Choosing where to give birth

Having a baby in Australia is generally very safe.

However, complications can sometimes arise that may affect you, your baby, or both. Your chance of complications may be higher if you have certain pre-existing health conditions or pregnancy complications.

For example:

• heart or kidney disease
• diabetes
• high blood pressure and pre-eclampsia

Throughout your pregnancy and birth, your healthcare team is there to work with you to identify any potential concerns and keep you informed. They will support you in making shared decisions together and manage any complications in the best possible way to ensure the safety and wellbeing of you and your baby.

There are different options for where to have your baby, including:

• at home with a registered midwife
• at a midwifery unit or birthing centre
• at a hospital with midwives and obstetricians

Your chance of pregnancy complications may help determine where you should have your baby.

The choice you make about where to give birth may also depend on where you live. Access to birth services may vary across Australia.

You can have your baby in the private or public healthcare system.

Your maternity care may include a combination of public or private care from obstetricians and midwives. Your preference for where you want to give birth should be respected. However, you should make sure you are making an informed choice.

Some people choose to use an independent midwife for their birth. If you choose a midwife, they should be registered with the Australian Health Practitioner Regulation Agency (AHPRA).

Independent midwives choose to work privately, rather than be employed by a hospital.

The midwife will care for you:

• throughout your pregnancy
• during labour and birth
• after your baby is born

Private midwives may also be able to give you care in hospital.

A midwife should be present if you plan to have a home birth.

Home birth

If you have a normal pregnancy and both you and your baby are healthy, you may be able to give birth at home. However, if there are risks or complications during your pregnancy, home birth may not be a safe option.

Your midwife may recommend that you give birth in hospital for reasons such as:

• you are expecting twins
• your baby is breech
• you have had a caesarean section previously

If you give birth at home, you should be supported by a registered midwife or doctor.

Some public hospitals and birth centres can also provide homebirth services.

Home birth can provide advantages like:

• increased likelihood of spontaneous vaginal birth
• a more positive, relaxing experience
• less need for pain relief
• lower rates of problems after birth, such as infections and depression

There are also some disadvantages to consider with a home birth.

Some pain-relief options, such as an epidural, are not available if you have a home birth. You may investigate other forms of pain relief, like:

• water immersion
• a TENS machine
• breathing exercises

If you need more help, or your labour is not progressing well, your midwife can recommend you be transferred to hospital. It's a good idea to book into your local hospital just in case. Ask your midwife what would happen if you needed to be transferred to hospital during labour.

Midwifery units or birth centres are another place where you can have your baby. Birth centres are popular, so book in as early as you can.

A birth centre may feel more like a home than a hospital maternity unit. This can help you feel more relaxed. You're also more likely to go home 24 hours after giving birth in a birth centre. You may receive follow-up care by midwives in your home.

There are some things to think about if you're considering giving birth in a midwifery unit or birth centre. You may need to be transferred to a hospital birth unit if there are any complications. You may not be able to have certain kinds of pain relief, such as an epidural.

A birth centre might not be suitable if you have a higher chance of pregnancy complications, or if you have had previous labour complications. You can check with the birth centre you are interested in.

Most Australian women give birth in a public or private hospital maternity unit. If you choose to give birth in hospital, you will be cared for by midwives employed by the hospital. Your doctor will be updated regularly, and may be present at the birth.

You'll be able to make choices about the kind of care you have. If there is more than one hospital in your area, you can choose which one to go to. Your midwife or doctor can help you make this decision.

If you have a Medicare card this can cover the costs of giving birth in a public hospital.

The advantages of giving birth in hospital are:

• access to anaesthetists — doctors who give epidurals
• access to neonatologists and paediatricians — doctors who specialise in newborn care
• access to other specialist services
• that you can have a caesarean section if needed
• that your baby can be transferred easily to a special care baby unit (or neonatal intensive care unit) if needed

There are some things to consider about a public hospital birth. These include that you:

• may be encouraged to have early discharge where a midwife will visit you at home the next day
• you may be looked after by different doctors or midwives throughout your pregnancy

Choosing to give birth in the private healthcare system can have advantages like being able to choose:

• a private hospital
• a public hospital with private wards
• the obstetrician you want

Private health insurance may cover some of the costs of giving birth privately. Check with your insurance provider what is covered to during your pregnancy, birth and postnatal period. This might include accommodation during your pregnancy, birth and postnatal period. Ask your doctor, obstetrician or midwife what out-of-pocket fees are expected.

If you don't have health insurance, you can pay for private care out of your own pocket.

Private obstetrician and general practitioner

You can choose to receive care from a private obstetrician. They should be a fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or RANZCOG.

You can also choose a general practitioner obstetrician (who has postgraduate training in obstetrics). If you want, you can choose both.

You will have appointments with your doctors in private rooms. Some obstetricians work in conjunction with a midwife who helps care for you during pregnancy.

As a private patient, you may be admitted to a private hospital or a public hospital of your choice.

Postnatal care will be provided by the hospital midwives and your doctor.

Make sure that you and your birth partner have all the information you need to choose where to give birth. It's your choice. You can also change your mind at any time.

Ask as many questions as possible about your local maternity services and the risks and benefits of different birth options. You may want to travel to access more services. You can get more information from:

• your midwife
• local hospital maternity units and birthing centres
• your doctor
• the Midwives Australia website

Here are some questions you might want to ask before deciding on a hospital or birthing centre.

• Can we tour the maternity facilities before the birth?
• When can I discuss my birth plan?
• What pain relief will I be able to use?
• What birthing aids, such as a birthing chair or bean bags, are available?
• How long will the baby and I be in hospital?
• What happens if I need to be transferred from a birth unit to hospital?

For more information on birth options, you can speak to your doctor or midwife.

The Royal Women's Hospital website has fact sheets on labour and birth in different languages.

You can find your nearest maternity hospital or early childhood health centre here.