Questions to ask yourself before you choose your care provider

GPs are the gatekeepers to maternity care — with most women relying on their GP to facilitate their decision-making about care provider, and provide the necessary referrals to the chosen model of care (Stevens et al., 2014).

In an ideal world (and with many excellent GPs) you will be given detailed counselling by your GP about the full gamut of care provider choices (and birth venues) available to you..  

This counselling should also be accompanied by an evidence-based discussion of what is best for you and your circumstances (if you want a certain type of birth, or have certain health considerations, which care provider is best suited to supporting that). Yet common experience tells us this rarely occurs, and the direction of the discussion is generally dictated by your health insurance status alone. 

A study by Stevens et al. (2014) — “What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports” found:

• Only 7.7% of women reported that all models of pregnancy care were discussed with them

• 26.8% of women reported that only one model of care was outlined to them (of those — private OB care was the most common (61.1%) followed by GP shared care (22.3%))

• GP shared care was discussed with women most frequently (64.4%), and private midwifery care was discussed least frequently (hospital birth – 12%, homebirth – 8.2%)

• “women’s health insurance status was the strongest predictor of the presence of discussions about each model”

Those results were fairly damning in terms of the limited options presented to pregnant women — with a lack of knowledge of the different models (or the differences between them, and evidence supporting them), and certain biases towards medical-models, curtailing women’s informed decision-making. Not to mention that midwifery led-care, and even more so, private midwifery care (both associated with some of the best outcomes for mothers and babies) were the least likely to be mentioned. 

While these statistics are now dated, and we hope that the increased access to birth education and information facilitated by social media and key podcasts like Australian Birth Stories and others in recent years has changed things a bit, we also know that significant numbers of you are not provided with the full spectrum of your choices, that your insurance status continues to dictate what choices are presented, and that there are ongoing issues with certain GPs refusing to complete referrals for some services.

So before seeing your GP to discuss your pregnancy, we suggest doing the research to inform yourself of the choices available to you in terms of care provider, and place of birth, and thinking about how these choices align with your values.

As well as ongoing doula support from conception through to postpartum, we offer one-off, individualised, mini and maxi birth choices consultations where we can work through this information with you and support to you to reach informed decisions about the right model of care for you. This is your pregnancy and birth, and there is every chance you will be more researched on the topic than your GP. Do the work first, and go to them for the tick-box referral. We would love to chat, get in touch.

Sources:

• Australian Institute of Health and Welfare. (2023). Australia’s Mothers and Babies. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/about

• Stevens, G., Thompson, R., Kruske, S., Watson, B., & Miller, Y. D. (2014). What are pregnant women told about models of maternity care in Australia? A retrospective study of women’s reports. Patient Education and Counseling, 97(1), 114–121. https://doi.org/10.1016/j.pec.2014.07.010