If you do not have private health insurance or you choose to be treated as a public patient at a public hospital, most of your care is provided by a midwife or doctor at a public hospital or birthing centre.
Public care offers several options, each of which are free of charge if you are a Medicare cardholder. These options include:
- Hospital care
- Birthing centre
- Shared care
- Team midwifery
- Midwives clinic
- Hospital Doctor
- General Practitioner
Public hospital care
If you are receiving public care, your GP will refer you to a public hospital (probably the closest one to your home).
You will need to book in at the hospital antenatal clinic, where a midwife and a doctor (usually the Registrar) will see you. If everything is normal, a midwife will provide all further reviews. If any complications or problems develop, the midwife will obtain further medical advice.Midwives and doctors will assist with your labour and delivery.
If you would like further information, you can contact your local teaching hospital and ask to speak to a midwife in the antenatal clinic.
Birthing Centre
Birthing centres are usually attached to hospitals, and provide a more home-like and relaxed atmosphere than hospital labour wards, with comfortable furnishings, drinks and snacks on hand. You also don't have to be surrounded by medical and technological equipment.
Women who expect to have a complication free pregnancy and birth may choose to give birth in a birthing centre, where a more natural (or less interventionist) approach to birth is encouraged.
If you choose to go to a birthing centre your antenatal care will be provided by the birthing centre midwives (usually the same midwife or team of midwives). As well as conducting each antenatal visit, the midwives will also care for you during your labour and perform the delivery.
In some birthing centres, the midwives will also care for you after the baby is born. It may also be possible to have a shared arrangement between the midwives at the birthing centre and the obstetrician of your choice, although this is not routine and you should enquire before making any decisions.
The aim of a birthing centre is to ensure that you are able to experience a relaxed birth, free of apprehension and stress. Birthing centres also offer you greater control over the way you want to labour and give birth. For example, you don't have to lie down to have your baby - you can choose the position or positions that work best for you. In addition, you have more of a say about your pain management - if you decide you need something for the pain, you can choose from a variety of conventional and alternative therapies.
Unless complications arise or an emergency occurs, you will not be moved, however, if you require an epidural or there are complications you will be transferred to the labour ward or delivery suite of the hospital. For this reason, birthing centres usually work best when they are in close proximity to the main delivery suite, so that if a problem does arise a transfer will be easier and quicker.
Shared care
You may wish (or need) to share your antenatal care between more than one caregiver.
Shared care may involve dividing your care between: your own family doctor or GP and a hospital clinic; an obstetrician and a midwife; or a GP and a midwife. Shared care is an option if it is difficult for you to visit the hospital.
When you give birth you will be admitted to the hospital as a public patient.
Team midwifery
At some of the larger teaching hospitals, you may be able to receive your care from a team of midwives. This type of care is similar to the care you receive at a birthing centre - a small team of midwives provides your antenatal care and is on hand to look after you alternately during labour and birth.
In some units the midwife team will also care for you after the baby is born. You will still give birth to your baby in the delivery suite at the hospital, but you have the advantage of knowing the midwife/s.
With this more personalised form of care, it has been found that most women require less pain relief and experience fewer complications and interventions.
Midwives clinic
This form of care is offered throughout most major teaching hospitals.
At a midwives clinic, you will usually see the same midwife throughout your antenatal care, however, when you go into labour you will be cared for by the hospital delivery suite staff.
After your baby is born, the postnatal ward staff will provide care. It isn't necessary to see a doctor unless any concerns or complications arise.
Midwifery based programs can have advantages and disadvantages. For example, if your pregnancy becomes complicated you will be referred to the medical staff or care may be shared between the midwife team and the hospital medical staff. In addition, you will not be cared for by the same midwife/s who provided your care during your pregnancy. Instead a midwife whom you have not met previously will care for you in labour and after the baby is born.
Hospital doctor
Within the public hospital system you can also elect to see the hospital doctor (Resident / Registrar) throughout your pregnancy. With this form of care, you may not always see the same doctor at each antenatal visit, and a midwife will care for you during your labour and delivery (providing no complications arise).
An obstetrician still maintains responsibility for this clinic and if necessary, will see patients referred by either a midwife or a hospital doctor. In addition, other specialist doctors (eg: physicians) are on hand and if necessary, you may be referred to them.
In the past there used to be long queues to see the hospital doctor, however with the introduction of the midwives clinic, waiting times have been reduced.
Other antenatal procedures and services (eg: blood tests, ultrasound's, physiotherapy, social workers etc) are also available at the hospital and it may be possible to combine appointments for your convenience.
General Practitioner
You can elect to have your GP provide shared antenatal care in conjunction with either the hospital midwife or doctor. You will still need to book in at a hospital.
It is unlikely that a metropolitan GP will attend the delivery, which is usually performed by the delivery suite midwife (unless there are complications, in which case a registrar or obstetrician will assist).
In rural areas and smaller towns, your local GP may perform the delivery, providing a similar role to that of an obstetrician in a metropolitan hospital but in a country district hospital.
The advantages of choosing your local GP to provide your care are the rapport you may have developed and the convenience of visiting his/her surgery. Your GP is also likely to be closely involved with your new family when you come home eg: providing vaccinations and medical advice.
If you would like more information about this option, you can contact the Royal Australian College of GPs.
Compare public hospital care with private hospital care or talk to EB members about birth experiences.