Choosing the best maternity care for your family
You and your partner have a variety of health care options to consider for pregnancy care. Not all of these services are available in all communities and a first step might be to take some time to investigate what is on offer locally and further afield. The earlier you start in the pregnancy the more time you will have to evaluate the services available. Don’t hurry these decisions. Weighing up the options and speaking to the relevant people will ultimately help you feel more comfortable about the decisions you’ve made. You always have the right to a second opinion and to change caregivers at any time.
Many parents give little thought to choosing a midwife or doctor and rely on recommendations from friends or their family doctor. However, choosing a caregiver is the most important decision that you will make.
There is clear research evidence that the major influences on the outcome of the birth (that is, the health of mother and baby) are the attitudes, practices and philosophy of the primary caregiver. The way this person views birth, their management style and their level of commitment to the normal birth process will determine how they care for you and the services they perform.
It is worthwhile discussing your goals for the birth and then working together to seek the caregiver who will best assist you achieve this outcome. It is quite acceptable to “shop around” for appropriate health care and interviewing potential caregivers can be rewarding.
Choosing a Birth Place
The environment in which a woman labours and gives birth has a major effect on the birth. The mother’s physiological responses will be affected by her surroundings and the result can either speed or delay the process. Her main need is to feel safe and protected from danger or harm, since during the hours of labour she will feel particularly vulnerable.
Many expectant parents assume that their baby will need to be born in a hospital. The World Health Organization states that normal, healthy, pregnant women may wish to consider a number of options, and that for these women, giving birth in their own home is the safest option. In choosing a place to give birth, the availability of suitable caregiver to assist you will be a major factor. You may find that some birth places are impractical because there is no caregiver able to provide the necessary service in that location.
Be prepared to support your partner’s choice. She may want to arrange several alternatives and make her final decision during labour. For example, she may make a booking at the hospital, but choose a midwife who can assist her in either your home or at the hospital, depending on how the labour develops and how she feels at the time.
The availability of home birth depends largely on the availability of midwives who provide this service. In some places, home birth is provided through the local health authority, and in other areas engaging the services of an independent midwife will be necessary.
You may need to make extensive enquiries to determine the availability of home birth where you live.
- Freedom to “do your own thing” in the privacy of your own home.
- No need to make special arrangements for other children.
- Your partner will be naturally in charge, since this is her own place.
- You may invite anyone you wish to attend and participate.
- Reduced risk of medical technology or drugs being used routinely – you will be asked to consent to every procedure.
- Reduced risk of infections.
- The baby will be welcomed into its own home and family with little chance of separation or disruption.
- No need for you to make hospital visits to see the baby – the midwife will provide post natal care in your home.
- Your home must have basic equipment – telephone, plenty of water and ready access.
- If there is a complication with the labour, your partner will need to transfer to the hospital which can be traumatic.
- Although the midwife will carry basic medical equipment of most situations, if there is a problem with the baby, emergency transfer to the nearest hospital may be necessary.
- You will need to arrange for additional help in the home following the birth, as your partner will still need to rest with baby for the first days, even weeks.
Hospital labour ward
The majority of women give birth in a standard hospital labour ward. Care in the hospital is free. Labour wards vary in their facilities and the degree of privacy they offer, and a visit during the pregnancy will help you to decide if this is where you want to be for the birth. During this visit, you may wish to raise the following issues:
- Are there any restrictions on whom we can invite to the birth?
- What are the hospital policies regarding:
- Position for labour and birth? Is giving birth on a floor mat acceptable, if requested?
- Procedures that are routinely performed, unless specifically refused?
- What equipment do you have to enable women to get comfortable during labour: extra pillows, armless chairs, floor mats, bean bags, hot packs?
- Do you have showers or baths available for use during labour to ease the pain?
- Breastfeeding – is the hospital accredited as being “Baby Friendly” using the World Health Organization’s guidelines?
- What are the hospital’s rates for Caesarean section, forceps, epidurals, episiotomy and induction?
- What facilities do you have for support people?
- When do you suggest we come to the hospital in labour?
Birth centers are designed to be as home-like as possible and have their own staff of midwives to oversee the pre-natal care and the birth. They aim to enable women to give birth with as little intervention as possible.
Since a birth centre operates as a separate facility it is important to register for their programme as early as possible. They often set strict limits on the numbers of clients that they can take.