Pregnancy
and birth care options
There are many different pregnancy and birth care options (types
of care) available in Victorian public hospitals. Depending on
where you live, some or all may be available to you. This section
explains the various factors that you may wish to consider in order
to choose the type of pregnancy and birth care most suited to you.
Things that may affect your decision or influence your choices
- your address (do you live in the country, a town or city?)
- your general health and previous pregnancy/childbirth outcomes
- your lifestyle, social and cultural circumstances
- your feelings and/or previous experiences of pregnancy and
birth
- costs associated with care
- your feelings about particular types of care and care providers.
Once you've begun your pregnancy care, its usually possible to
change care if you change your mind. Because pregnancy takes
place over nine months - you do have time to explore all your options,
with the help of your carers.
Costs
In Victoria, there is no charge for labour and birth
care in public hospitals - and in some places, pregnancy care is
also free. However, depending on the type of care and location,
you may be asked to pay "out of pocket" expenses or costs
for:
- pregnancy care provided by your local GP or obstetrician
- pathology tests (for example, blood tests)
- ultrasound procedures
- childbirth education classes
- use of a phone.
If it is difficult to afford these things, most hospitals will
help to ensure that you have access to services and are not disadvantaged.
Types of care
(also called models of care)
A model of care is the way in which your care, or episodes of
care are organised and the philosophy upon which it is based. Think
of it as a recipe. It is made up of a combination of various
ingredients or components. These components are:
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Continuity of care
Care is given:
- during pregnancy (antenatal care)
- during labour and birth (intrapartum care)
- after the birth of your baby (postnatal care).
(Please see below for more information on antenatal,
intrapartum and postnatal care).
Seeing the same caregiver or small group of caregivers throughout
pregnancy, labour and birth and afterwards is called continuity
of care.
Many women have contributed their experiences and ideas about
continuity of care to research studies concerned about what is
important to them during pregnancy and childbirth:
- many think it's important to have only a small group of people
caring for them. This means they get to know their carers - and
their carers get to know them.
- others prefer to have only one carer, if possible.
- some don't mind, as long as their carers treat them with respect
and care for them safely.
- others think it's important to get to know the midwife who
will care for them during labour and birth.
Different levels of continuity are available in different hospitals.
You may wish to ask about what is available when you first discuss
this with your GP or when you ring or visit the hospital.
Pregnancy
(Antenatal care)
Regular antenatal care is important. Throughout
pregnancy you should have regular appointments with a carer,
to monitor the health and wellbeing of you and your baby.
This will include things such as:
- asking you about your health
- checking your blood pressure
- monitoring your baby's growth.
You can ask questions and talk about anything that may
be bothering you. If you have extra medical or personal
needs, arrangements will be made for you to see doctors
or other relevant professionals.
Labour and Birth
(Intrapartum care)
During labour and birth, midwives will look
after you most of the time - but you may see a doctor as
well. Your carers will:
- give you support
- help to make you comfortable
- help you relax and understand what is happening
- monitor the wellbeing of you and your baby
- assist you in making choices about pain relief
- assess
if you need any special care - and if so, discuss options
with you.
Care after birth
(Postnatal care)
After your baby is born, a midwife will:
- monitor your wellbeing
- offer education and support for breastfeeding and
caring for your new baby
- encourage you to rest
- talk with you about what you may expect as a new mother,
and what is normal.
In most hospitals you will be transferred from the birth
suite to the postnatal ward an hour or two after the birth.
There, midwives will provide most of your care - and a
doctor will call round to check on your progress. The exception
to this is in a Birth Centre or a hospital with rooms where
you stay for the duration of labour, birth and postnatal
care.
At home a midwife will probably visit you once or twice at
your home - or you may visit your GP.
Many hospitals have special arrangements for those women
who are able to leave hospital early. Usually a midwife
you already know will visit you at home to provide extended
postnatal care.
Your local maternal and child health nurse will receive
information that you have arrived home and will come to
visit you. Usually your GP will also be advised that your
baby has been born. Both these professionals are likely
to be involved in offering you and your baby continuing
care and support.
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Care provider
You can receive pregnancy and birth care from a midwife, GP or
obstetrician - or a combination of these. If your pregnancy is
going well, with little or no risk of complications - you may have
a midwife or GP as your main carer.
Not all of these professionals are available as main carers in
all areas of Victoria.
Midwives
Childbirth is a normal, significant process for women and their
families. Midwives have an important task in health counselling
and education, not only for women, but also for families and the
community. They must complete specific education to qualify and
register as a midwife. Midwives can be male or female.
A Midwife will consult with you to:
- supervise, care for and advise you during your pregnancy
- support you during your baby's birth
- care for you and your baby after the birth
- detect if anything about you or your baby changes from
what is normal
- obtain specialist assistance when needed
- if necessary, carry out some emergency measures in the
absence of a specialist.
How midwives work in the Victorian public health system
Employed by a public hospital
- in the antenatal clinic, birth suite and postnatal ward
- in a Birth Centre that is a separate facility within the
hospital, which contains antenatal clinic rooms and birth
rooms where you also have your postnatal care
- in a team with other midwives, (Called Team Midwifery).
- with a small number of ‘assigned’ women (Called Caseload
Midwifery or Know Your Midwife.
- provide postnatal care for women in their homes (domiciliary
care/domiciliary midwife)
- provide childbirth education classes.
Employed by a Community Health Centre
- provide antenatal care and some postnatal care
- provide childbirth education class
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Obstetricians
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).
How obstetricians work in the Victorian public health system
Obstetricians provide some of the care at a public hospital antenatal
clinic. You may see an obstetrician if she or he is on duty at
the time of your appointment, depending on the hospital. You are
more likely to see an obstetrician if your pregnancy is, or becomes,
complicated.
In some rural or outer metropolitan areas, public hospitals may
provide birth care - but not antenatal care. If so, you may receive
antenatal care by a chosen obstetrician and book into the hospital
for the birth, as a public patient.
General Practitioners (GPs)
Usually, 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.
You may want to discuss with your GP:
- her/his interest and experience in maternity care
- if she/he is accredited to assist with your pregnancy
care and/or birth care at the hospital you have chosen to
give birth.
How GPs work in the Victorian public health system
Shared Care means receiving antenatal care from a chosen GP as
well as visiting the hospital where you will have your baby for
specific visits. If you see your GP for antenatal visits, she or
he may attend your baby's birth - depending on the arrangements
between your doctor and the specific hospital.
In some rural or outer metropolitan areas, public hospitals may
provide birth care but not antenatal care. If so, you may receive
antenatal care from a chosen GP or obstetrician and book into the
hospital for the birth, as a public patient.
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 a(n):
- obstetrician
- midwife (and possibly student midwife)
- obstetric Registrar (senior trainee Obstetrician)
- obstetric Resident (trainee Obstetrician)
- GP.
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.
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Place of care for pregnancy and birth
Pregnancy
It is important for you to receive regular pregnancy (antenatal)
care. Appointments can take place at:
- a clinic at the hospital where you will have your baby
- a Birth Centre if the hospital has one
- a community setting, such as a community health centre (GP
or Midwife)
- your GPs practice
- in some locations you will attend visits at an obstetrician's
practice even though you will attend a public hospital for
the birth of your baby.
In some rural or outer metropolitan areas, public hospitals may
provide birth care - but not antenatal care. If so, you can receive
antenatal care from a GP or chosen obstetrician and book into the
hospital for the birth, as a public patient.
Labour and birth
Some women feel the physical surroundings in which they will labour
and give birth, are very important. There are some options which
may be available to you:
- a hospital birth suite (labour ward/delivery suite) setting
- a Birth Centre (home-like) setting.
This is an important question to discuss with your carers. When
considering specific hospitals, you should also feel free to ask
to look at their facilities. For example, you could ask what facilities
are available for your partner and/or family to be with you?
Level of care
Some women are said to have "risk associated pregnancy or
a high risk pregnancy." This means they have a higher than
normal chance of complications during their pregnancy. This is
usually because they:
- have a serious health condition, or
- had serious problems with a previous pregnancy.
Several hospitals have special clinics for women who experience
such problems. If you think you may be in this 'high risk' category,
you will find a range of health care professionals on hand within
the clinic to give you the support you need.
Extra Services
During your pregnancy you may need extra support or care due to
cultural, social, or emotional circumstances. For example, you
may:
- need culturally appropriate care
- need the services of an interpreter
- nave emotional difficulties
- have problems in your relationship
- have an intellectual or physical disability
- need support visits at home
- beyond 2 July 2007, have difficulties with housing
- have financial difficulties or burdens.
If so, most hospitals provide a range of services or allied health
professionals, such as interpreters or social workers to give you
the help and understanding you may need. Several hospitals also
have specific antenatal clinics or you may be put in touch with
relevant support groups. Talk to your GP, midwife or obstetrician
about any issues which may be concerning you.
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