What is a midwife and why would I need one?

By Liz Wilkes, My Midwives

Before they have a baby (and sometimes after!) many people think that a midwife is ‘just a kind of nurse who helps the doctor when you are having a baby’ however this is not correct.

Midwives have a separate education process and registration from nurses, in fact many midwives have never been a nurse. They are health care practitioners who have one single area of practice – women who are pregnant through labour and birth to six weeks after a baby is born. They are the most skilled provider in care in normal birth and they are educated and registered to provide this care under their own authority – which means by themselves – referring to doctors when necessary.

Interestingly the evidence from across the world and here in Australia show that in fact care from a midwife you know – which is called ‘midwifery continuity of care’, is the safest forms of care providing better outcomes for both mother and baby. Yet many women do not know that it is even possible to have a midwife you know providing all your care from early pregnancy until your baby is six weeks old. Over the last decade midwifery continuity of care – also called ‘caseload care’ has been offered in a range of ways in hospitals across Australia to bring Australia into line with many other countries, such as our neighbours in New Zealand, who have had this option for many years.

With the popularity of midwifery continuity of care – hospitals that offer this type of care are usually filled very quickly with birthing women. So recent changes now mean that midwifery continuity of care can be offered in another way, subsidized by Medicare. In Queensland and Victoria midwives who are not based in hospitals work in a way similar to GP’s, in that women can self-refer and also receive a Medicare rebate for the visit. These midwives also have visiting rights into a range of public hospitals in Queensland and in limited hospitals in Perth and Melbourne. The midwives are called private practice midwives or endorsed private practice midwives and provide antenatal and postnatal care in the community or the woman’s home and can provide birth care in a range of hospitals. The care, funded by Medicare and/or private health insurance rebates, can start at any time during pregnancy and continues to up to six weeks after birth similar to the hospital based model.

So why have your own midwife? What is the difference between hospital caseload and private practice?

Having a midwife who you see during your pregnancy and is on call for you for labour, birth and to six weeks after birth, means you know your birth care provider. I asked people whether they would prefer having someone they know and trust or a stranger and they soon understand what I mean. In addition research categorically shows that women having midwifery continuity of care are more likely to have a normal birth, more likely to breastfeed their baby, are less likely to have postnatal depression and are less likely to have epidurals and inductions of labour. They are more satisfied with their birth. Babies the same or better outcomes for babies born under medical care including admission rates to special care nursing and Apgar scores.

The difference between private midwives and hospital caseload is really about who is actually employing the midwife and therefore who the midwife answers to – with the hospital continuity model the midwife is employed in the hospital and therefore, it can make it difficult when women want to have something that is not in alignment with hospital policy. There are also several factors that may impact whether the midwife is on call or not, and that depends on the hospital.

Private practice midwives providing midwifery continuity of care are employed by the woman – therefore the woman is calling the shots. Private midwives can generally adapt their visits more easily to meet clients needs, can have longer consultations and potentially may offer more visits after baby is born, especially in the home. Having a midwife on call for six weeks after your baby is born is an amazing option to ensure you are safe and confident in caring for your baby.

It is important to examine what the options are locally and to consider your options.  Midwives work closely with whoever else you want, or need, involved in the care of you and your baby and in addition private practice midwives can directly refer to both obstetricians and paediatricians as well as order blood tests, scans and can prescribe drugs.  If you don’t know your choices at this important time then you don’t really have any.

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Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.

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