Options for where you give birth
Pregnancy and childbirth are natural life events and in most cases you will have a natural birth. While all women hope for a normal pregnancy and birth, there is always a chance of complications in pregnancy – to the mother, the baby or both of you.
Some complications are found early in pregnancy and other problems may develop later in pregnancy or in the birthing stage. The purpose of your care is to identify any risks and manage them in the best possible way for you and your baby.
The following information describes most of the choices for pregnancy and birth care for public and private care options. The choice you make about where to have your baby will depend on your needs and risks and, to some extent, on where you live. Wherever you choose, the place should feel right for you.
Giving birth in Australia is generally safe wherever you choose to have your baby. Healthy women assessed to be at ‘low risk’ should be offered a choice of birth setting. If you choose to give birth at home or in a unit run by midwives, you should be given information by your midwife or doctor about what would happen if you need to be transferred to hospital during labour, and how long this would take. If something goes seriously wrong during your labour, it could be worse for you or your baby than if you were in hospital with access to specialised care.
You may be advised to give birth in hospital if you have or develop certain medical conditions. For women with some medical conditions it is safest to give birth in hospital because specialists are available if you need extra help during labour and birth.
Making an informed decision
It’s important that you and your partner have all the information you need to make the choice about where you give birth. It is your choice, and even after you have decided where you want to have your baby, you can still change your mind. Your midwife will discuss the options that are available in your area, though you are free to choose any maternity services if you are willing to travel.
As well as your midwife, you can get information from:
- birthing centres
- your doctor’s surgery
- local hospital maternity units
- Midwives Australia
Talk to your midwife about going to look around the local maternity services. Don’t hesitate to ask questions (see the lists of helpful questions below) if you don’t understand something or if you think you need to know more. You may also want to get advice from your friends and family.
If you have a straightforward pregnancy and both you and the baby are well, you might choose to give birth at home. However, if there are risks or complications during your pregnancy, home birth may not be a safe option for you or your baby.
If you give birth at home, you should be supported by a registered midwife, doctor or obstetrician who will be with you while you’re in labour. If you need any help or your labour is not progressing as well as it should, your midwife will make arrangements for you to be transferred to hospital.
There are some disadvantages you should think about if you’re considering a home birth:
- you may need to be transferred to a hospital if there are complications during the labour, birth or afterward
- epidurals are not available at home
Your doctor or midwife may recommend that you give birth in hospital. For example, if you are expecting twins, if your baby is breech or you have had a previous caesarean – your midwife or doctor will explain why they think a hospital birth is safer for you and your baby.
Midwifery units or birth centres
Midwifery units or birth centres are more comfortable and homely than a maternity unit in a hospital. Your care will be provided by midwives. There’s a big demand for places in birth centres and midwifery units, so book in as early as possible. The advantages of giving birth at a birth centre or midwifery unit include:
- being in surroundings where you may feel more relaxed and able to cope with labour
- you’re more likely to be looked after by a midwife who you have got to know during your pregnancy.
There are some things to think about if you’re considering giving birth in a midwifery unit or birth centre:
- you may need to be transferred to a hospital delivery suite if there are any complications
- in a unit that’s completely separate from a hospital, you won’t be able to have certain kinds of pain relief, for example an epidural – ask your midwife whether the unit or centre is part of a hospital or completely separate
- your doctor or midwife may feel that it’s safer for you to give birth in hospital.
Midwifery units or birth centres are options for women with normal or low-risk pregnancies. Birth centres aren’t suitable for women with a higher risk of complications. This includes women who have heart or kidney disease, diabetes, high blood pressure or who have had complications in previous labours. The guidelines can vary from centre to centre. Check with the birth centre. During labour, you can do what feels comfortable – walk around, sit, squat or kneel. You can have people of your choice at the birth. You may be allowed to have children with you too. If a problem arises during your labour that requires medical attention, you may be moved to the hospital delivery suite.
In a birth centre, you’re likely to go home 24 hours after the birth and have follow-up care by midwives at home.
Planning a birth in a midwifery unit or birth centre
Ask your midwife if there are any midwifery units or birth centres in your area. There may be others you can use if you’re prepared to travel.
Here are some questions you might want to ask:
- How long would it take if I needed to be transferred to hospital?
- Which hospital would I be transferred to?
- Would a midwife be with me all the time?
- Can I visit the unit before I give birth?
- What facilities are available, for example birthing pools?
Most women give birth in a hospital maternity unit. If you choose to give birth in hospital, you’ll be looked after by midwives but doctors will be available if you need their help. You’ll still have choices about the kind of care you have. Your midwives and doctors will provide information about what your hospital can offer. The advantages of giving birth in hospital include:
- having direct access to obstetricians, anaesthetists (who give epidurals and general anaesthetics) and neonatologists (specialists in newborn care)
- you can access other specialist services
- you can be provided with a caesarean section immediately, if required
- there is a special care baby unit if there are any problems.
- There are some things you should think about if you’re considering a hospital birth:
- you may go home directly from the delivery suite or you may be moved to a postnatal ward
- in hospital, you may be looked after by a different midwife from the one who looked after you during your pregnancy.
Planning a hospital birth
Your midwife or doctor can help you decide which hospital feels right for you. If there is more than one hospital in your area you can choose which one to go to. Find out more about the care provided in each so you can decide which will suit you best.
Here are some questions you might want to ask:
- Are tours of the maternity facilities available before the birth?
- When can I discuss my birth plan?
- Are TENS machines available for pain relief or do I need to hire one?
- What equipment is available, for example mats, a birthing chair or bean bags?
- Are there birthing pools?
- How long will I be in hospital?
- Wherever you decide to give birth, you can change your mind at any stage of pregnancy. Talk to your midwife or doctor if there’s anything you’re not sure about or you want to know more.
- Are fathers, close relatives or friends welcome in the delivery room?
- Are they ever asked to leave the room – if so, why?
- Can I move around in labour and find my own position for the birth?
- What is the policy on induction, pain relief and routine monitoring?
- Are epidurals available?
- After the birth how soon can I go home?
- What services are provided for sick babies?
- Who will help me to breastfeed my baby?
- Who will help me if I choose to formula feed?
- Are babies with their mothers all the time or is there a separate nursery?
- Are there any special rules about visiting?
If you have private health insurance, then you may be able to choose your own caregiver – such as an obstetrician, doctor or independent midwife – and choose a private hospital or a public hospital with private wards for the birth.
You will need to check with your health insurance fund to find out what areas of care, including accommodation, are covered during your pregnancy, birth and postnatal period. Some health insurance funds will give rebates for services by independent midwives. Please note that services by independent midwives are not covered by Medicare. You can also pay for private care yourself if you are not a member of a health insurance fund.
Private obstetrician and general practitioner
With this option you receive care from a private obstetrician (Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists) and/or a specialist doctor (who has either a Diploma from, or is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or equivalent postgraduate training in obstetrics) in their own private rooms. Some obstetricians may employ a midwife who may be involved in your antenatal care.
You may be admitted to a private hospital or public hospital (as a private patient) of your choice. You will be cared for in labour by midwives employed by the hospital but your doctor will be closely involved in your management and will normally be present at the birth of your baby. Some obstetricians or doctors may also provide care during pregnancy and for birthing at home. Postnatal care will be provided by the hospital midwives and your doctor.
Some women choose to have a home birth with an independent midwife (registered with the Australian Health Practitioner Regulation Agency (AHPRA). The midwife will care for you through your pregnancy, birth and after the baby is born. This is an option for women with normal or low risk pregnancies.
Home births are not recommended for women with a higher risk of complications. This includes women who have heart or kidney disease, diabetes, high blood pressure, who have had complications in previous labours or a previous caesarean. You will need to discuss this with your midwife.
If complications do arise, you may need to be transferred to hospital. You should prepare a plan B – a backup plan to go to hospital as part of your birth plan. Some hospitals like you to make an advance booking just in case, and your midwife will be able to advise you about local needs. In hospital, your care will be provided by a midwife employed by the hospital.
Here are some questions you might want to ask if you’re considering having your baby in a midwifery unit or birth centre, or in hospital: