Are you just buying the first pram you see, or do you like to do a little research to ensure you get exactly what you want? A pram that fits in your car, that is light, that’s suitable for jogging or shopping or walking on the beach?  A pram that you’re going to be happy with for a long time? If you’re having a baby here on the Sunshine Coast, you might be happy to go with what other people tell you to do or the easiest option. But if you’re like many women I know, you want all the information so you can prepare for the healthiest, best birth possible.

Start at the beginning ….

You probably had your pregnancy confirmed by a GP but didn’t realise that what happened next could change the direction of your life.  Did your GP outline all of your options for where you could give birth and who could look after your medical care during pregnancy, birth and after your baby was born?  This information is hugely important because where and from whom you receive your care could mean the difference between a fully supported, positive experience and healthy, natural birth, or months of anxiety followed by a traumatic birth, breastfeeding problems and a difficult start to mothering your baby.  

I’ve seen and heard it all …..

Think I’m exaggerating?  I’ve worked with pregnant and birthing women, new mothers, their partners and families for around 25 years and I’ve seen some women enjoy fabulous, euphoric births while others experience trauma, disappointment and great distress which doesn’t just stop after they leave the hospital.  I’m here to explain to you that your choices are important and that it’s worth taking some time to consider what you want for your baby’s birth.  Why?  Because you’ll remember it forever, because it impacts your start to mothering, because it affects your baby’s health, and because it afffects your family.

What’s a model of care?

Firstly, it’s important to understand the difference between models of care in maternity.  On one hand you have the midwifery model of care.  Midwives are trained to care for women through pregnancy and birth then care for mothers and babies up to six weeks after birth. Most pregnant and birthing women in the world are cared for by midwives.  Their focus is on normal, physiological birth with use of skills to keep things on track, avoiding drugs and procedures unless medically indicated. Midwives are trained to recognise complications and refer to specialist doctors called obstetricians while continuing to support the mother.  

On the other hand you have the obstetric model of care.  Obstetricians are specialist doctors who are trained in the complications of pregnancy, labour and birth, i.e. the things that go wrong.  They spend years focussing on abnormalities of pregnancy and birth, and their tools of the trade are medications and medical procedures.  They’re the ones we want around when labour and birth become complicated and can’t be resolved by traditional or non-interventionist techniques, and we’re very grateful for their expertise at those times.  However most obstetricians rarely see normal, natural birth so their perspective is that birth is dangerous most of the time and likely to require drugs and interventions.  This focusses much more on the physical process rather than the emotional aspects of birth, and doesn’t leave a lot of room for natural, physiological birth, which many women want.

I’ve heard thousands of birth stories during my career.  Women and their partners tell me about the wide range of care they receive from both midwives and obstetricians:

That their obstetrician was completely supportive of their wishes, gave them all the time they need during antenatal visits to answer their questions, and gave them confidence during the birth.  Others say their obstetricians would dismiss their concerns or say they’d talk about the birth later in pregnancy, or that they could do whatever they want during birth eg. “You can hang from the chandeliers if you want” but then insist that they lie on their backs to give birth.  Or that they were counting on their doctor knowing what they wanted but another doctor was on duty and disregarded their wishes so they ended up with interventions they didn’t want.  Or that they felt completely disrespected because their doctor drew a smiley face on their belly after performing a caesarean section.  

Some felt they were talked into having drugs and interventions they didn’t need which led to a caesarean birth.  And others were angry that when the doctors arrived all the lights came on, loud voices were used, they were treated like just a body rather than a woman giving birth and that had led to feeling traumatised long after the birth.

I hear about many midwives who create a calm environment in the birthing space, who speak kindly and respectfully to both the mother and partner, and do all they can to help the mother have a positive emotional as well as physical experience.  Some teach the mother how to breathe and relax and stay calm, and others help the mothers into different positions to ease backache or help move labour along.  Other midwives are less hands-on, leaving the mother alone or focussing on their computer more than the mother’s comfort, others offer pain relief or tell the mothers that “it’s only going to get worse” or that they’re not going to make it if they don’t lie down, and seem to be more comfortable offering drugs and interventions rather than providing emotional support. 

Many midwives would love to be more hands-on with each woman in their care but are not able to because they’re looking after another woman at the same time or have so much recording and paperwork to do that there just isn’t time.

The way you are treated during pregnancy, and during birth, and after your baby’s born, means the difference between a positive experience that you feel good about, regardless of whether you had a natural birth, an induction or a caesarean, or that can leave you feeling disappointed, frustrated, angry or traumatised.  So your choices do matter.

On the Sunshine Coast you can give birth at these places

• Sunshine Coast University Hospital (which I’ll refer to as SCUH – pronounced skuw)
• Buderim Private Hospital
• Home 

Is there a difference between public and private?

Generally, public hospitals are less likely to offer drugs and interventions than private hospitals because at the end of the day these procedures are more expensive.  Interventions such as inductions, drugs for pain relief or speed up labour, forceps, vacuum extraction, continuous monitoring and episiotomies are usually lower in public hospitals compared to private.  Caesarean rates are usually higher in private hospitals, because women can choose elective procedures and caesareans when they’re private patients, or high risk women might choose private obstetric care.  

Although I believe caesarean rates are still higher at Buderim Private Hospital, I’m hearing of more and more routine interventions being used in women’s labours at SCUH which is extremely concerning, considering that most of the women (you!) are healthy women in good health with low-risk pregnancies. Why is it a problem?  Because if you intervene in normal labour you’re likely to create complications that snowball to needing more interventions, changing the course of the way your body works, and potentially leading to caesarean birth.  This is known as a cascade of intervention.

The World Health Organisation states “Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15%.”   That includes all women who are likely to have complications in labour.  Not many, is it?  If Australia’s caesarean rate is 34%, one of the highest rates in the developing world, what is your hospital doing to lower that average so that you’re more likely to experience a straightforward, uncomplicated labour and birth?  Ask your caregivers how many women in their care have a physiological, normal birth without interventions.

What are the implications of the place I choose to give birth?

Care at SCUH is free, covered by your Medicare plan, as it’s a government run public teaching hospital attached to University of the Sunshine Coast.  Some of the implications of this are that:

• It’s a large hospital with around 3,000 women birthing there every year.
• There are student doctors and midwives who might attend your birth.
• Unless you have your own midwife you’re not likely to know the people in attendance at your birth, which reduces levels of comfort.
• It has a state of the art Neonatal Intensive Care Unit should your baby need special care. The operating theatres are always open for emergencies.

If you choose the private system you hire a private obstetrician or a team of obstetricians and give birth at Buderim Private Hospital. This used to be seen as superior or better quality care, but with the new SCUH more and more women have moved to the free, public service.  If you’re choosing a private obstetrician, ask how many women in their care experience physiological, normal birth and how many have a caesarean, to give you an idea of how they practice. 

What types of care are available to you?

Shared care with your GP and the hospital midwives,  care from a private obstetrician or team of obstetricians, from the hospital midwives on duty, from a team of hospital midwives, or you can hire your own private midwife.

Why choose a private midwife?

Receiving care from the same caregiver right throughout pregnancy, birth and in the early postnatal period is called continuity of care. This is known as the gold standard or the best type of care. It’s obvious that if you get to know one person or a small team of people and see them right through your pregnancy you’ll know how they work and they’ll learn what’s important to you.  When you’re in labour you won’t have to get to know a stranger or explain yourself to them because they already know what you want.  That makes it more likely that you will have better outcomes during birth and also in the postnatal period as you learn to breastfeed and care for your baby.  

On the Sunshine Coast you can receive continuity of care through SCUH’s Midwifery Group Program (MGP), if places are available and you qualify, or by hiring a private midwife and birthing at SCUH or at home. I live and work in Noosa and unfortunately the MGP doesn’t extend up here as we’re too far from the hospital for them to provide a group of midwives, so we don’t have that option.

Is homebirth safe?  What happens if there’s a problem or emergency?

Yes, planned homebirth with qualified carers for low-risk women is safe and you can locate statistics and information online about it, or talk to a private midwife to find out more.  Around 1,500 women give birth at home in Australia each year.  Midwives are trained to recognise problems and will call for help or transfer to hospital if they believe staying at home is no longer safe.  On the Sunshine Coast we have a number of highly trained and respected homebirth midwives who attend local homebirths every year.

If a woman transfers from a homebirth her private midwife goes with her. The midwife can continue to provide medical care if she has what’s known as “visiting rights” with the hospital. Midwives who chose not to be vaccinated for Covid-19 no longer have visiting rights and although they still accompany the birthing woman to hospital, their care shifts to non-medical support while hospital midwives and doctors take over the medical care of the woman. 

I’ve created the table below to show all of your options – where you can give birth and who can care for you medically i.e. your caregivers. I’ve divided your care into three areas: pregnancy care, labour and birth, care immediately after birth in the first few hours or days, then postnatal care of you and your baby which is generally regarded as up to 6 weeks after birth.  I’ve included some pros and cons and look forward to hearing from you if you’re a birthing woman or a maternity care professional with any comments on what I’ve written based on my experience talking with birthing couples on the Sunshine Coast for 11 years and all around Australia for more than 25 years.