During pregnancy and birth, your healthcare team will help you identify any risks to you or your baby, and manage them in the best possible way.

Here are some of the options available to you, including public and private care alternatives. The choice you make about where to give birth will depend on your needs and risks and, to some extent, on where you live. Whichever option you choose, the place should feel right for you.

Giving birth safely

Having a baby in Australia is generally considered safe regardless of the location. Healthy women assessed to be ‘low risk’ should be offered a choice of where to give birth.

If you opt to give birth at home or in a unit run by midwives, you should be given information by your midwife or doctor about what would happen if you need to be transferred to hospital during labour, and how long this could take. This option is higher risk than hospital should something go seriously wrong during labour.

You may be advised to give birth in hospital if you have, or develop, certain medical conditions.

Making an informed decision

You and your birth partner should have all the information you need before choosing where you have your baby. It’s your choice. That said, you can change your mind at any time. Your midwife will discuss the options available in your area, but you’re free to choose any maternity service if you’re willing to travel.

You should ask as many questions as possible. As well as your midwife, you can get more information from:

• birthing centres
• your doctor
• local hospital maternity units
• Midwives Australia

Option: midwifery units or birth centres

Midwifery units or birth centres are typically comfortable, and more like a home, than a hospital maternity unit. They’re run by midwives and are popular, so book in as early as you can.

Birth centres and midwifery units are an option for women with normal or low-risk pregnancies. They aren’t suitable for women with a higher risk of complications, such as women who have heart or kidney disease, diabetes, high blood pressure, pre-eclampsia or who have had complications in previous labours. Check with the birth centre.

The advantages of giving birth at a birth centre or midwifery unit include:

• being in surroundings where you may feel more relaxed and able to cope with labour
• you’re more likely to be looked after by a midwife whom you know well.

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 delivery suite if there are any complications.
• You may not be able to have certain kinds of pain relief, such as an epidural.
• Your doctor or midwife may feel that it’s safer for you to give birth in hospital.

You’re more likely to go home 24 hours after giving birth in a birth centre, and receive follow-up care by midwives in your home.

Here are some questions you might want to ask before deciding on a birth centre:

• How long would it take if I needed to be transferred to hospital?
• Which hospital would I be transferred to?
• Would a midwife be with me all the time?
• Can I visit the unit before I give birth?
• What pain relief will I be able to use?
• What facilities are available: for example, birthing pools or baths?
• How long will the baby and I be in hospital?

Option: hospital birth

Most Australian women give birth in a public or private hospital maternity unit. If you choose to give birth in hospital, you’ll be looked after by midwives, but doctors will be available if you need their help. You’ll still have 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.

The advantages of giving birth in hospital include:

• You will have good access to obstetricians, anaesthetists (who give epidurals and general anaesthetic) and neonatologists (specialists in newborn care).
• You can access other specialist services.
• You can have a caesarean section immediately, if required.
• Your baby can be transferred easily to a special care baby unit (or neonatal intensive care unit) if necessary.

Things to consider about a hospital birth:

• You may go home directly from the delivery suite or you may be moved to a postnatal ward.
• In hospital, you may be looked after by a different midwife from the one who looked after you during your pregnancy.

Here are some questions you might want to ask before deciding on a hospital:

• 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 equipment is available: for example, mats, a birthing chair or bean bags?
• Are there birthing pools or baths?
• How long will the baby and I be in hospital?

Option: home birth

If you have a straightforward pregnancy and both you and the 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 doctor or midwife may recommend that you give birth in hospital if, for example, you are expecting twins, if your baby is breech or if you have had a caesarean previously.

If you give birth at home, you should be supported by a registered midwife (see ‘Independent midwives’, below), doctor or obstetrician who will be with you while you’re in labour. If you need more help, or your labour is not progressing well, your midwife should make arrangements for you to be transferred to hospital.

Some hospitals like you to make a booking in advance just in case.

There are some disadvantages to consider with a home birth:

• You may need to be transferred to a hospital if there are any complications during the labour, birth or afterwards.
• An epidural will not be an option at home.

Options if you have private health insurance

If you have health insurance, you may be able to choose your own caregiver — such as an obstetrician, doctor or independent midwife — and to choose a private hospital or a public hospital with private wards.

You will need to check with your insurance provider to find out what is covered, such as accommodation, during your pregnancy, birth and postnatal period. Some health insurers provide rebates for services given by independent midwives, which are not covered by Medicare.

You can also pay for private care out of your own pocket if you are not a member of a health insurance fund.

Private obstetrician and general practitioner

You can choose to receive care from a private obstetrician (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.

In this case, you will have appointments with your doctors in their private rooms, which are like a doctor’s surgery or clinic. Some obstetricians work in conjunction with a midwife who helps care for women during pregnancy.

With this option, you may be admitted to a private hospital or public hospital (as a private patient) of your choice. You will be cared for in labour by midwives employed by the hospital but your doctor will be updated regularly, and will usually be present at the birth.

Some obstetricians or doctors may also provide care during pregnancy and during a home birth.

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

Independent midwives

Some women choose to have a home birth with an independent midwife, registered with the Australian Health Practitioner Regulation Agency (AHPRA). Independent midwives choose to work privately, rather than be employed by a hospital or other health organisation.

The midwife will care for you through your pregnancy, birth and after the baby is born. This is an option for women with normal or low-risk pregnancies.

Where to seek more help

• Speak to your doctor, or call your nearest maternity hospital or early childhood health centre. You can find them here.
• Call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse.
• Visit the Raising Children Network for advice on birth options.