What kind of birth do you want?
You’d think after more than three long years of waiting for the moment where I had reason to make that decision, that my answer would have been simple and known once I fell pregnant. In fact, it took me quite some time to choose a primary care-giver and to feel at peace with my decision for birth care.
Making such a huge decision when you’re swimming in nausea and wrestling with the knowledge that you are in fact pregnant yet it’s still ‘early days’ in those initial weeks of your pregnancy can be quite challenging. As such, I decided to put together a bit of a summary outlining the major options you have for birth care in Melbourne.
So, if you’re planning on becoming pregnant, currently trying to conceive, are newly pregnant or know someone else that is – I’m hoping this will prove a handy resource for you! Keep in mind that this is specific to Melbourne, Victoria – Australia. No doubt there will be some overlap or similar options in other locations though so this may provide a rough guide even if you live outside of the Melbourne metropolitan area.
I’ll start with providing a brief overview of each birthing option beginning with the traditionally lowest interventionist model to the highest. In Part 2 I’ll share a little of my own decision making process with you all!
BIRTHING OPTIONS in MELBOURNE:
- Free Birth – Birthing at home or in a location of your choice unassisted, without any medical assistance. You can read more about this here.
You can watch a pretty amazing free birth out in nature here.
N.B. Freebirthing was not an option I considered personally and thus I have not done any research into this option.
- Home Birth with a doula – Also sometimes considered free birth as a doula is not a medical attendant. A doula is someone trained in being a birth support and birth attendant. They can provide a calm and supportive presence, make suggestions on birth positions or breathing to assist with pain relief and also are an extra support to your primary birthing partner if you have one. They do not perform medical tasks such as monitoring the baby’s heart rate as a midwife would, nor are they medically trained. Most doula fees are approximately $1500 in total. You can hire them for hospital birth attendance also.
Doula suggestions in Melbourne: Several of these women were recommended to me when I was investigating Doula services to support me in the private model of care.
- Sarah Goldberg at Nurtured Birth (rec. by my obstetrician)
- Linda Forbes (formally Linda Perucic) at Nurturing Birth & Babies
- Nina Isabella of Mama Shanti
- Nicole Tracy at Nurtured by Nature
- Home Birth with a registered midwife:
This is a planned home-birth and you will need to pay for your midwife’s attendance privately. This is usually around $3000- $5000 in total. You cannot claim any rebates for these fees via Medicare or any private health companies. This was originally the first option I considered, even though it is not considered “safe” by most official medical authorities in Australia. To assist you in making your own decision about Home Birth, I suggest you read and consult some of the following for a balance of medical opinion and other women’s experiences.
- Home Birth Australia
- “Benefits and harms of planned hospital birth compared with planned home birth for low-risk pregnant women” – Cochrane Review
- Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England – National Prospective cohort study BMJ (2011)
- Royal College of Obstetricians and Gynacolegists official statement on homebirth –
“The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) does not endorse planned home birth. Fewer than 1% of deliveries in Australia, and a greater proportion in New Zealand, are planned home births. The true incidence of planned home birth is somewhat difficult to accurately assess, particularly in New Zealand. While supportive of the principle of personal autonomy in decision making, RANZCOG cannot support the practice of planned home birth due to its inherent risks and the ready availability of safer options for labour and delivery in Australia and New Zealand. Where a woman chooses to pursue planned home birth, it is important that reasons for this are explored and that her decision represents an informed choice, considering all the possible benefits and potential adverse maternal and perinatal outcomes.” (July 2014, due for review July 2017)
- Australian College of Midwives position on Home Birth –
“This Position Statement should be read in conjunction with the Australian College of Midwives’ Guidance for midwives regarding homebirth services (2011). The Australian College of Midwives supports the choice of midwife-attended homebirth as a safe option for women with uncomplicated pregnancies. The ACM identifies 10 key principles for safe homebirth services.”
- One Melbourne woman’s personal experience of a positive, planned home birth with a registered and experienced midwife.
- Birth Centres:
These are an option akin to something between home birth and public hospital birth. It was my understanding, based on the research I conducted earlier this year, that there were currently no birth centres operating in Melbourne anymore. However, I met someone later in my pregnancy who told me about the Mercy Hospital for Women in Heidleberg. Apparently, they do have midwife run birth centres there through the public system. You may need to be in their catchment area to access this service publicly but I would strongly suggest giving them a call and considering this option. The woman I met was pregnant with her third and had nothing but praise for this model of care!
Maternity Group Practice at The Mercy
- Birth in a public hospital:
If you choose to give birth in a public hospital my understanding is that you must go to the public hospital that is closest to your home address unless you have specific medical issues that require you to receive care in a tertiary level hospital. Each public hospital may have different variations on how they provide your care. My closest public hospital is the Royal Women’s Hospital and they offer the following options within the public, Medicare funded system:
– Hospital based care: team (assigned to a specific team of doctors/midwives/dieticians etc.) or caseload (assigned to one specific midwife and a back-up midwife). Caseload is extremely popular and there is significant evidence to support improved outcomes for women who receive continuity of care in their pregnancy and birth. If you are interested in being assigned to caseload care I suggest you enquire about it before you fall pregnant or as soon as you know you are pregnant!
– Shared Care: a small amount of visits at the hospital (with whichever doctor or midwife is available) and the majority of other visits with your own doctor (e.g. your GP) or a midwife you have privately signed up with at their clinic location. If you have signed up with a private midwife know that whilst they will be able to provide care throughout your pregnancy and they can attend your birth, they will NOT be delivering your baby at the hospital. Your baby will be delivered by whoever is rostered on at the time and your midwife can be with you for support but not to medically deliver. Privately hired midwife fees vary from about $2000 – 4000.
– Community Clinics: similar to shared care
– Obstetrician: If you have a pre-existing medical condition (or one that develops during pregnancy) that raises you from low-risk you will be referred to an obstetrician as your primary carer within the public system (Medicare funded).
You can read more about these options and access a mass of excellent free resources at the Royal Women’s website here.
- Birth in a private hospital:
There are several private hospitals in Melbourne and your decision around whether to go private or public may be affected by firstly whether you have private health insurance that covers birth in a private hospital, secondly your choice of obstetrician and thirdly how far away your preferred hospital is from your home address.
Some popular and well known private hospitals in Melbourne are:
- Frances Perry House (located within the Royal Women’s building)
- St Vincents and Mercy Private
- Freemasons (You may wish to know that it is rumoured to be called “Caesar’s Palace”…do your research on your Ob here!)
- Many more listed here.
When you choose to birth in a private hospital, all or the majority of your care will be overseen by the obstetrician you choose. Some obstetricians work on their own while others work in a group practice. Your pregnancy and birth support choices may include:
- A single private obstetrician
- A private obstetrician that works in a group practice
- A private obstetrician and a privately hired Doula for support
Some obstetricians I have heard positive reports of in Melbourne:
- Peter Jurcevic (my choice in the end!) Well known for facilitating natural birth as greatly as is safely possible. Works publicly and privately.
- Mark Umstad – his name pops up quite often in positive references.
- Kym Jansen- part of an all female group practice (N.B. This group states on their site that they are not supportive of privately hired Doulas or midwives attending the birth as extra support).
- Guy Skinner – several friends hired Guy and were extremely happy with him and their experience. I did not feel that his style would suit my needs though.
- Lionel Steinberg (affectionately known as Vaginal Lionel! Therefore a great option if you are after a VBAC or want someone who will support and facilitate vaginal birth).
Obstetrician fees in Melbourne vary enormously! Anywhere from around $3500 at the low end, right up to $10,000. Your private health insurance covers your stay in the hospital but not your obstetric fees, nor does it cover any other scans and tests (many of which are free if you go public). Also keep in mind that whilst your obstetrician will be at the birth, the smoother things are going, the less you will see of them. It will be the midwives rostered on at the time who will be present for the majority of the time throughout the earlier labour stages.
In summary, who cares for you throughout your pregnancy and where you want to give birth is an incredibly personal and unique decision to be made by you and your partner.
My general pieces of advice are:
– Do your research.
– Have a strong idea of what you want and what is important to you (e.g. a natural birth, the safest birth, to be close to home, to have access to medical interventions, a longer hospital stay/shorter stay, financial constraints etc.).
– Ask LOTS of questions and meet with several care providers if you can.
– Talk to your partner about your preferences, fears, questions.
– Discuss with willing friends their own personal experiences of private, public, home birth and so forth.
– Don’t feel pressured to decide straight away or feel embarrassed/guilty if you change your mind.
– Most importantly: Listen to your instincts and that Motherly intuition. It is your best guidance in this sea of information and endless options.
Stay tuned for Part 2 of this post where I will share my own personal decision making process for birth and pregnancy care.
Love & Blessings,