Choosing a care model for pregnancy

So the pregnancy test is positive! Now what? Whilst nine months feels like a far reach, making an informed decision at the start of your pregnancy could change your birth outcome. Knowing that many care models for pregnancy are out there may feel daunting, in Australia, we’re lucky to have options for all incomes and family dynamics.

In Australia, only 8% of women in Australia have access to the ‘Gold Standard’ of continuity of care. What is continuity of care? Continuity of care refers to seeing a single care provider for the entire duration of your pregnancy to the delivery of your child. This can look like a private obstetrician, shared care with your GP or even hiring a doula.

But the Gold Standard of continuity of care refers to Midwifery Group Practice- a program run by local Public hospitals, in which the pregnant woman sees the same group of midwives throughout her pregnancy, birth and postpartum. This care model for pregnancy is associated with the lowest rates of interventions in Australia.

While it can feel overwhelming to navigate your way through doctors, midwives and models right for you- we wrote this piece with you in mind. Below is the lay of the “baby care land”.

This care model for pregnancy is a relatively new model of antenatal and maternity care at participating public maternity hospitals. Under MGP, you’ll be assigned to a group of midwives who will support your pregnancy, labour, birth and postpartum period.

Known as the ‘Gold Standard’ of maternity care in Australia, MGP offers easy access to and collaboration with specialists, and reduced rates of medical intervention. It’s free and you can self-refer, but you’ll need to get the ball rolling quickly to lock this model in. Places in these programs are limited and fill up fast, with only 8% of pregnant women in Australia able to access this kind of care. It’s recommended to apply for this care as soon as you know you’re pregnant.

Midwifery Group Practice

Model of Care Location Cost

Caseload Midwifery or Midwifery Group Practice (MGP)

 Public Hospital Covered by Medicare

This model of care is a relatively new model of antenatal and maternity care at participating public maternity hospitals. Under MGP, you’ll be assigned to a group of midwives who will support your pregnancy, labour, birth and postpartum period.

Known as the ‘Gold Standard’ of maternity care in Australia, MGP offers easy access to and collaboration with specialists, and reduced rates of medical intervention. It’s free and you can self-refer, but you’ll need to get the ball rolling quickly to lock this model in. Places in these programs are limited and fill up fast, with only 8% of pregnant women in Australia able to access this kind of care. It’s recommended to apply for this care as soon as you know you’re pregnant.

Private Midwife

Model of Care Location Cost
Private Midwifery

Private midwife rooms and/or your home

Roughly $6,000 ($1,500 Medicare rebate)

Additional costs to be aware of if birthing in a Private hospital.
Hospital birth and stay in hospital (if Private)
Obstetrician fees
Additional tests not routinely conducted (certain genetic and neonatal screenings, additional ultrasounds, etc.)
Conducting appointments at home rather than in the midwife’s rooms

A popular choice amongst those planning a home-birth, the Private Midwifery model is run by highly experienced midwives who choose to provide care outside of the hospital system. You can select your own midwife, with a back-up arranged for the birth in case your chosen midwife is unavailable. You’ll receive continuity of care from the same person throughout pregnancy, labour, birth and postpartum, and your midwife can prescribe medication and arrange routine tests like bloods, ultrasounds and prenatal screenings, without referral. When required, they will refer you on to other specialists, with whom they collaborate heavily throughout your pregnancy. Depending on the midwife selected, care can be provided in a clinic setting or at some hospitals, but it’s best to speak with your midwife to understand what their presence in this setting might practically look like, given hospital-based care also includes rostered midwives and doctors.

Research heavily supports this care model for pregnancy, with most adverse outcomes and pregnancy or labour interventions significantly reduced when working with a private midwife. Perhaps that’s why private practising midwives are almost always booked in advance, so you need to get on to this option early in your pregnancy if it’s your preference. And don’t expect too much help from Medicare – this can be an expensive option, with very little rebate available.

Shared Care

Model of Care Location Cost

Shared Care with GP or Endorsed Midwife

GP rooms

At the discretion of the shared care provider – it could be bulk-billed (free), or charged at standard or long consult GP appointment rates (check with your GP for more detailed costs)

This model allows for shared antenatal care between your local GP or an endorsed midwife, together with your local Public hospital. This makes for an excellent option if you have an existing relationship with a medical professional you trust. However, your chosen birthing hospital will need to approve your shared care practitioner, and this option is off the table for high-risk pregnancies.

After reaching 36 weeks pregnancy, you’ll be referred on to your birthing hospital’s team of midwives and doctors for all remaining care in your pregnancy, as well as labour, birth and the first few days postpartum. Your postnatal follow-up at six weeks postpartum will see your care handed back to your chosen GP or midwife.

Birthing in a Public Hospital

Model of Care Location Cost

Public Hospital Care

Your local maternity public hospital

Covered by Medicare

Under Public hospital care, you’ll be assigned a maternity hospital based on your location, and you will need to contact the hospital early in your pregnancy (either independently or via your GP) to arrange antenatal appointments. Due to the accessibility of this option, wait times at appointments can be long.

This model does not offer continuity of care, so you will likely see a different midwife or doctor at each visit, depending on who is rostered on. The same goes for labour, birth and postnatal care – the professionals in your corner are dictated by the hospital’s roster rather than any ongoing relationship you may have with them. Your postnatal hospital stay is likely to be shorter than a private hospital birth, with many women choosing to return home on the same day or within days of giving birth.

Private Obstetrician/ OBGYN

Model of Care Location Cost
Private Obstetrician
Your obstetrician’s rooms (usually in or near the hospital in which you’ll be birthing)
At the Obstetrician’s discretion. Expect to pay around $5,000- $8,000 for pregnancy management + an initial appointment fee.

The private obstetrician model is promoted for its ability to provide continuity of doctor care throughout pregnancy. Obstetricians are specialists in identifying and treating problems in pregnancy, labour and birth, so they will likely guide your prenatal and labour processes, rather than being guided by you. If you have a preferred obstetrician and wish to lock in this model, it’s best to call them as soon as you find out you’re pregnant to determine whether they will be available for your pregnancy and birth. Keep in mind, though, that doctors in this model of care usually operate within a small rostered team, so there is no guarantee that your preferred obstetrician will actually deliver your baby when the time comes.

Under this model, you can expect shorter routine appointments throughout your pregnancy, but for many appointments an ultrasound is included. For birth, you will need to book into one of the specific hospitals from which your chosen obstetrician works and, during labour, you will usually be looked after by that hospital’s midwives until they call for your obstetrician when you are fully dilated or the baby’s head is in view.

Family Birth Centre

Model of Care Location Cost
Family Birth Centre
Family birth Centre, usually attached to public hospital
Covered by Medicare

Family birth centres are designed to feel more like home than a clinical hospital setting, and are only available for low-risk pregnancies. They aim for minimal medical intervention, with fewer pain relief options available than you’d find in hospitals. Gas and some drugs may be available, but the centre’s midwives are more likely to encourage the use of relaxation, movement, water and other forms of natural pain management. If an epidural is requested, you will be moved to an attached or nearby hospital’s labour ward. Similarly, if emergencies or unexpected medical issues arise during birth, most birth centres will transfer you to hospital.

After birth, the centre’s midwives will assist with feeding and caring for your baby. You may be sent home quickly, or stay a night of two, after being checked by a doctor.

Birthing centres are typically in high demand, and not available in every State and Territory. If you’re in Victoria, hospital resources are being redistributed towards the implementation of Midwifery Group Practice (MGP) models and away from family birth centres in response to a growing body of research highlighting the benefits of continuity of care models for pregnancy.

Doula support

Model of Care Location Cost
Doula
In your home

At the discretion of doula, and not covered by Medicare

Perhaps one of the most misunderstood care models for pregnancy in modern society, a doula is a professional support person who focuses on the needs of the pregnant person and their partner throughout pregnancy, birth and postpartum. At your request, they may be present at your birth and will act as your advocate throughout labour.

Commonly, doulas will explore the physiology of pregnancy and birth with you, including providing you with options and understanding your personal preferences. They are often chosen for the mental, physical, emotional and practical preparation they encourage for birth and postpartum, and many offer continuity of support after birth through food nourishment, household support and newborn care.

The first trimester is a challenge, and navigating options can feel overhwelming. We’re here for you- every step of the way.

Find more articles in our journal.

Visit our shop to find out more about The Prenatal supplement to help support a healthy pregnancy.

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Visit our shop to find out more about The Prenatal supplement to help support a healthy pregnancy.

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