You start telling people you’re pregnant. Everyone gets excited and starts throwing questions to you; “when are you due?”, “do you know if you’re having a boy or girl?” and “where are you having your baby!?
There may be more potential answers to this last question than you think! Over the coming couple of weeks, I am going to be sharing more information about your care options for pregnancy and birth. The system can seem complicated if you don’t know where to start, but hopefully I can try to make it a bit clearer! You may have more options than you may realise! More options, more choice!
All you Perth mums-to-be are lucky; I have plenty of examples and options for you! If you aren’t lucky enough to be in Perth then have a look at how the options apply to your area; you will likely have similar models of care available to you
To put it super simply, you can choose between a homebirth, birthing at a family birth centre, public hospital, or private hospital. Each of these locations have different “models of service” that you can choose from for your antenatal, birth and post-natal care.
A doula may be able to assist with a birth at any of these locations. Some doulas choose to only work in a particular setting and some settings may have restrictions on the number of birth support people a woman can bring with her. Check out the tabs below to see your options at each location. Click the links to find out more!
Community Midwifery Program (CMP)
The philosophy of the CMP is “to protect and support natural birth and to provide clients with evidence based, holistic care from known midwives throughout the continuum of pregnancy, labour, birth and the postnatal period”.
This is another option that is available for women who meet the criteria for a “low-risk” pregnancy, however they also have the CMP risk model (more on the risk model later!).
You will be allocated a midwife who will be your midwife for all your care. They usually have a second midwife who is their cover when they are on leave and you will likely have a few appointments with them throughout your pregnancy too. This means you have two midwives who know you and your birth plan for when you go into labour. Your antenatal appointments are usually at your home.
These midwives are able to assist with births in hospitals, family birth centres or at home. When assisting with a birth at a hospital, they call it a “domino birth”. This means your CMP midwife will attend the hospital with you and continue your care in this setting. Aside from home births, the CMP program can be used for birthing at;
Kalamunda Birthing Rooms
King Edward Memorial Hospital (KEMH)
Family Birth Centre (KEMH)
Fiona Stanley Hospital
CMP books out in advance, so it is beneficial to complete the application form as soon as you can to avoid missing out. Head to the CMP website (click here) to find the eligibility criteria, more information and self-referral application form.
Community Midwifery Program - Risk Model
This model runs the same way as the CMP program (see above!) The difference is this model allows some women with higher risk pregnancies, that would have been excluded from the CMP and family birth centres, to have the continuity of care that CMP provides. Women who choose and are accepted into this model must agree to birth at KEMH.
Some of the risk factors that would exclude you from CMP but are allowed in the “CMP risk model” include a previous caesarean (hoping for a VBAC), previous post-partum haemorrhage or if you are expecting your 6th child. There are other inclusion and exclusion criteria, so be sure to have a look online: CMP – risk model inclusion criteria
As the CMP is coordinated by KEMH, you must live within the KEMH catchment area to be eligible for the risk model. They do, however, make as exception for women wishing to have a VBAC. For these women, preference is given to those within the KEMH catchment area, but those who live outside are still frequently accepted.
To apply for the CMP risk model, use the same self-referral form as applying for CMP. The form and more information can be found here!
Midwifery Group Practice (MGP) & Family Birth Centres
Midwifery Group Practice is the model of care used at both of Perth’s Family Birth Centres, an option at Armadale Health Service and some other rural hospitals around WA (including Broome and Bunbury). This model of care allocates you to a midwife who is your primary midwife. You will have a small group of “back-up” midwives in-case your midwife is unavailable the day you go into labour and you will meet these midwives during your antenatal appointments at the centre.
There are two Family Birth Centres in Perth; one based at King Edward Memorial Hospital and the other at Fiona Stanley Hospital. The one at Fiona Stanley is relatively new. You can choose to self-refer or can ask you GP to refer you. You can find the referral forms online at each of their websites;
To be eligible for either Family Birth Centre, you must be deemed to be “low-risk” and there is quite a strict set of criteria available online at each website (above). Some reasons you may not be eligible are; previous c-section, heart or lung conditions, some autoimmune diseases and if you are expecting more than one baby. Both centres are set up to feel like home, however attached to the main hospital if you need to be transferred. You are able to have pain relief, however an epidural requires being transferred to the hospital ward. This model of care aims for a discharge time of around 4-6 hours after birth (providing there are no concerns) which means you get to go home almost straight away! Don’t fret, you still get immediate post-natal care; a midwife will come out and visit you at home for the first 5 days.
They usually book up very quickly so make sure you look into this and book ASAP to get a spot.
Independent midwives, otherwise known as private midwives.
For this model of care, you can choose a midwife who will be with you for your antenatal, birth and postnatal care. This model is most common if you would like a homebirth. In saying that, many of the independent midwives are also able to assist you to birth at King Eddies. Unfortunately, none of the other public hospitals in Perth allow private midwives to have admitting rights. It is a good idea to check if your midwife is able to assist at hospital at as part of your questions before choosing the one for you.
These are private midwives. As such, this route is not cheap, but very comparable to private hospital birth option. Medicare may cover some of the cost, dependent on if the midwife is endorsed by Medicare – it’s good to check with them!
This is a very common, well-known option. To be eligible, you must go to your GP and they refer you to your nearest public hospital. Your antenatal care is provided to you by midwives and doctors (if needed) and you visit the hospital clinic for these appointments. You will be eligible for a hospital based on where you live. Unfortunately, this system does not allow you to choose a midwife or a doctor. You are seen by whoever is rostered on during your antenatal appointments and when you go into labour. Some women enjoy having lots of different midwives as they feel they get multiple points of view throughout their care.
A list of public hospitals with a maternity ward in Perth:
- Armadale Health Service
- Bentley Hospital
- Fiona Stanley Hospital
- Joondalup Health Campus
- King Edward Memorial Hospital
- Osborne Park Hospital
- Rockingham General Hospital
- St John of God Midland Public Hospital.
If you want to check which public hospital you would be referred to, you can visit this website to check. The catchment areas for each hospital change so it can be good to double check if you live between two!
My first question to you when considering this option is: do you have maternity cover on your private health insurance?
If you answered no, then I highly recommend that you continue looking at other options. Although it is not impossible, having a baby with a private obstetrician at a private hospital without private health insurance is a VERY expensive choice. Even with private health insurance, there is usually quite a lot of out of pocket expenses during the antenatal period. You will need to check how long you need to have your cover prior to having a baby as there is usually a waiting time before insurance companies will let you claim.
If you do have private health insurance or you’d like to know more anyway, then keep reading!
In this model, you choose a private obstetrician who coordinates your care with their team of midwives throughout your antenatal period and your birth. You get to know your obstetrician and their team throughout your antenatal appointments and you give birth at the private hospital where your chosen obstetrician works. Being at a private hospital usually means you have a private room and many women find they are able to stay longer in hospital after they birth. Private hospitals are known to have much nicer facilities on the wards, usually better food and your partner is often able to stay with you overnight (it would be a good idea to confirm this with current COVID-19 restrictions!).
Many private obstetricians have developed a more individual way of working. If you have an idea of your birth plan and what your priorities are in your care, I highly recommend you look for an obstetrician who also holds these priorities in how they work. Some obstetricians have specific terms in their contract that you sign when you agree to have them in your birth team. For example, there are a few in Perth who will not allow you to have a doula!
Obstetricians are the experts at obstetric surgery. They are very good at monitoring potential complications and discussing alternative pathways and interventions that are available. With this in mind, the rate of caesarean section is much higher at private hospitals compared to public. If a low intervention birth is important to you, then make sure you are asking your obstetrician about their caesarean rate and their birth beliefs prior to choosing one!
GP Shared Care
One of the first things you should do when you find out you are pregnant is to arrange an appointment with your GP. At this appointment, your GP will review your health, order some blood tests and should discuss your pregnancy care options (which is what this series of posts is all about!). One option is GP shared care. Not all GPs are registered to provide GP shared care and not all birth setting are able to accommodate it. If you plan on giving birth at a public hospital, it is likely you will be able to opt for GP Shared Care if your GP is registered.
In this model, your GP will provide your antenatal appointments. There are a couple of appointments in early and late pregnancy at the hospital you will birth at however if your pregnancy is uncomplicated, your GP will continue to provide your antenatal appointments until 36 weeks. After 36 weeks you will usually have the rest of your antenatal appointments at the hospital until you give birth.
Women who opt for this model usually choose it because they have a great relationship with their GP who knows their family history. If English is your second language, you may have a GP who speaks your primary language and can explain things more clearly to you. The cost of GP shared care is covered by Medicare if your GP bulk bills, otherwise you pay the gap (as you would for other GP visits).
Freebirth is defined as intentionally giving birth without the assistance of a medical birth attendant (such as a midwife or obstetrician). Usually a women who freebirths gives birth at home, however there is a movement of women who choose to get out in nature and birth “on the land”. Just to be clear, women who have their baby on the way to the hospital or birth centre are not classed as having a freebirth as their intent was to go to the hospital, their baby came faster than expected!
The rate of freebirth is on the rise and it is thought that most women who choose to freebirth have had a previous birth in the health care system where they have not felt supported to the point of not wanting to go back. Many women in the last year who have decided to freebirth have done so because of restrictions in place around the number of support people they were (not) able to have.
Doulas are not medically trained and therefore can attend a freebirth while still calling it a freebirth. In this capacity, it is very important for the woman and her partner to remember their doula is not able to make medical suggestions but rather is there to support them with labour and birth techniques and strategies. Professionally, as a doula, I have decided not to work with women who wish to freebirth. I feel my skill set and strengths are better suited to other models of care. There are many amazing doulas in Perth (and wider WA) who have chosen to ONLY support women to freebirth so if you are interested, I am more than happy to pass on their details to you!