My Personal Decision Making Process
In Part One I shared all the different options available to you when it comes to choosing pregnancy and birth care in Melbourne. Here in Part Two I’m going to share the process I went through with my partner – both from the head and heart perspective in deciding what model of pregnancy care and birthing location suited our needs. It is absolutely not designed to dictate a specific model of care to you. As I mentioned in my previous post, this decision will be unique and personal to you and your partner.
When I first began preparing to conceive, I had always planned to seek care in the Private model. We started paying private health insurance to cover pregnancy over three years ago. One of my close friends who is a medical specialist had given birth at Frances Perry House – the private wing of Royal Women’s and was a strong advocate. She’d had a positive, natural and empowering birth and I trusted her knowledge and experience. Also, given that this hospital was just a 5 minute walk from our home – it made logistic sense! The other thing that this friend pointed out to me was that whilst it was a small private wing, it was attached to a tertiary level major hospital and the NICU (neonatal intensive care unit). Therefore, if anything went wrong with you or your baby, you had the best care and resources right there with you. With some other small private hospitals those resources are not as easily accessible and a transfer to a major hospital would be required.
Over the years, as I began to evolve and change my views and opinions around many concepts; my thoughts around birth care began to change. The key turning point for me was early last year when a friend lent me “Birth With Confidence: Savvy choices for normal birth” by Rhea Dhempsey. This book taught me about some extremely important theories and concepts regarding the medicalisation of birth such as “The Cascade of Interventions,” how fear and stress in labour can interrupt the release of normal and very helpful hormones in birth and that pain in childbirth was not a pathological experience, it is a normal, physiological process! This book changed my thinking around birth completely and led to a plethora of further reading, research and questions by me. Follow the hyperlinks if you’re keen on preparing for a natural birth and would like to do a little further reading of your own.
The basic message from this book though & many others that advocate ‘natural birth’ is this: “If you want a smooth, positive, trauma free birth – choose a planned homebirth with a trained midwife. If you are willing to risk a birth that will be hurried and potentially loaded with unnecessary medical interventions – choose an obstetrician in a private hospital.”
This is not a message I feel very comfortable with to be honest and one I think needs addressing by natural birth advocates and medical professionals from both ends. I believe that women should be able to have the birth they want regardless of the location they choose. Home, birth centre or hospital; every woman deserves to feel safe, supported and respected in her decision. Messages from obstetricians around home-birth and likewise, messages from natural birth advocates about hospital births both tread a fine line between informing women and instilling fear in the potential outcomes that may arise based on their choice of birth place.
A Home Birth?
However, with these things in mind, I entered this pregnancy and had spent the 6 months or so prior to falling pregnant; envisaging a planned homebirth at our apartment with a registered midwife. It seemed more in line with my evolving ‘spiritual’ views and outlook on life and almost everything I’d read outlined it as a safe, viable option. In saying that, I wasn’t completely locked in to the idea and I was comforted by the fact that we had one of the best hospitals in Australia just 5 or so minutes from our door. When I expressed to my partner that I was interested in exploring Homebirth as an option he remained reasonably neutral. He’s a pretty calm and measured guy so I appreciated the fact that he didn’t shut me down on the idea but he did say that he didn’t feel particularly comfortable with the concept either. We agreed to explore a variety of options and began to discuss what we thought was important to us.
We decided to weigh up the pros and cons between the following 3 options:
- Hire a private midwife to support a planned homebirth
- Hire a private midwife and birth in the public system at the Royal Women’s
- Hire a private Obstetrician and birth in the private system at Frances Perry House
We explored ideas around cost, comfort, convenience, safety, facilities, support that would be available to us before, during and after the birth and very importantly to me the potential for a positive/natural and empowering birth.
I spoke to many friends and asked them plenty of questions. Thank you to all my girlfriends for being oh so patient with me! I would say that of the friends I spoke to about half birthed in the private system (at Frances Perry or St Vincents) and the other half in the public system (at Sandringham or Royal Women’s). I also spoke to my friend who’d had two very positive planned home births. Guess what? Every single woman I spoke to was happy with their decision to go private, public or birth at home and said they’d do the same again! So, I was then left with the knowledge of their experiences and my own intuition to guide me.
The Luxury of Choice?
There’s something to be said of the supposed luxury of choice in this experience. My sister, conversely to me, was not experiencing the same dilemma in decision making. Seven years younger than I, private health insurance that didn’t yet cover pregnancy, living in Gippsland and with a prior history of high blood pressure meant her decision was pretty much made for her. She was referred to an Obstetrician within the public system (due to history of hypertension) yet had no other complications or risks so was eligible for shared care with a midwife. She would give birth at Warragul Hospital and her care would be shared between the obstetrician and the midwives there. Warragul in fact has an excellent name for facilitating natural, positive births and my sister has felt this to be supported throughout the pregnancy. If you live in Warragul and fall pregnant, lucky you!
What did we want?
Initially we decided that a large, comfortable room with the possibility of staying in a city hotel was not so important to us. We think our apartment is pretty comfortable anyway so returning home quickly from the hospital didn’t bother us initially. With this is mind we wondered if private care was really necessary. We knew the Royal Women’s was an excellent hospital so we felt assured that in terms of the level of care we’d receive, this should be on par with Frances Perry House. I did like the idea of having one midwife to support me throughout the pregnancy and the birth though so we decided to explore the option of hiring a private midwife to provide care in the public system and ask some questions about homebirth at the same time. I wanted a positive, empowering birth experience and of course a healthy Mum and baby after the fact. My partner’s prime concern was that me and the baby were to come out the other end safe.
Meeting the Care Providers
From here we decided to go and meet some different care providers and explore the care available to us. I wanted to keep my options open so I booked an appointment with private obstetrician Kym Jansen at ‘Women’s OGS’ just in case as I knew that spots with her would fill up quickly. The first place we visited was a private Midwifery run service called MAMA in Kensington and had what they call an “Options” appointment with one of the midwives there when I was about 7 weeks pregnant. It is free and they basically run you through all your different options and the various services they provide. We left the appointment feeling informed but not sold on this particular midwife – my Motherly instincts weren’t settled so we elected to keep looking. This particular midwife was quite anti private obstetricians although she did speak highly of Kym Jansen and another obstetrician I was yet to hear of – Peter Jurcevic.
I then did a little more research and came across a private Midwifery service called My Midwives in Brunswick. After this appointment, I felt much more settled and confident with the actual midwife I spoke to and the service they provided. However, I started to question the fact that hiring a private midwife to birth in the public system (or at home) was going to cost us pretty much the same amount as hiring a private obstetrician to birth in the private system. I also felt a little overwhelmed by how large the Royal Women’s Hospital was and confused by the fact that sometimes I’d see someone there and other times I’d see my private midwife at their clinic in Brunswick. I was beginning to feel a little ‘lost in the system’ and wondered if maybe after three years of paying for private health insurance we should make the most of it and reap the benefits of a few extra days in a smaller hospital with plenty of support right at our fingertips. In addition to all this I learned that due to hospital policy, the private midwife I hired would be present at the birth but not able to participate in the hands-on sense in the delivery – this would be whoever was rostered on in the public system at that time.
By this point in time I was nearly 10 weeks pregnant, experiencing all day-every day nausea, my head was swimming with all the various options available to us and yet I could feel that intuitively I was in fact being gently steered towards the right decision. The home-birth idea began to naturally fall away from my psyche, the public system felt too large and overwhelming yet I wasn’t quite sold on the women’s team of obstetricians at Frances Perry either. I had a niggling feeling that despite the great reports from other mothers; that wasn’t the right decision for me. I decided to give Peter Jurcevic’s office a call and was immediately comforted by the warm, friendly receptionist on the other end of the phone. I asked about his fees, whether he would be available around the time of my due date (e.g. no holidays booked!) and if it was true that he practiced in a manner that was conducive to facilitating and supporting women to experience a natural and positive birth experience. All answers were positive!
Feeling at Ease
We stepped into his office at almost 11 weeks and both immediately felt at ease. He was calm, sensible, gentle and encouraging yet also a very practical realist; keen to facilitate natural birth but also a statistics man who liked to manage expectations. Both my partner and I walked away from the appointment feeling comfortable and assured by his manner and intuitively I felt our baby say “Yes! He’s the right one!” An instant sense of calm washed over me and those motherly instincts were at last satisfied.
Following the Heart
So finally, at almost the end of the first trimester, our decision was made. I’d gone from wanting a homebirth with a midwife to feeling very settled and at peace with a male obstetrician in the private system! After many, many hours of reading, research, discussions, pros and cons lists and listening to other people’s experiences; I can tell you all that our final decision was ultimately because it “felt right.” I cannot emphasise this strongly enough as an essential component in any major decision making process we go through in life. Yes, do your reading, gather all the information and resources available to you, listen to other people’s experiences to gain insight and perspective but when your brain is at bursting point? It’s time to let your heart step in. In pregnancy, your heart is a beautiful leader because it’s not just your heart, your baby will help you answer those big questions too. I honestly felt that come through so strongly for me both with deciding upon our major care provider and also for many other decisions that followed; they never end I’m afraid!
What Happens Next?
More decision making! Because once you’ve decided on your care provider then you have decisions to make about ultrasounds, genetic testing, pregnancy related screening tests; the list goes on. For some people; there is no decision to make here as they are more than happy to go along with everything recommended by their care provider. I felt a little differently about some of these tests. For me to go into further detail about all of these scans and tests, the pros and cons associated with each and why we decided to decline some that are considered routine would probably require an entire other blog post! So instead, for anyone keen to do their research and make their own informed decisions about ultrasounds and further testing in pregnancy I’d recommend you read some of Dr. Sarah Buckley’s work and again, listen to your heart and that of your baby’s. Both have been my ultimate guide in this pregnancy and as I approach the 39th week I am feeling relaxed, prepared and very at peace!
Much Love and Many Blessings always,
P.S. Stay tuned for an upcoming post on how I’ve been “Preparing for Birth” throughout this pregnancy!0