Different types of Midwifery Care
Private Midwifery Care
Update March 2011: Eligible midwives who work collaboratively with a medical practitioner can access the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS).
A private midwife offers women the opportunity to birth at home and continuity of care.
Women choose a private midwife if they want to know and trust their care provider throughout pregnancy, birth and post-natally. The midwife does all of your prenatal visits, is ‘on call’ to be with you throughout the entire labour and birth, as well as for a few hours after the birth. She also provides daily home visits and support in feeding and caring for your baby for up to 6 weeks after the birth.
Currently women choosing a private midwife have to pay for their services out of their own pocket between $3,000-6,000 for their services. Some private health funds will cover a small amount of this. You may also be able to claim a very small amount back on tax. You can claim a tax offset of 20 cents in the dollar of your net medical expenses over $1,500.
Some private midwives are registered for Medicare and you may be able to claim some of your care on Medicare.
With the insurance crisis as it is in Australia at the moment, independent midwives providing private services are presently uninsured. This has made their availability scarce and in many areas non-existent. Private midwives have also temporarily lost their visiting rights to many hospitals because of being uninsured, limiting their services to just home-birth (if they continue to practice).
The current Federal Government is in the process of making it extremely difficult, if not impossible for Australian women to choose an independent midwife as their care provider.
From July 2010, many women may no longer be able to access a private midwife due to new regulations restricting their services. See the Home Birth Australia website for more details.
The Rudd Government plans to make private midwives ‘collaborate’ with a Doctor in order to gain registration. Unfortunately the Australian Medical Association refuses to acknowledge the substantial international evidence clearly demonstrating the safety and benefits of home births for mothers and babies (see resources section here.) Due to the AMA’s position, it will be almost impossible for private midwives to find one to ‘collaborate’ with. A Doctor may then be able to veto your birth choice which means you may no longer be able to choose where and with whom you wish to birth.
Midwives are a highly skilled profession in their own right with a significantly different set of skills to doctors and they must be recognised as such here in Australia, as they are in other countries. The legislation before the Senate fails to do this and instead provides doctors with control over ALL Australian women’s births.
Thousands of women across the country will be unable to utilise the services of providers with a proven record of improving outcomes. Denying pregnant women access to independent midwives saddles our health care system with hundreds of millions of dollars in additional costs each year.
It is hoped that this situation will be resolved in the near future, to facilitate this choice for women and their families. We hope that they will be able to offer their services to women at home and in hospital in the future. If you are concerned about this, please see here for how you can take action about this.
Find a Midwife
To locate a private midwife in your local area, please check here for Australia wide information or if you are in the Sydney area, check this list from Homebirth Access Sydney.
Midwifery Group Practice
Also known as ‘Caseload Midwifery’, Midwifery Group Practice (MGP) enables women to be cared for by the same midwife (primary midwife) and supported by a small group of midwives throughout their pregnancy, during childbirth and in the early weeks at home with a new baby. Midwifery care focuses on women’s individual needs and is women centred. This service provides you with continuity of care and enables you to develop a relationship with your midwife through out your pregnancy. This form of maternity care has shown to produce the best outcomes for low risk women, as is recommended by the World Health Organisation as the gold standard of care. Where situations arise that indicate a need for medical involvement, midwives work collaboratively with medical colleagues to co-ordinate the best care for mother and baby. The Primary Midwife will continue to provide care regardless of the need for medical involvement. Each midwife only takes on 4 -5 women per month.
Team Midwifery Program
Under this care instead of having one midwife you will be seen by a small team. You will have one primary midwife during your pregnancy, birth and after the birth of your baby – in hospital and/or at home. You can also be seen by anyone in the team.
You will be seen by anyone of the midwives rostered on for you prenatal visits. Midwives will attend your labour and birth, as well as care for you after the baby is born. You don’t usually see the same midwife for your care and you will have a different midwife for the labour/birth and after the baby is born.
Midwifery is a very old, archetypal tradition of care, and from a purely human, clinical perspective, it makes sense. Birth is women’s business, if I can use a cliché. Midwives have a different perspective to doctors: they don’t let risk rule the day. They will focus on the positives and put the risk in perspective. — Dr Andrew Bisits, the head of obstetrics at John Hunter Hospital in Newcastle (Good Weekend, 05/09/09)
An obstetrician is a doctor who has undergone extensive specialist training. She or he is a specialist in:
- maternity care (obstetrics)
- women’s reproductive health (gynaecology).
Obstetricians can provide life saving support for high risk mothers and babies.
Find an Obstetrician
11 questions to ask your Obstetrician
Women state that they chose private obstetric care for safety and continuity of care. What’s interesting is that the Australian research shows that private obstetric care offers no higher safety levels for low risk women, nor do they offer continuity of care, because you will be attended to by an unknown midwife for the majority of your labour.
The research also shows that those women under the care of a private obstetric care are far more likely to have a caesarean than those in a public hospital setting. This is very interesting when you consider that the research shows those with private health insurance to be the healthiest in our society.
Remember just because you have private health insurance doesn’t mean you need to hire a private obstetrician, if you want a natural birth you may be better off being under the care of a midwife.
Midwives are the experts in normal births. Obstetricians are the experts in abnormal births. Leave a normal birth in the hands of an obstetrician, and it’s more likely to end up abnormal. – Independent Midwife, Jennie Tesky (Good Weekend, 5/09/09)
General Practitioners complete further training if they want to give pregnancy and birth care to women. They may hold a Diploma in Obstetrics and Gynaecology or complete other short courses.
Carers in public hospitals
Depending on the location of the hospital, your antenatal visits and your labour and birth care will probably be with the carer on duty. This may be with:
- midwife (and possibly student midwife)
- obstetric Registrar (senior trainee Obstetrician)
- obstetric Resident (trainee Obstetrician)
Different obstetricians, midwives and GPs are usually rostered on duty in the antenatal clinics and birth (delivery) suites at public hospitals, so you may receive care from different people at different times, unless the setting provides continuity of care options which allow you to see the same person or small group of people.
How will my caregiver’s beliefs about birth affect my birth experience?
Robbie Davis-Floyd, PhD a medical anthropologist says “What a caregiver—a doctor, nurse, or midwife—believes about birth will have a major effect on your birth experience; in fact, it is likely to determine whether you have a normal or a highly technological birth.
Around the world, there are three major paradigms of birth and health care: the technocratic, humanistic, and holistic models….
The technocratic model, dominant almost everywhere, views the birthing body as a dysfunctional machine about to break down at any moment and in need of constant vigilance and regular intervention to function properly.
If your practitioner practices technocratically, you are almost certain to have a great deal of technological intervention in your birth—to have your labor induced or augmented with Pitocin, to be continually tied to the electronic fetal monitor, to have an epidural, and, a third of the time, to have a cesarean delivery.
If your practitioner is humanistic and holistic, meaning that he or she trusts your body, your baby, and the birth process, you are very likely to have a normal and highly empowering birth. In other words, the paradigm of the practitioner is a primary determinant of the outcome of birth. What you want in birth does not count nearly as much as what your practitioner believes about birth and the female body.”
I believe that midwives … are key health care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system. We need to realise that potential so that mothers have real choice in their birthing experience, and their babies have the best start in life. This is one of the best investments we can make in the future of our nation. — Deputy Prime Minister Julia Gillard, Midwifery By The Sea – Riding The Waves Of Change, Speech – ANNUAL CONFERENCE OF NSWMA, 20th October 2005
Photo credits: Middle – Katrina Folkwell