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by Rebekka Atz
The birth of your baby is an amazing and significant event! Once the exciting news that you are expecting a child has sunk in, you might start thinking about your birthing options. We are very lucky to have several to choose from in Australia. Choosing the right location and care are important factors in determining how “good” and satisfying the birth of your baby will be. Think about what you want and desire, and find the best birthing option that is available for you.
More than 300,000 babies are born in Australia each year 1. Most are born in a hospital, but there are also other options you should consider. In Australia, women have four main birthing options:
This is the most popular birth choice among Australian women. More than 95% of all babies are born in the maternity ward of a hospital 2.
If you choose to give birth in a hospital, you are looked after by qualified, registered midwives. Doctors are available and are often called in for the actual birth. After the birth, you will be transferred straight to the maternity ward where you and your new baby will be cared for by nurses and midwives. You can choose to go home hours after the birth, if you wish.
Sometimes you have the option of using your private obstetrician (OB) or midwife at a public hospital.
How to book in
Your general practitioner (GP) will refer you to a hospital. You have to book an appointment at the hospital’s antenatal clinic. You will usually see a doctor and a midwife during your initial visit.
Births at a public hospital are covered by medicare.
Pros and Cons for hospital births
- Special Care units are often available
- You have direct access to medical specialists if problems arise
- You have access to epidurals and general anesthetic
- You can be provided with a cesarean section immediately, if necessary
- Some women feel safest in a high tech environment
- The midwives who care for you during birth might be different than the ones who administered your antenatal care
- You might be unfamiliar with the midwife or not “like” the midwife
- Different midwives might be with for the duration of the birth (shifts)
- Procedures are subject to regulations and protocols of the hospital and are often not negotiable, for example the hospital might not allow certain birthing positions, or allow the birthing women to eat or drink during labour
- Your baby’s father might not play an active role in the process
- Foreign territory – you might find it difficult to focus on the birth in an unfamiliar environment
- The medical staff at the hospital might be prone to intervene during birth, even if not medically indicated, for example artificial rupturing of membranes, or medically speeding up labour
- Individual options (such a water births) are usually not accommodated
Hospital Birth – private
About 33% of all hospital births in Australia happen in a private hospital2. If you choose to birth in a private hospital, you might have a private room, but this is not always the case. You will see your private (OB) for antenatal visits, but be aware that it is not guaranteed that he will be present at the birth. Private OBs usually only show up for the few minutes of the actual birth, if they show up at all.
Compare your local hospitals. Some larger public hospitals can handle special medical needs better than small private hospitals. Some women choose their local public hospital over a private one even though they have private health insurance.
Out of pocket costs and expenses paid by your private health insurance (PHI) vary. Make sure that your health plan covers the pregnancy and birth. Most PHI plans have a 12 month waiting period for births. You should also make sure to have family coverage – the baby needs to be on the plan as well! Often PHI plans only cover the hospital expenses related to the actual birth. You might still need to pay to employ your private OB, which is around A$5000 (but can be a lot more if you require special screenings, tests and other care).
Pros and Cons of private hospital births:
- Some women might feel more comfortable and safe in private care
Private hospitals have higher intervention rates and significantly higher Cesarean section rates than public hospitals 2.
Although birth centres are very popular in SA and ACT, only 2%-3% of babies born in Australia are delivered in a birth centre2. Birth centres only exist in some parts of Australia. Most are attached to a hospital, but there are also a few “free-standing” (independent) centres that are run by qualified midwives.
Birth centres generally have a nicer “look and feel” than a hospital maternity ward, and they appear more homely. Their policies and practices vary. Some are open to alternative and more natural birth practices, while others follow hospital policies closely.
Birth centres often offer antenatal and postnatal care.
For birth centres, you usually need a referral from an OB, and you must qualify as a “low risk pregnancy” (the interpretation of this can vary). About 33% of women who are initially booked in at a birth centre will be transferred to the hospital ward for various reasons, such as breech position of the baby, gestational diabetes or difficult ultrasound (numbers vary)3.
Some private OBs will agree to attend a birth at a birth centre – check with your OB before you choose.
Births are free of charge in a public hospital birth centre.
For private birth centres, check with your PHI and the birth centre. You should expect between A$1500 and A$2500.
Pros and Cons of a birth centre
- More homely feeling environment
- More familiarity with the midwives
- Birth centres have good (low tech) equipment available
- Birth centres work with the hospital, so you can easily be transferred to the hospital’s maternity ward if complications arise
- There is a better chance you’ll receive one-on-one care by a midwife for the duration of the birth
- Pain relief is focused on alternative methods (breathing techniques, aromatherapy, TENS machines)
- You are less likely to have an intervention such as an episiotomy or forceps delivery 3,4
- Birth pool is often available
- The full range of pain relief is not available, eg no epidurals
- Birth centres often have long waiting lists
- Birth centres are subject to the protocols and regulations of the hospital, meaning you might be transferred to the maternity ward of the hospital during pregnancy or birth
“Midwives who work in birth centres, and who run these centres themselves, have a completely different birth philosophy to midwives who are stuck with a shift system, in large teams that are part of a rigid hospital hierarchy. They know how to keep birth normal. That is the most important thing.” (Sheila Kitzinger (5) )
To have a home birth means to give birth in a non-clinic setup, usually your own home. Very few babies in Australia are born at home (0.4%, or about 1100 each year)2. Women who choose to birth at home do so because they prefer the intimate private setting and familiar surrounding. Some women choose a home birth following a previous negative hospital experience, or to be able to make choices that are very difficult to implement in a clinic setup (such as Vaginal Birth after Cesarean or viginal breech birth).
Against common belief and the cliché of a hippie birth in a campervan, women who plan a birth at home seem to be more educated and of higher occupational level7,8. A study by the University of Western Sydney (UWS) found that 75% of homebirthing women hold a tertiary degree (compared to 25% of all women in Australia)9.
Homebirthers need to be able to trust their bodies and the natural process of birth.
Research shows that birthing at home is a very safe option for many women6. Fetal death rate is significantly lower than the average fetal death rate (0.5% compared to 7.2% overall average)2. (Interpretation of these numbers should be considered carefully, eg was the birth planned at home, was the birth high or low risk.)
There are publicly-funded homebirth programs, but they are restricted to very low risk women, and women often have to be transferred to hospital care during pregnancy. Publicly-funded programs are not available in QLD, ACT or Tasmania.
Some independent midwives are available for homebirths, but they are not widely accessible. In the NT, for example, there are no independent midwives. Publicly-funded homebirths are currently the only option for a midwife-attended homebirth in the NT.
If you want to participate in a publicly-funded homebirth program, it is best to contact the midwives directly to find out if you need any referrals. Often you need a referral from your GP.
If you chose to hire a private midwife, you will have to contact her directly and make an appointment.
Publicly-funded programs are free of charge.
Independent midwives have to be paid out of pocket. If the midwife is medicare eligible you can apply for a medicare rebate for prenatal and postnatal care, but the birth is not covered by medicare. If you have PHI, check with your provider for rebates. Costs vary, but “full service” (including pre and postnatal care) is about A$3000 – A$5000 (about $2000 for the actual birth).
Pros and Cons of a homebirth
- You can choose midwife to personal preference and individual practices
- Continuity of care – you get to know the midwife very well
- Intimate familiar environment – allows undisturbed birthing process
- Low rates of intervention
- You can choose who is present at the birth
- Focus on baby and mother
- Birth is treated as a family event rather than a medical procedure
- Father can be involved at a much higher degree than during a hospital birth, if desired
- Publicly-funded homebirths have to follow tight regulations
- Medical technology is not immediately available in case of an emergency
- Homebirthers may encounter negative attitudes from friends and families
These are the most basic birthing options in Australia. Regulations and availability vary by state and territory. There are also significant differences in the birthing options available closer to a city compared to those available in a rural area. You might be able to tailor your prenatal and birthing care and find combinations of all models (e.g., you might hire a private midwife and organise shared care with your OB).
It is important to remember that is is a great privilege to have a wide variety of birthing options available in Australia. Sometimes you will have to work very hard in order to make things happen once you have decided what is best for your and your baby. Great births happen at the hospital, at the birth centre, and at home. You can have a fantastic birth anywhere!
- Australian Bureau of Statistics
Australian Institute of Health and Wellfare: Australia’s Mothers and Babies (2012)
- Australian Journal of Advanced Nursing 2000 Vol.18(1)
University of Western Sydney/ La Trobe University: Birthplace in NSW, Australia: An Analysis of perinatal outcomes using routinely collected Data
Sheila Kitzinger: Birth your way: choosing birth at home or in a birth centre
The Medical Journal of Australia (MJA 198 (11) · 17 June 2013) : Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years
The Midwifery Journal: Birthing outside the system : Perceptions of risk amongst australian women who have freebirths and high risk homebirths. Melanie Jackson (2012), University of Western Sydney
- ABC (2012): Home birth proponents highly educated