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Pregnant women can get free pregnancy and postpartum care with a private endorsed midwife and give birth at the Royal Prince Alfred Hospital under a new model dubbed the best of both worlds.
The NSW-first program is designed to give women the benefits of having the same private-practising, endorsed midwife throughout their pregnancy and for eight weeks postpartum, as well as access to the facilities of a major public birthing hospital.
Simone Payn, Sydney Local Health District’s principal midwifery manager, said public hospitals had been fielding an increasing number of requests from women who wanted the continuity of care of a private endorsed midwife, but also wanted to give birth in hospital, rather than have a home birth.
“This is about giving them that choice,” Payn said. “We wanted to create a model in which, at no stage, the women miss out on anything.”
The model, a collaboration with Annandale’s Birth Time Village, is similar to GP-led or shared care: the endorsed midwife does not attend a woman’s labour and birth in hospital.
Payn said the model aimed for a seamless transfer of care from the endorsed midwife to the hospital for her delivery, then back to the endorsed midwife for postpartum care.
Private midwives have historically been prohibitively expensive, but Australia has a growing workforce of endorsed midwives trained and accredited to provide Medicare-covered antenatal care, including routine screening.
Elena, 33, is one of nine women who have so far enrolled in the privately endorsed midwives’ maternity antenatal postnatal service (MAPS).
“You get the best of both worlds,” the expectant mother said. “You have the safety in the hospital, and you have this one person you trust to care for you and who knows you as a whole person.”
Elena’s first pregnancy with her daughter (now three) was marred by fragmented, costly, “mechanical” care.
“I didn’t feel supported,” she said. “Every person I saw had different opinions … I felt they were just ticking boxes.”
Beth Newman, a private endorsed midwife with Birth Time, said: “This is what we’re trying to remedy.”
“We can be that bridge with the hospital,” Newman said, “so women know that we have those interpersonal relationships within the place they’re going to be birthing.”
Elena said the model’s continuity of care aligned with her wishes, and she felt empowered to ask questions.
The NSW Birth Trauma inquiry identified continuity of care with a known midwife as the gold standard, but demand for Midwifery Group Practice care far exceeds its availability.
“Continuity of care is the answer to birth trauma,” Jo Hunter, co-founder of Birth Time, said. “My feeling is that this sort of care is the way of the future.”
Under the collaborative model, pregnant women meet with their endorsed midwife at least six times during their pregnancy at Birth Time Village for physical checks and emotional check-ins.
Newman, said the 45- to 90-minute bookings allow women to discuss concerns or questions they have, including birth planning, and involve partners in preparations.
Women also have three to four scheduled appointments at RPA’s birth centre or obstetric clinic (at 12-14, 28-30, 36 and 41 weeks), as well as ultrasound and pathology referrals, vaccinations and anti-D injections.
“Care is very individualised,” Payn said. “If a woman needs to see an obstetrician, she can also do that through the hospital.”
These appointments were also an opportunity for women to meet RPA’s small team of midwives, one of whom would be at their birth.
Women would then receive eight to 10 bulk-billed endorsed midwife visits up to eight weeks after birth, when women are at greatest risk of postpartum complications, anxiety and depression.
Associate Professor Serena Yu at the University of Technology Sydney’s Centre for Health Economics Research and Evaluation questioned whether this model offered continuity of care, given that the midwife could not attend the birth.
“As the Birth Trauma Inquiry heard, a lot of the time what a woman is unhappy with happens at the birth,” Yu said.
Vanessa Scarff, associate professor in midwifery at UTS, said the model was “truly fantastic” despite not enabling the endorsed midwife to be at the birth.
“It’s not perfect, but it’s getting pretty close,” Scarf said of the model that would enable women to benefit from their endorsed midwife’s comprehensive understanding of the physiology of pregnancy, labour and birth.
“If they detect any deviation from normal, the woman is booked into the hospital to manage any complication in collaboration with her midwife,” Scarf said.
NSW Nurses and Midwives Association general secretary Michael Whaites was optimistic that the model would work, as it did for private obstetricians, and hoped it would eventually be offered at other NSW hospitals.
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