not required to follow specific hospital policies in the management of your care.
If you hire a private practicing midwife, you can expect to see them for visits in their private clinic, or in your own home. Your home birth will be attended by two PPMs (as required by law) who will bring resuscitation equipment, IV equipment and fluid, and standard emergency medications to manage postpartum haemorrhage. PPMs follow the Australian College of Midwives Guidelines for Referral, and have extensive training to know when they must consult an Obstetrician or transfer to a hospital for obstetric medical management. The majority of births attended by PPMs occur in the home, but you may also birth at a hospital if the PPM has admitting privileges.
To hire a PPM and have a home birth, you can expect to pay $5,000 - $8,000. A portion of this fee can be reimbursed by Medicare for your antenatal and postnatal appointments. You may also claim the cost on your tax assessment and possibly get a medical expense rebate. However, it is unlikely your private health fund will pay for the birth delivery itself, as it is extremely rare to find one that will cover a home birth, but you should double-check directly with your insurance provider about your personal policy. Understandably, this is an investment, and many women simply will not be financially able to take this option. But, if you have the means and desire to avoid an in-hospital birth, this cost will be well worth it for you.
PPMs are very busy, and their availability fills up fast! If you know for sure you want a home birth and a private midwife caring for you, you might consider researching who your local midwives are and contacting them pre-conception to ask about their projected availability. If you are in Sydney, contact me and I can refer you some names!
Ten Questions to ask when interviewing a Private Practicing Midwife:
What are your thoughts on women giving birth and what do you feel your role is in providing care for them? This question invites them to share their personal birth philosophy and will help you evaluate whether it is aligned with your birth vision.
How often do we meet for both antenatal and postnatal appointments and where?
How many clients do you take on a month?
Can I expect you to be at my birth, or do you have an on-call system with a back-up midwife, and would I be able to meet them?
Are there any situations/conditions in which you would recommend NOT waiting for physiological birth? Or in other words, would you ever recommend to transfer care to an OB for induction and why?
Do you support "high-risk" clients to birth at home? (i.e. gestational diabetes, VBAC, twins, breech presentation) and what is your experience in this?
In your experience, what are the most common reasons for a home birth transfer?
How do you manage emergency situations and how do you know when to consult/refer to obstetric medical care? Do you have a specific OB whom you work with regularly or do you refer to the nearest public hospital?
Do you have admitting privileges at any of the nearby hospitals, so that if we transferred you could continue being my care provider?
I'm also considering hiring a doula. How would you feel about this and how would you collaborate with them as a member of my birth team?
Private Obstetrician
Alternatively, if you would prefer to birth in a hospital (public or private), and you have private health insurance with maternity cover you would be able to hire a private obstetrician to manage your care. When it is time for your birth, private hospital staff midwives will care for you and carryout your physician’s orders and plan for your care. Your OB will be present at your bedside when your birth is imminent, or perhaps sooner if a concern develops.
When you birth in a private hospital, you are likely to stay longer then in a public hospital, and will have access to postnatal midwives and lactation consultants while you are there. However, you are not likely to have any postnatal support at home, unless your provider's OB practice offers this service.
From a cost perspective, as I mentioned in Part 2, you can expect to pay $2,500 - $3,400 to your private OB, in addition to the costs for antenatal visits, outpatient ultrasounds, blood and other screening tests, and the private hospital fee which could total as much as $7,000 - $10,000. Again, even with private insurance, this is a BIG investment, and many women will not be able to afford this option. You might also have the option to be a private patient in a public hospital (and thus save on the hospital fee), if your private OB has admitting rights.
Keep this in mind: obstetricians are medical providers and ultimately, surgeons. They were likely trained in an obstetric culture with a perspective that views birth as a medical event, one that comes with risk that must be managed (controlled) and intervened upon. If you desire to be induced or have a caesarean, or if you have a past medical history, or a true high-risk medical condition that requires a specialist, then having an experienced obstetrician may be the ideal care provider for you.
However, if you are visualising a low or no-intervention physiological birth, is obstetric care what you really need? Has your pregnancy been normal and straight-forward with no concerns? Perhaps this money spent on on your specialist OB, would be better utilised by paying for care after the birth, such as lactation consultants or postpartum doula support.
Or if you feel most comfortable in the care of a private OB, you need to find the right provider who is 100% supportive of your goals. “There’s no point engaging a private obstetrician who is good at the medical management of birth and expecting to go in and have a physiological birth without intervention,” says Dr. Rachel Reed, former Midwife and researcher[1].
Your mission is to find the right OB provider for you. There are some obstetricians who are incredibly women-centred in their care delivery, and who believe in physiological birth. But if this is what you desire, then you have to seek them out. Ask for recommendations from family members, close friends or women in your community groups. Most importantly, treat your initial consult as job interview for them, before deciding to entrust yourself and your baby to their care. You may have to invest paying $150 - $200 for each initial consultation (and you might need 2-3!) to find the right private OB provider for you, but this would be worth it to ensure you feel safe, respected, and seen, and to improve the likelihood that you will have the beautiful birth experience you are envisioning.
Ten Questions to ask when interviewing a Private Obstetrician:
What are your thoughts on women giving birth and your role in providing care for them? (Again, this is the same question you would ask a private midwife. This is the opportunity for you to find out this OB's personal birth philosophy and how supported you will be in pursuing yours.)
How often do we meet antenatally, and will this be billed as individual outpatient visits or included in your pregnancy management fee? And what can I expect in these offices visits (length of visits, Screening tests? US scans? Fluid checks?)
Can I expect you to attend my birth, or do you partner with other OBs in a back-up on-call arrangement? Would I be able to meet those providers prior to the birth?
At what hospitals do you have admitting privileges? Do those facilities differ in terms of policies or services they offer (wireless and waterproof ctg monitoring, birthing tubs)?
How often and in what situations would you recommend induction? Can you estimate how often you induce your clients in your practice?
If I am seeking a natural spontaneous labour and birth, how do you feel caring for me if I go past my due date, or even past 41 or 42 weeks?
Can you share your rates of these common birth outcomes: - Spontaneous vaginal birth - Instrumental birth - and do you tend to use ventouse, forceps or both - Episiotomies - and what is your decision process about whether to recommend one - Unplanned caesareans
Do you support VBAC, and do you have any conditions to this? How does your management of a client planning for a VBAC differ than the care plan for your other clients? How often are your clients successful when attempting a VBAC?
How would you feel if I had a birth plan or birth preference document? And moreover, how would you feel if my plan had informed decisions that differed from your personal or your hospital's routine recommendations? (e.g. declining routine vaginal exams, choosing intermittent auscultation over CTG monitoring, or having a physiological third stage with optimal cord clamping). (To be clear, you are not asking for their permission to disagree with them here, but you are looking for how they respond. If they seem genuine, supportive, and reinforce the idea that you are the decision maker, then those are good signs. If they seem defensive, annoyed, or frustrated by this question, these reactions might be red flags, and its better to discover these at your initial consult, before officially hiring them).
I'm considering hiring a doula. How do you feel about this and how would you collaborate with them as a member of my birth team? Also, does your hospital have any specific policies concerning the presence of a doula?
Final Thoughts on How to Choose Your Maternity Care Provider:
Spend some time reflecting on what is most important to you to have in your birth experience.
Determine the ideal birth place where you will feel the most safe and choose the model of care that is best for your needs and circumstance.
If hiring a private provider, treat your initial consult as their job interview! You are the consumer, the one that is consenting to their care, and it is vital that they are onboard with your birth vision. "When you are heading off into your childbirth rite of passage, think about who will be around you and whether they align with what you want." says Dr. Rachel Reed [1]. (BTW, I highly recommend reading Dr. Reed's amazing book Reclaiming Childbirth as a Rite of Passage).
Overall, TRUST YOUR INSTINCT. Look for those feelings of when you feel supported and encouraged by a provider's presence and philosophy of care, and you can say a full-bodied YES! Alternatively, pay attention to those feelings in your body if you feel scared, intimidated, or that you notice if your "good-girl" syndrome is coming out and wants to please the provider because of some sort of perceived authority or power dynamic. This is YOUR birth and not theirs. Empower yourself with knowledge, be brave and advocate for yourself!
Also, keep in mind, that if you have already chosen a model of care/maternity provider, and you now feel that their values and practice methods are not aligned with your evolving feelings and birth goals, there is always an option to change providers, even if you are 40 weeks. It's never too late! You need to honour your feelings, be brave and seek another care option.
I hope this 3-part series has given you a basic understanding of how to find the best care provider for you. If you have any questions or comments about this post, or the previous two parts, please pop them in the comment box below! I'd love to hear your thoughts.
Also, if you are interested in learning more about my doula support and how I can help you navigate your journey to birth and manifest a beautiful positive experience, please reach out to me today by filling out an enquiry on my Contact page.
Reference:
[1] https://www.pregnancy.com.au/ask-the-expert-dr-rachel-reed-getting-what-you-want-from-your-birth-journey/
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