When I was recently at the ‘Nambour Markets’ promoting our Face of Birth screening night on Friday, where we will also be raising awareness of continuity models of midwifery care, I was again reminded that so many women don’t know their options, before choosing a care provider, and even more seem to just choose what is culturally trendy and safe i.e. what their friends did – private hospital and obstetric care. This is despite all research and evidence pointing to midwifery led continuity of care, being the one where women report greatest satisfaction, has least intervention and the best outcomes. I wonder how many women actually know this?
So what is this continuity of care? And where can you access this?
Continuity of care means that you know the person, who is responsible for your care and she/he knows you well too. It means you have one primary person, who will do most of your care in pregnancy, during labour and birth and post-partum as well. It is someone you can create a close relationship with during your meetings before birth.
There is a fair bit of confusion about continuity of care. But as a thumb rule continuity of care is when a woman knows who her personal midwife is and has her direct contact number she can use any time.
Continuity of care here on the coast, is only really available through an independent midwife in a homebirth situation. You hire the midwife privately and pay for her yourself. She will then see you all the way through your pregnancy, most often with a back-up midwife as well. She will be there at your birth and look after you in the 6 weeks after your baby is born as well. That is continuity of care!
A new option that has hit the coast recently is Medicare eligible midwives. These midwives can provide your prenatal care either in your home or in a clinic, and you can get some Medicare rebate on the fees. These midwives are often happy to support you through a homebirth or to go with you to the hospital. Unfortunately they still cannot claim the actual birth via Medicare. And they also can’t act as a midwife in the hospital setting, only as a support person. You can still claim your pre and post natal care expenses, and then pay in full for the birth. Even though this model is still providing lots of controversy and splits among our midwives, it is still a step in the right direction to get homebirth accepted and legalized and also to get continuity of midwifery care available to many more women, without great cost.
Our public hospitals don’t provide continuity of care. The midwifery clinic in Noosa does however, have only two midwives who will see you through your pregnancy. They don’t work in the birth suit though, so won’t be with you at your birth, but they will see you again after your baby is born. But this is only available for women in Noosa.
Caboolture hospital do have a very small and limited service of one to one midwifery called ‘holding hands’, but it is not for Sunshine Coast women yet and they don’t provide the homebirth option either.
The same goes for our private hospital. There is no midwifery continuity of care here either and it is still the midwife you will be working with during your birth. Hiring a private doctor does not count as continuity of care in my books. It is nice to see the same person many times during your pregnancy, but a private obstetrician will not guarantee you to be there at your birth and if he/she is there, it is generally very brief or even just on the phone.
So what is all this fuss about continuity of care?
As I mentioned in the beginning, all research and evidence points towards midwifery models of continuity of care being the one where women report greatest satisfaction, has least interventions and the best outcomes.
On top of this we can look at how birth works.
The main hormone in birth, which is responsible for contractions, dilation and birth, bonding and falling in love with your baby, and the breastfeeding ejection reflex, is Oxytocin, also called the love hormone. Michel Odent calls it the shy hormone, because to work well, it requires an environment where the woman feels safe, loved, have trust in the people around her, feels nurtured and private. What oxytocin doesn’t like is bright lights, questions, strangers, fear and being watched.
So to promote oxytocin, which is the same as promoting normal birth, you really need an intimate relationship with your caregiver, who will know you well by the time you are ready to give birth, and whom you will have developed a feeling of safety and trust with. It also calls for homebirth, birthing centers, but that is a another blog post all together. Continuity of care is not just about low risk birth though, which in many settings are the criteria for getting it. It is about women, and proper maternity care for all kinds of births.
So women out there……the evidence is there, but the politicians are only going to get off their ‘butts’ if you are demanding these choices to be available to you. As midwives and doulas we can jump up and down, but ultimately it is women, as consumers, in great numbers, who holds the power.
On a last note, please don’t just take my word. Do your own research, and make sure you choose the best option for you. Continuity is good for all kinds of birth choices. Even if you are deemed ‘high risk’, you still deserve proper care from a known midwife, who can also help you get the appropriate help, if it is outside her scope.
It is your birth and your choice. What kind of care would you really like?