Wednesday, 10 April 2013

Models of Care

Not everyone knows that there are different models of care you can choose when you are expecting a baby. There are many different options out there than simply booking into your local public hospital (or into your Sisters Obstetrician). Some are limited by the where you choose to birth – at home, in a Birth Centre, at the local Public Hospital or the local Private Hospital.

Independent Midwifery

In this model you choose your own Privately Practicing Midwife to care for you throughout your pregnancy, during your labour and birth and until your baby is 6 weeks old. Some Independent Midwives work collaboratively with Obstetricians for true continuity of care (if Obstetric care is required), some are even employed by hospitals so you can choose to birth your baby at home or in the hospital (cared for by your own Midwife). Some are Medicare Eligible which means you can get rebates for some services from Medicare, some Private Health Funds may also offer rebates. All appointments are typically 1 hour long with some Midwives seeing you in your own home.

Caseload Midwifery or Group Practice

In this model you are booked into your local Public Hospital for care and are allocated a Primary Midwife for your care. Usually, you will see the same Midwife throughout your pregnancy and after your baby’s birth, with an on-call system utilised for birth. Some hospitals run a Homebirth program through this model. It is always worth asking about this if you are going public – but ask early as places are often booked up by 6 weeks of pregnancy. Antenatal visits are usually longer than through the clinic, and these Midwives usually continue to see their women until their babies are 1 week old – with some continuing care until 6 weeks of age. Some of these Midwives will do home visits – some only at the hospital.

Antenatal Clinic (Midwives Clinic or Doctor’s Clinic)

In this model you are booked into your local Public Hospital and allocated to either the Midwives Clinic or Doctors Clinic based on your risk factors. You may see the same clinician at each antenatal visit (although this is rare), you are cared for by the hospital staff for your birth and postnatally. Some hospitals run a ‘Midwifery-at-Home’ program where a hospital Midwife visits you at home for a few days. Typically, your antenatal visits will be 15 minutes long, and Midwifery at Home visits 40 minutes until your baby is 5 days old.

Private Obstetrician (Public or Private Hospital) or GP/Obstetrician

In this model you book in with your chosen Obstetrician (or GP with additional Obstetric qualifications - this is usually in rural areas) for antenatal care and your chosen hospital for birth. Your Obstetrician will see you for your antenatal visits. During labour, you will be cared for by the hospital midwives with your Obstetrician usually arriving for the birth to ‘catch’ your baby. He/she will then continue to care for you while you remain in hospital and most will do your 6 week check.

Midwife Shared Care or GP Shared Care

In this model, you see your own Private Midwife or GP for most antenatal visits. During labour you are cared for by the hospital team (Midwives and Doctors) and can return to see your Midwife or GP postnatally.

Basically, whatever model you choose do your research. There is no use going to the Midwife or Doctor who cared for your Sister/Mother/Best Friend if you don’t like them, or if their birthing beliefs are far from your own. You are perfectly entitled to ask questions, get statistics and change care providers at any time. As you pregnancy progresses, you may find that the idea of a Homebirth appeals to you or that your Obstetrician who was once supportive of your wish to VBAC is now trying to book you in for a Caesarean Section at 38 weeks as he/she is going on holidays.

It's worth mentioning that Midwives working in Public or Private hospitals rarely look after one labouring woman. A more realistic picture is two labouring women, plus women for assessment, plus answering the phone, plus assisting other Midwives with births checking drugs, etc. An Independent Midwife is just looking after you! Remember it is Your Body, Your Birth and Your Baby – YOUR CHOICE.


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