Choosing your pregnancy and birth model of care — preparing before you see your GP
Approximately 300,0000 women receive pregnancy care and give birth in Australia each year (AIHW: Australian Institute of Health and Welfare, 2023).
GPs are the gatekeepers to maternity care — with most women relying on their GP to facilitate their decision-making about care provider, and provide the necessary referrals to the chosen model of care (Stevens et al., 2014).
In an ideal world (and with many excellent GPs) you will be given detailed counselling by your GP about the full gamut of care provider choices (and birth venues) available to you — from general public maternity care, midwifery led care (both through public hospital continuity programs and private midwifery), to private obstetric care and shared care (both with private midwives and with said GPs).
This counselling should also be accompanied by an evidence-based discussion of what is best for you and your circumstances (if you want a certain type of birth, have certain health (emotional and physical) considerations, which care provider is best suited to supporting that). Yet common experience tells us this rarely occurs, and the direction of the discussion is generally dictated by your health insurance status alone.
A survey of women in Queensland in 2012 (yes, a very long time ago, but all we have to go off formally), was reported on by Stevens et al. in their 2014 article “What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports”. It found:
Only 7.7% of women reported that all models of pregnancy care were discussed with them
26.8% of women reported that only one model of care was outlined to them (of those — private OB care was the most common (61.1%) followed by GP shared care (22.3%))
GP shared care was discussed with women most frequently (64.4%), and private midwifery care was discussed least frequently (hospital birth – 12%, homebirth – 8.2%)
“women’s health insurance status was the strongest predictor of the presence of discussions about each model”
Those results were fairly damning in terms of the limited options presented to pregnant women — with a lack of knowledge of the different models (or the differences between them, and evidence supporting them), and certain biases towards medical-models, curtailing women’s informed decision-making. Not to mention that midwifery led-care, and even more so, private midwifery care (both associated with some of the best outcomes for mothers and babies) were the least likely to be mentioned.
We don’t have an updated account of these statistics. While we hope that the increased access to birth education and information facilitated by social media and key podcasts like @australianbirthstories and others in recent years has changed things a bit, we also know that significant numbers of you are not provided with the full spectrum of your choices, that your insurance status continues to dictate what choices are presented, and that there are ongoing issues with certain GPs refusing to complete referrals for private midwifery and other services.
So what does this mean? Well, do your research before presenting to your GP for your referral. Start to think about what you want out of your pregnancy and birth experience, how do you want appointments to look and feel? What is important to you? What has the experience of others around you been (the good and the bad)? What do you want out of your birth? And how do the available models measure up when it comes to those goals.
As well as ongoing doula support from conception through to postpartum, we offer one-off, individualised, mini and maxi birth choices consultations where we can work through this information with you and support to you to reach informed decisions about the right model of care for you. This is your pregnancy and birth, and there is every chance you will be more researched on the topic than your GP. Do the work first, and go to them for the tick-box referral. We would love to chat, get in touch.
Sources:
Australian Institute of Health and Welfare. (2023). Australia’s Mothers and Babies. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/about
Stevens, G., Thompson, R., Kruske, S., Watson, B., & Miller, Y. D. (2014). What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports. Patient Education and Counseling, 97(1), 114–121. https://doi.org/10.1016/j.pec.2014.07.010
