WOMEN: DECIDING HOW AND WHERE YOU’D LIKE YOUR BABY BORN
This is something to be discussed early in your pregnancy. In recent years some women have questioned the increased use of technology in obstetrics and the ‘over-medicalisation’ of pregnancy and childbirth. They view child-bearing as something that should proceed naturally, and accuse obstetricians of intervening too much, especially in labour and delivery. Are these criticisms justified?
I agree that child-bearing is natural and shouldn’t be treated as a disease. But nature, left to her own devices, isn’t always a good midwife. It’s estimated that without antenatal supervision or help during labour, only six out of ten confinements would result in healthy mothers and babies. There are abundant statistics to show that modern obstetrics saves the lives and preserves the health of many mothers and many more babies. Worldwide, almost all the women who die as a result of pregnancy or childbirth have no access to modern obstetric care.
Though lately there has been a very small number deciding on home birth with a midwife in attendance, the vast majority of Australian women choose to give birth in hospital, where specialist help and emergency facilities (such as humidi-cribs and blood transfusion) are available every hour of every day. I believe that this is the safest way to go. There’s no such thing as ‘no-risk’ child-bearing. Even the most normal pregnancy may run into problems during labour or with the newborn.
But not all women feel at ease in the atmosphere of hospitals, which they associate with illness. Hospital interiors can be intimidating, especially if you’re surrounded by complicated-looking, mysterious equipment. In response to consumer demands for more relaxing surroundings and less intervention during childbirth, some maternity hospitals have set up birth centres as an alternative to delivery in a labour ward. In these centres healthy women with normal pregnancies can proceed to natural deliveries assisted by a midwife, with full labour-ward facilities close at hand in case of any problems. The midwives also provide antenatal supervision and counselling for the women that they will assist in the birth.
Birth centres aren’t just labour wards with flowered wallpaper and homey furniture. The important features are the attitudes, philosophy and training of the midwives as caring, responsible and adaptable helpers who make no compromise to safety. More than four out of ten women booked for giving birth at a birth centre are transferred – at the suggestion of the midwife and with the mother’s agreement – to the labour ward for optimal safety in completing the delivery.
Another decision about antenatal care and hospital delivery is whether your admission will be as a public or private patient. Public patients generally attend antenatal clinics at the hospital; private patients see their doctor in her or his rooms. Both may go to antenatal classes at the hospital and may choose to have their baby at a birth centre (if available) or in a labour ward.
If you are a public patient, the aim is that the team of doctors and midwives you meet during antenatal supervision will assist during labour and delivery, but because the time of delivery isn’t quite predictable, such an arrangement isn’t always possible. The babies of public patients usually delivered by student midwives medical students under the supervision a qualified midwife and doctor. If any problems arise, a consultant obstetrician is called in. The babies of private patients are usually delivered by their own obstetrician. After delivery, private patients choose a single room or to share with or several others; public patients usually have beds in larger wards.
Your decision whether to be a public or private patient will depend on you finances and health insurance cover. Discuss likely costs with your hospital and doctor. Note that private health insurance applies a nine-month waiting period on
all pregnancy-related services, regardless of
whether or not you are pregnant when you join. This means that if you’ve joined just before you conceived and need ton admitted to hospital during your pregnancy (because of miscarriage or other pregnancy complication, including preterm birth), private hospital costs won’t be met by your fund.
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