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What are my options for pregnancy care in Australia?

Australians have access to a range of personal and high-quality maternity services and models of care. If you are pregnant or planning a pregnancy, there are many different options for care and support during pregnancy and birth. These include care from midwives or doctors, and care delivered in publicly or privately funded settings.

Learning about the options for pregnancy care in Australia, where you can give birth and the costs involved will allow you to make the choices that are best for you.

Who will care for me during my pregnancy?

There are 3 types of health professionals who can care for you during your pregnancy, depending on your health needs and where you plan to give birth:

• General practitioners (GPs) are doctors who promote general health and treat many different health problems. Your GP will often be the first health professional you see if you think you are pregnant.
• GP obstetricians are GPs who have additional training in women’s health. They offer shared care. This is where you see your GP as well as midwives or obstetricians for your pregnancy care. If you live in a rural or remote area, your GP might provide all of your pregnancy care and assist during the birth.
• A midwife has special training to support and care for you during pregnancy, labour and birth. Midwives work in public and private hospitals, with obstetricians and in the community. They help you to stay healthy during your pregnancy. If there are no complications, they can also help you give birth. Midwives also care for you and your baby in the first few weeks after the birth.
• An obstetrician is a doctor who has had special training to look after you and your baby during pregnancy, birth and straight after birth. If you are having your baby in a public hospital, you might only see an obstetrician if there is a medical need. If you choose to be cared for by a private obstetrician, they will manage your antenatal care throughout your pregnancy and may be present at the birth.

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What is antenatal care?

Antenatal care is the care you receive during pregnancy. You will have antenatal appointments throughout your pregnancy.

Antenatal appointments are important, even if you are healthy and your pregnancy is going well. They allow your midwife or doctor to check on your health and your baby’s health, and identify and manage any problems early. These appointments are also a good opportunity for you to ask questions and talk about any concerns you have.

In Australia, your options for antenatal care are linked to where you plan to give birth. If you want to give birth in a hospital or birthing centre, it’s a good idea to book in as early as possible.

When should I make an appointment?

If you have just found out that you are pregnant, it’s important to see your doctor (GP) or midwife to start your antenatal care.

It’s best to make your first antenatal appointment when you are about 6 – 8 weeks pregnant (usually, this is 6 – 8 weeks after your last period started). This appointment can be with a midwife, your doctor or at a clinic or hospital. Typically, this appointment will be with your GP.

What can I expect at an antenatal appointment?

At your first antenatal appointment, the doctor or midwife will confirm that you are pregnant. They will perform a detailed health check, including asking about your medical history and your family medical history. This helps to determine anything that may be relevant in managing your pregnancy.

They will discuss your pregnancy care with you, including:

• where you plan to give birth
• where you will receive antenatal care and which health professionals you will see
• how many appointments you are likely to have
• where you can go for antenatal classes

They may also offer you tests to check for health conditions that may cause problems during pregnancy or labour. It’s your choice whether to have any tests.

They will also give you information and resources on:

• vaccinations
• dietary recommendations
• other lifestyle and wellbeing advice for your pregnancy

How often will I have antenatal appointments?

You will have regular appointments throughout your pregnancy. Many people start off having appointments every 4 – 6 weeks. From about 24 weeks of pregnancy, you may have more frequent appointments.

Most people with uncomplicated pregnancies have about 7 – 10 appointments in total. If you or your baby are at a higher risk of problems, your doctor may recommend extra appointments.

You can also attend to antenatal classes to help you and your partner (if you have one) prepare for the birth. Many hospitals run antenatal classes. Ask your doctor or midwife about what is available.

Where can I give birth?

There are several options for where you can have your baby. The options available to you depend on where you live and whether you have any pregnancy complications. It is important that you understand the advantages and disadvantages of different birthing options.

Making the best choice for you depends on what’s important for you and your partner. For example:

• How far do you want to travel?
• What can you afford?
• Do you want to see the same doctor or midwife at every visit?
• Would you like your GP to look after you through your pregnancy?
• What kind of medical intervention or pain relief would you like during birth?

Your GP can discuss your options, help you decide what’s best and give you any necessary referrals. You may also choose to talk to your friends and family about their experiences. Keep in mind, pregnancy and birth preferences and experiences are different for everyone.

Public hospital

If you choose to give birth in a public hospital, and your pregnancy is low-risk, it’s likely you will be booked in at the local maternity hospital for your area.

Hospitals may offer different models of antenatal care, including:

• seeing midwives at the hospital’s antenatal clinic
• shared care between the hospital and your GP

Many hospitals offer a service where you see the same midwife or group of midwives throughout your pregnancy, and sometimes during the birth. This is called caseload or team midwifery.

The midwives caring for you will refer you to an obstetrician if you experience any pregnancy complications.

Some advantages of public hospital care are:

• You may be able to choose your model of antenatal care.
• You can have minimal intervention during birth if you choose, while still having access to medical intervention if you need it.
• Medicare covers most of the cost of care during the pregnancy and birth.
• Most major public hospitals can care for you and your baby if there are complications.
• You may be able to see allied health professionals if needed.

Some disadvantages are:

• You won’t be able to choose which midwife or doctor you see.
• You might not be able to see the same midwife or doctor throughout your pregnancy.
• The midwives or doctors you see during pregnancy might not be at the birth.
• Appointment waiting times may be longer than at a private clinic.
• After the birth, you’re more likely to be in a shared hospital room.

You can also choose to be a private patient in a public hospital. As a private patient in a public hospital, you will be cared for by your chosen doctor, but you will not be guaranteed a single room. You may be responsible for hospital, medical and diagnostic expenses, although you may receive a Medicare benefit for some services.

Private hospital

If you decide to give birth in a private hospital, you will be cared for by a private obstetrician or GP obstetrician. You will need to book in at one of the hospitals where your doctor works.

Most people who choose a private hospital pay for it with their private health insurance.

The first step is to see your GP for a referral to an obstetrician, who will then book you into the private hospital.

Some advantages of private hospital care are:

• You can choose the doctor who will care for you throughout pregnancy, labour and after birth, and develop a relationship with them.
• Your doctor and hospital midwives who care for you during the pregnancy will usually be there during your labour and birth.
• You might be able to choose a more convenient location for your care.
• The waiting time for appointments may be shorter than in the public hospital system.
• You may have the option of private room. If you do, your partner may also be able to stay with you.

Some disadvantages are:

• It’s expensive if you don’t have private health insurance.
• Usually there are extra costs that your insurance doesn’t cover. This may include a fee for an anaesthetist or paediatrician if you need one.
• Some services that are free to public patients may not be free if you are a private patient.

Birth centre

Birth centres provide a more comfortable and home-like environment to give birth than a hospital. They may be an option if your pregnancy is low risk.

A midwife or team of midwives will care for you during pregnancy, labour and birth. You might also see an obstetrician if there are any complications during your pregnancy or birth. Birth centres usually don’t offer epidurals.

You’ll usually go home within 24 hours after birth, with care from midwives at home afterwards.

Birthing centres are often attached to hospitals. If a problem develops during your labour, you may need to move to the hospital for medical care.

If you are interested in having your baby at a birth centre, see your doctor as soon as possible to find out what’s in your area and book in. Your doctor will usually refer you to the attached public hospital first, but in some cases you may be referred directly to the birth centre.

If you give birth at a birthing centre attached to a public hospital, Medicare will cover the costs of your birth. There may be some out-of-pocket costs for some tests.

Homebirth

You can choose to have your baby at home, if your pregnancy is low risk. If there are any complications, the midwife or doctor caring for you will arrange a transfer to hospital for medical care.

If you are planning to have a homebirth, you can choose to have your antenatal care with a private midwife or through a public hospital that has a homebirth service, if this is available in your area. If any problems develop, you may need to see an obstetrician.

You will need a referral from your doctor for a public homebirth service. You can find a private midwife on the Homebirth Australia website. You can book in to your local hospital as well, just in case complications arise.

It’s important to make sure that your midwife is registered and qualified for homebirths. Check that they have procedures in place to refer you to an obstetrician if needed, and to transfer you quickly and safely to hospital if a problem arises during your labour or birth or afterwards.

You will also need to make sure that your baby can get any treatments they need after birth. Check that your midwife or doctor can care for you after birth, examine your baby within the first week and refer your baby for standard newborn tests.

What is shared care?

Shared care is when your pregnancy care is shared between your GP and the health professionals at a hospital or birth centre. You will see your GP regularly throughout your pregnancy, visit the hospital for some appointments with a midwife or obstetrician and go to the hospital to give birth. This may be an option if your pregnancy is low risk.

If your GP doesn’t offer shared care, your hospital can give you a list of GPs who do. Some hospitals offer shared care with midwives or obstetricians. It is important to have the details of each of your shared care providers recorded in your medical records so they can be contacted if needed.

How long will I stay in hospital after I give birth?

After the birth, you might go home the next day, or you might need to stay in hospital for several days. Some people choose to go home from 6 hours after giving birth. How long you stay will depend on:

• your recovery and choice
• where you give birth
• whether you have had a caesarean birth
• whether you or your baby have any complications
• your support system at home

How much does it cost?

The cost of having a baby varies depending on whether you give birth in the public or private system.

In Australia, the costs of pregnancy care in a public hospital or birth centre are mostly covered by Medicare. This covers Australian citizens and some visitors to Australia. In the private system, you will need to pay for your care or take out private health insurance. Medicare and your private health fund will cover some of the costs of a private hospital stay, but you may still have to pay extra fees (known as 'out-of-pocket' costs).

Be sure to check that your private health insurance covers maternity care and whether there is a waiting period before you are covered.

It can be difficult to understand the costs of different care options. Talk to your doctor, hospital or health fund if you are unsure, or call Pregnancy, Birth and Baby on 1800 882 436.

Resources and support

For information, advice and support during your pregnancy:

• Talk to your doctor or midwife.
• Contact Pregnancy, Birth and Baby to speak with a maternal child health nurse by phone on 1800 882 436 or via video call.
• Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice..

Looking for information on maternity care options for rural and remote Australians?

If you are pregnant and located in a geographically remote region of Australia, your GP may play a more significant role in your antenatal care. You may be cared for collaboratively by different health professionals in your community.

You can find more information about maternity services in rural Australia specific to your area.

Looking for information on maternity care options for Aboriginal and/or Torres Strait Islander people?

• Different states have their own programs designed to meet the maternity care needs of Aboriginal and Torres Strait Islander people. Ask your doctor or Aboriginal health worker for more information.
• Birthing on Country is a culturally sensitive maternity care model that centres on Aboriginal and Torres Strait Islander values.
• The Royal Women’s Hospital offers culturally appropriate pregnancy resources for Aboriginal and Torres Strait Islander
• Aboriginal Maternity Services offers Koori maternity services around Victoria.
• NGIYANG provides culturally sensitive pregnancy care, early child development, immunisation, parenting support, education and referrals.

Looking for services in a language other than English?

• For help with support services in your language, call the Translating and Interpreting Service (TIS) on 131 450.
• Monash Women’s has health information in many community languages.