What are my Maternity Care Provider & Place of Birth Options?

Written By Georgia Slee

in Hawkesbury, Hills District & Greater Western Sydney

Choosing a care provider and place of birth is arguably one of the most important things you will do in preparing for your pregnancy, birth and postpartum. If your care provider and place of birth are aligned with your birth philosophies and vision for what you want your birth to look like, it is much more likely that you will have a positive birth experience.

Before considering the care provider and place of birth options that are available to you, it is incredibly important to really think about what you envision your dream birth to look like. This will enable you to establish your philosophies and be prepared to make the best decisions for you and your birth. I always recommend listening to and reading birth stories as a great place to start to help you explore what your ideal birth might look like. I highly recommend Australian Birth Stories podcast, as it features a very wide variety of experiences; all care provider and place of birth options are represented across its 400+ episodes. 

Contrary to common belief, there are actually quite a few options you can choose when it comes to your maternity care provider. Often, when your pregnancy is ‘confirmed’ by your GP, they will ask if you would like to go “private or public”, and then refer you on depending on your response, rather than discussing all potential options with you. The GP will be even less likely to ask about your birth philosophies and present you options that align with those (nothing against GPs necessarily, it is just unlikely they have been educated and trained in this, specifically).

Before delving into your options (yes, we will get into them eventually!), it is important to be aware of ‘the medicalisation spectrum’ of maternity care providers. This wouldn’t be a blog post written by me without numerous podcast recommendations, so of course, I highly recommend listening to episode two of The Great Birth Rebellion Podcast. In the episode, it is discussed in depth where care providers and birth locations generally sit in this ‘spectrum’, which stretches from physiological birth on one end, to a biomedical approach to birth on the other. You can also head to the Australian Mothers and Babies Report to read through detailed birth statistics from each Australian public and private hospital. @birthstats_nsw on Instagram publish an insightful and easily digestible breakdown of all the NSW hospital’s results in each annual report.

Once you are aware of your own philosophies about pregnancy, birth and postpartum, and are well-versed in the philosophies of your care provider and place of birth options, you will be able to make informed decisions about the best pathway to choose for you and your family.

Find below a list of maternity care models that are available in my service area, listed in order from most aligned with a physiological philosophy of pregnancy, labour and birth through to those more aligned with a biomedical philosophy.

Private Midwifery Care

Private Midwifery is widely believed to be the most woman-centred maternity care available. Private midwifery care involves hiring your own midwife who works for you as the birthing woman, and therefore, your health, well-being and plans and decisions for your pregnancy, birth and postpartum are their priority. Privately practising midwives provide continuity of care throughout all your antenatal appointments, during your birth and for your postpartum care.

Private midwives work in the community and come to your home for your antenatal and postnatal care, and you have the option of birthing at home or at hospital. At most hospitals, your midwife would attend your birth as a support and advocate for you, with the hospital midwives conducting the clinical care. The exception to this is Westmead Public Hospital, where some of the local midwives have a shared care arrangement, and can provide you with your clinical maternity care in hospital if you choose to birth there, or in the event of a homebirth transfer.

Privately practising midwives are endorsed midwives, which means that they have the ability to prescribe medication and order scans. At the time of writing this, it is still a requirement that you obtain a referral to a private midwife from a GP before you can access their care, however once you have that referral, and if your pregnancy progresses normally, you are unlikely to need to seek further care from any other maternity care provider. If complications arise in your pregnancy, your midwife may seek collaboration from other clinicians, such as an obstetrician, and your care may need to be shared or transferred, depending on the circumstances. However, unlike most hospital midwifery care models, endorsed midwives are able to work to their full scope of practice, and many will continue to be your primary care provider in instances that hospitals may consider ‘high-risk’. Examples of these may be women having a VBAC (vaginal birth after caesarean), pregnancies going beyond 41 weeks, women with a higher BMI than what is systematically considered ‘average’, gestational diabetes, and more.

Private midwifery care is not covered by private health insurance, however a portion of the antenatal and postnatal care is covered by Medicare. Each midwife will have their own fees, and their own ways of practising, because it is their own independent business that they operate privately. Generally, the midwives who service the Western Sydney area charge between $6,000-7,000 for their full services (before the Medicare rebate), which often includes the hire of a birth pool and other equipment and medications if needed.

Privately practising midwives almost always book out incredibly early, so if you are considering hiring a private midwife, ensure you contact them as soon as possible (even as soon as you know you are pregnant) to find out if they are available for your estimated due date.

Privately practising midwives who service the Hawkesbury, Hills District, Western Sydney and surrounds are:


Caseload Midwifery Practice (CMP) & Midwifery Group Practice (MGP)

Caseload Midwifery and Midwifery Group Practice are services provided in public hospitals where you, as the birthing woman, are assigned one midwife, who provides continuity of care throughout pregnancy, labour and birth and during postpartum. Generally, your midwife is supported by a small group of midwives who may step in for appointments or on-call if your primary midwife is unavailable.

CMP and MGP programs may involve your midwife visiting you at home for your antenatal appointments or require you to go to hospital. Your midwife will most likely visit you for your postnatal appointments at home, after your discharge from hospital. Most programs require you to give birth in hospital, however, Westmead Public Hospital’s Caseload Midwifery Program does offer publicly-funded homebirth for ‘low-risk’ women with uncomplicated pregnancies. 

Caseload Midwifery and MGP care is aimed to be holistic and woman-centred; your midwife will provide care that is specific to your personal needs and preferences. Continuity of carer allows you to form a relationship with your midwife, build rapport and trust with them so you can feel safe to share your philosophies and vision for your birth. Women with their own midwife often feel at ease to discuss any concerns and ask questions that they may feel uncomfortable or intimidated asking a stranger.

Caseload and MGP is similar to private midwifery care in that the spots book fast! Additionally, most hospitals require you to fit certain criteria (the specific criteria varies between hospitals, but often they require you to be what they deem ‘low-risk’ and have no complications and a straightforward health history) and live in the catchment area to be eligible for their programs. If you are hoping for this maternity model of care, I would highly recommend contacting your local public hospital that provides CMP or MGP as early in your pregnancy as possible, even as soon as you know you are pregnant, to ensure you have the best chance of getting into the program.

If you have Medicare, the full cost of your pregnancy, birth and postpartum care under Caseload Midwifery and Midwifery Group Practice is covered, excluding any gaps for any GP appointments or private scans/tests.

Greater Western Sydney Public hospitals that offer Caseload Midwifery Practice or Midwifery Group Practice:


Public Hospital Maternity Care

Having your baby at a public hospital is the most common pathway for a majority of Australian families. In 2021, 75% of mothers who gave birth in a hospital did so in a public hospital, according to the Australian Mother’s and Babies Report. There are many possible reasons for this, the most likely of which being geographical and financial accessibility and the fact that it is the cultural norm in Australia.

During your first trimester, you will be giving referrals for your initial tests and scans by the GP, and once you approach 13 weeks gestation, will be recommended to book in with the hospital for your care for the remainder of the pregnancy and birth.

After an initial booking in appointment at the hospital, you will be booked in every four weeks or so to see a midwife or obstetrician (depending on your health circumstances); dates that generally coincide with particular weeks in gestation that align with standard tests, scans and procedures (e.g. morphology scan, glucose tolerance test, whooping cough vaccine, etc.). At these appointments, there is unlikely to be a guarantee of who you will be seeing, and quite often it is a different person every time. This is why public hospital maternity care is often described as ‘fragmented care’.

If you have an uncomplicated pregnancy, you will most likely continue to see hospital midwives for all your appointments. If something comes up in your pregnancy that requires collaboration with an obstetrician, you may be asked to see one of the OBs that work in the hospital for some or all of your remaining appointments.

Many larger, tertiary hospitals have different teams for the antenatal ward and fetal maternal assessment unit, birth suite and postnatal wards. Some smaller regional hospitals may have one team that works across all maternity. So, depending on the hospital you are birthing at, you may or may not have met the midwives or obstetricians who are on shift when you arrive in labour ready to birth your baby. 

If you have an uncomplicated labour and birth, and you and your baby are well, it is likely you will be discharged within hours of having your baby. If you have a complicated birth, caesarean section or your baby is unwell, you may stay for a number of days or more. Many hospitals have a ‘midwives at home program’, where your postpartum care is provided in your home in the days and possible weeks after your baby is born.

If you have Medicare, the full cost of your pregnancy, birth and postpartum care under public hospital maternity care is covered, excluding any gaps for any GP appointments or private scans/tests.

Greater Western Sydney Public Hospitals that provide maternity care:


GP Shared Care with a Public Hospital

General practitioner or GP shared care works similarly to public hospital maternity care, except that for your antenatal appointments, you can opt for your community GP and the hospital to work collaboratively and share your care between them. This is often only an option for healthy, well women with what the hospital deems ‘low-risk’ pregnancies.

This is an option to have access to a form of continuity of care with a GP that you already know and have a relationship with, especially if you are being seen by different midwives at the hospital. It also may be easier for some women than having to go to the hospital for every appointment; their GP might be closer to home, or they may feel more comfortable attending with any older children they may have. Under GP shared care, you will birth your baby at the public hospital with their clinical team.

Not all GPs offer shared maternity care, so if this is something you are considering, I would recommend discussing it with your GP early in your pregnancy. If your GP does not offer shared care, you can ask your hospital if they have a list of GPs that they collaborate with.

If you have Medicare, the full cost of your hospital-based pregnancy, birth and postpartum care is covered, excluding any gaps for any GP appointments or private scans/tests. You may be out of pocket for your GP visits, so this is something worth considering and discussing with your GP.

Private Obstetrician

An obstetrician is a doctor trained to provide medical care to pregnant and birthing women. They are educated and experienced in looking after women with complications and conditions in pregnancy and birth. Obstetricians can also provide care for healthy women with uncomplicated pregnancies, and often do so in collaboration with midwives. You will need a referral from your GP to access the services of a private obstetrician.

If you are interested in hiring a private obstetrician for your maternity care, you generally have the option of birthing in either a public or private hospital, depending on where and how the obstetrician practices. Each private obstetrician will only have a small selection of hospitals that they can provide labour and birth care at, and these will either be private or public hospitals. This is a significant consideration when selecting your obstetrician, as the hospital you birth at will play a key role in your experience of labour, birth and postpartum. The costs involved also vary considerably between birthing at a public versus a private hospital.

Most private obstetricians will see you for your antenatal appointments at their clinic or ‘rooms’, which are most often situated outside of the hospital. Antenatal care with a private obstetrician will likely involve having your ultrasounds, and some tests, in-house at their clinic. Private obstetricians collaborate with midwives, both at their rooms with those they employ, and at the hospital. You will most likely be attended to by midwives during your labour, with your obstetrician on-call for you, staying updated of your progress and arriving in person when your midwives inform them that you are close to having your baby.

If you have private health insurance cover for maternity care, part of the fees charged by your private obstetrician will be covered. There may be an out-of-pocket expense for your obstetrician’s fees, as well as for the fees charged by the private hospital, if that is where you are birthing. It is well worth doing your research and speaking to your obstetrician about any potential fees that may come up during your maternity care.

Greater Western Sydney Private Hospitals that provide maternity care:

As with all aspects of maternity care, your choice of care provider and place of birth is entirely up to you. Unfortunately, there are factors that may limit your access to all of these options, including geographical location and your financial situation. This is why it is so important to begin considering the options available to you early on, even before you fall pregnant, to ensure that you are well aware of what you want your birth to look like so you can make the decisions that are right for you. 

As your doula, I can and do provide pregnancy, birth and postpartum support in all of these models of care and places of birth. If you would like to have a discussion about your options and what doula support could look like for you and your family, please get in touch with me. Knowledge is power, and I am incredibly passionate about supporting families to get informed about their options so that they have the best chance of having an empowered and positive birth experience.


Sources:

Western Sydney Local Health District. (n.d.). Privately practicing midwives - WSLHD - ministry of health. Privately Practising Midwives | Women’s & Newborn’s Health Westmead Hospital. https://www.wslhd.health.nsw.gov.au/WNH/Health-Professionals/privately-practicing-midwives 

Australian Institute of Health and Welfare. (2023, December 13). Australia’s mothers and babies, place of birth. Australia’s mothers and babies. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/place-of-birth 

Department of Health and Aged Care. (2023, February 1). What does an obstetrician do?. Pregnancy Birth and Baby. https://www.pregnancybirthbaby.org.au/the-role-of-your-obstetrician 

Georgia Slee
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