Models of care in pregnancy


Pregnancy models of care – do they really matter? 

Public or private care? That's the first question most families consider when choosing where to birth their baby.  Soon most realise that the choices are so much wider than even that!

When I was pregnant with my first baby these were the questions I first asked myself when deciding what to choose:

Public or private obstetric care? 

I chose private.

Why? Partly for some assured privacy, as I was working as a training obstetrician at the co-located public women’s hospital.

Though mostly in the knowledge that by choosing a private obstetrician I had a fully qualified specialist, of my choice, available to me 24/7. Continuity of care was also a high priority, allowing me to be cared for by the same obstetrician, her colleagues and midwives throughout my pregnancy.

Unfortunately direct consultant-obstetrician care and continuity of care throughout pregnancy, birth and post-natal time, is only available at very few public hospitals. Choosing a private specialist practice provided this for my baby, family and I.

What if I had birthed at the public hospital? I would have certainly chosen a midwifery team model – again for the importance of continuity of care.

Which maternity hospital? 

The private hospital I choose was co-located on site with the public hospital.

Why was this important?

Because this provided the best of both worlds. As an obstetrician I’ve seen the best and the worst of birth, and I wanted to make sure that both my baby and I could directly access either the neonatal  (NICU) or adult intensive care unit (ICU) in the unlikely event that this was needed. Similarly, having a public hospital on site provided the added backup of 24 hour trainee obstetricians and anaesthetists if there was an emergency and my obstetrician was not yet in the hospital.

I was also keen to avoid any separation from my baby. Because my private hospital was co-located I would not have needed to leave the building to access and visit the NICU.

Male or female obstetrician? 

I think this is a deeply personal choice.

It must first be recognised that interpersonal skills, surgical skills and birthing skills are not gender dependent. My recommendation is to find someone with all three skills, and then choose based upon on their approach to healthcare and birthing.

I chose an all-female group of obstetricians, as these obstetricians best reflected my personal views on birthing and parenting, and were the best fit for me personally.

Individual obstetrician or a group practice of obstetricians?  

I chose a group.

Why? I strongly value transparency. I wanted to know exactly who could or would be at my birth, and by choosing a group I knew this from day one. An obstetric group that only covers within their group ensures you know exactly who could or should be at your birth. I also knew that  because of their rostering I would always be assured of a well-rested obstetrician regardless of the time of day or night.

In the group I choose I met all three other obstetricians during my pregnancy, so not only did they know me, but I knew each of them and we were able to share our expectations for my pregnancy and birth.

All birthing healthcare providers should be driven by safety, patient education and surgical excellence. You should be comfortable expecting this with whatever model you choose.

Be your own advocate or seek out others who can be.  Your birth involves you, your body and your baby.

Your voice should always be heard.