Making a decision for your prenatal care?

So the pregnancy test is positive, but what next? Nine months feels like a lifetime of morning sickness, frequent peeing and swollen ankles, but the decision around prenatal care seems to be made in the snap of a finger.

In Australia, we’re lucky to have options beyond forking out expensive insurance premiums for 12 months before falling pregnant, or settling for your sister-in-law’s uncle’s cousin’s obstetrician.

From free prenatal care under Medicare-covered birth options to private care with a private obstetrician, the choices are a veritable smorgasbord as boundless as your pregnancy cravings. Which can make it even more difficult to know what is right for you.

Caseload Midwifery or Midwifery Group Practice (MGP)

Location: (some) public hospitals and your home (for postnatal care)

Cost: Free- as covered by Medicare

How it works:

• Upon contacting your local hospital for antenatal care, you’ll be assigned to a group of midwives who will support your pregnancy, labour, birth and postpartum period.

Pros:

• This model is known as the gold standard of maternity care in Australia, with reduced rates of medical intervention
• It’s free
• You can self refer

Cons:

• This is a relatively new model of antenatal and maternity care.
• 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

Private Midwifery

Location: Private midwife rooms and/or your home

Cost: Roughly $6,000 (with $1,500 rebated by Medicare)
Additional things to note:

• Public hospital: free
• Private hospital: Obstetrician fees- usually substantially lower than their regular rates, given all prenatal care is provided by a midwife + any out-of-pocket costs associated with a private hospital stay
• Additional tests not routinely conducted (Eg. certain genetic and neonatal screenings, additional ultrasounds)
• Conducting appointments within your home rather than at midwife rooms

How it works:

• Run by highly experienced midwives who choose to provide care outside of the hospital system
• If you’re planning a home birth, it’s good to note private midwifery care can be provided in your own home
• Depending on the midwife selected, care can be provided in a clinic setting or at hospital

Pros:

• Research heavily supports this model of care, with most adverse outcomes and pregnancy or labour interventions significantly reduced when working with a private midwife
• 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
• 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

Cons:

• 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
• Don’t expect too much help from Medicare – this can be an expensive option, with very little rebate available

Shared Care with GP or Endorsed Midwife

Location: Your GPs rooms

Cost: At the discretion of your 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)
Additional things to note:

• Public hospital birth and stay: Free
• Private hospital birth and stay: Costs depend on your private health cover

How it works:

• Shared antenatal care with your local GP or an endorsed midwife
• 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.

Pros:

• Of great comfort to those who have a pre-existing relationship with the GP

Public Hospital Care

Location: Your local maternity public hospital

Cost: Free- as covered by Medicare

How it works:

• You’re assigned a maternity hospital based on your location
• You’ll need to contact the hospital early in your pregnancy (either independently or via your GP) to arrange your booking

Pros:

• It’s free! And our standard healthcare in Australia is of pretty high quality

Cons:

• 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 with them
• Due to the accessibility of this option, wait times at appointments can be long

Private Obstetrician

Location: Your obstetrician’s rooms (usually in or near the hospital in which you’ll be birthing)

Cost: An initial appointment is typically charged at around $200, with all other appointments covered by the obstetrician’s fees. The overall fee ranges from $5,000-$8,000, and covers the cost of obstetrician appointments and their attending your labour and birth.

Additional things to note:

• Payments may be made in instalments, starting at around 20 weeks – it’s worthwhile checking your obstetrician’s payment requests at the time of booking.
• Medicare rebates may apply for all out of hospital appointments, but private health insurance will not cover any gaps for additional screenings, ultrasounds etc.
• Private hospital stays during and after birth may incur excess costs, but will be wholly or partly covered by private health insurance – check with your insurer for more details.

How it works:

• 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
• 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.

Pros:

• Provides continuity of care throughout pregnancy

Cons:

• 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

Family Birth Centre

Location: Family birth centre, usually attached to public hospital

Cost: Free- under Medicare, if using the standard midwife team available at the centre.
Additional things to note:
Some aspects may be claimable through your private health insurance if using a private midwife or doctor.

How it works:

• Designed to feel more like home than a clinical hospital setting, this model of care is managed by midwives
• 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.
• It’s worth noting, 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

Cons:

• This model of care is only available for low-risk pregnancies
• 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

Doula

Location: In your home

Cost: At the discretion of doula, and not covered by Medicare

How it works:

• 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.

Navigating the pregnancy world can be overwhelming — we hope that with the above information, your knowledge grows, just like your baby bump.

(Special thanks to Jasmine @thecovertmidwife for sharing her expertise with us).

Find more articles in our journal.

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