Birthing options in the Perth metro area: what is right for you?
The maternity care system in Australia can be a tricky one to navigate and as a result, women are often unaware of the different options available to them for birth. YES we have options! Culturally we tend to associate childbirth with hospitals, but there are other choices out there!
Prior to booking in with a maternity care provider, it is important to think about what type of birth you would like. For example, are you considering a home birth? Are you planning a natural, drug-free birth? Would you like the options of having pain relief? Do you want a midwife or a doctor to attend the birth? Would you prefer the option of having an elective Caesarean? You may even be considering a free-birth. Depending on your thoughts relating to these questions, you can then look for a care provider who will meet your needs. I have provided a summary of birthing options for the Perth metro area, along with some points to consider for each.
Remember - this is YOUR pregnancy, YOUR birth, and YOUR choice. You need to find a care provider who will support your preferences for birth. Trust your instincts - if something doesn’t feel right then it isn’t. You have every right to change care providers at any point during your pregnancy journey, even when you are in labour!
Your Birthing Options – A Quick Summary
In terms of where you can birth your baby in the Perth metro area, I’ve listed your options below. There are several pathways of maternity care you can access, although this is of course optional, and I’ve provided more information on those further on.
At home, either with CMP midwives, a private/independent midwife, or by yourself supported by whoever you wish (free-birth).
At a birth centre – there are 2 in Perth; one in Subiaco alongside Kind Edward Memorial Hospital and one in Fiona Stanley hospital in Murdoch. Each have their own catchment areas.
At a public hospital – there are 9 in the Perth metro area with maternity services. Where you live will determine which public hospital you can book with.
At a private hospital – there are 4 in the Perth metro area with maternity services. Peel Health Campus in Mandurah also has a private maternity ward. There are no geographical restrictions and you can book with whichever private hospital you prefer.
Wherever you like if you are looking into free-birth – some women choose to birth at home, in their garden or in the ocean, usually in a place with which they feel a deep connection.
The Deep Dive into your Birthing Options
In the following sections I take an in-depth look into the birthing options available across the Perth metro area, including their locations and a positive and negative point to consider for each. It is important to remember that these are subjective – I have tried to be as neutral as possible but ultimately you may think differently and that’s OK!
Free-birth
Free-birth is still a rather controversial birthing option in Australia, and there is a common misconception that free-birth is actually illegal. This is not the case at all, and I also feel that it is necessary to state that maternity care in general is not mandatory either. I read somewhere on social media recently that up until the medicalisation of birth, free-birth was simply. . .birth! That really prompted me to reflect on my own perspective.
Free-birth is essentially giving birth to your baby without the assistance or presence of a trained healthcare professional (such as a midwife or obstetrician), instead you are supported by whoever you choose. Some women choose to have a doula present for their free-birth, although it is important to remember that doulas are not a midwife-substitute and cannot assist you with the birth. Some doulas do not feel confident with taking on clients who are planning to free-birth so if you are considering hiring a doula, this may be the first question you ask them.
Free-birth is becoming more popular in Australia, especially during the Covid-19 pandemic which has pushed many women to research alternatives to birthing in hospitals. To be honest, I am surprised that the number of women who choose to free-birth isn’t higher given the fact that many women are ‘risked out’ of accessing the services of the CMP and birth centres (more on that later!). However, with birth being portrayed as dangerous and unsafe in our society, and those who choose to free-birth pigeon-holed and vilified by the media, it isn’t a shock to see that many women are funnelled into the hospital system as a result.
Food for thought:
+ Freebirth gives you complete autonomy, freedom, and control over your birth experience.
- Given its’ controversy, you are likely to encounter some very unpopular opinions regarding your choice.
Community Midwifery Programme
Clinic Locations:
Lakeside Shopping Centre, Joondalup.
King Edward Memorial Hospital, Subiaco.
Kalamunda District Hospital. Kalamunda.
Lanao Way, Atwell.
Birthing Locations:
In your own home.
Family Birth Centre, Subiaco.
King Edward Memorial Hospital, Subiaco through the Risk Model or VBAC Model.
Kalamunda Birthing Rooms, Kalamunda.
The Community Midwifery Programme (CMP) supports women with low-risk pregnancies within a 50km radius of Perth CBD. Upon being accepted into the programme, you will be allocated a primary midwife who will conduct your antenatal appointments wherever possible. These will either be done at one of the CMP clinics, in your home or at the hospital. Your birth will be attended by the midwives on-call. It may not be your allocated midwife, but the midwifery teams are relatively small, so you are likely to have met them during your pregnancy care. The midwives will then visit you at home for your postnatal care.
The CMP also offer a risk model of care for women with certain ‘high risk’ pregnancies, for example if you have had a previous Caesarean, although you have to birth at KEMH. There are inclusion criteria for this service which can be found here.
Food for thought:
+ The evidence shows that midwifery-led care leads to better outcomes for mother and baby.
- The CMP has very strict criteria for eligibility, meaning that these services are not accessible for all women. I have included a link to their exclusion criteria here, although it is not very detailed.
Birth Centres
Midwifery Birth Centre, Bentley - scheduled for completion in mid-2024
There are two birth centres in the Perth metro region (with one more on the way), staffed solely by midwives, and they support normal birth for “low risk” women. Both birth centres have catchment areas, so access to these services will be dependent upon which suburb you live in. Places are also limited as the birth centres are small – there are 3 birth suites at Fiona Stanley and 4 at Subiaco.
You can book to just have your baby at the birth centres, or you can also apply to have your antenatal care here too. Both offer continuity of care through a Midwifery Group Practice (MGP) service. After being accepted into the programme, you will be allocated a primary midwife. All your antenatal appointments (excluding your ultrasound scans) will be done at the birth centre, with your primary midwife wherever possible.
Food for thought:
+ The facilities tend to be more homely and inviting than the hospitals, with less medical equipment which adds to that ‘clinical’ feeling.
- Many women are excluded from accessing these services because their pregnancy has been deemed ‘high risk’. I’ve provided links to the exclusion criteria for Fiona Stanley here and for Subiaco here.
GP Shared-Care
If you have a great relationship with your GP and they offer shared maternity care (not all GPs do), this may be a convenient option for your antenatal and postnatal care. Most of your antenatal appointments will be with your GP and they will submit a referral to the hospital whose catchment area you fall into for the birth (click here for more information on this). You may be required to attend the hospital for a booking appointment around 24 weeks and from 36 weeks onwards, all your remaining antenatal checks will be at the hospital. The GP will then see you around 6-8 weeks after the birth for your postnatal check-up.
Food for thought:
+ Your pregnancy and postnatal care will be provided by a practitioner with whom you already have a good relationship and is familiar with your health history.
- In my experience unless it is a specialty of theirs, GPs are not as knowledgeable about pregnancy and birth as midwives.
Privately Practicing Midwives:
Vicki Hobbs from Back to Basics Birthing has written an excellent post which includes a list of private midwives who practice in the Perth metro region. Click here to be redirected to Vicki’s website.
Private or independent midwives have much more autonomy with their practice as they are not employed by an organisation and are therefore not restricted by rigid policies or guidelines. This is a great option if you are planning for a home birth and are unable to access the CMP or have been excluded from booking with the birth centres due to their eligibility criteria. Engaging the services of a private midwife means that you will have continuity of care for your entire journey, from pregnancy right through to your postpartum period. They work with back-up midwives, who cover them in the event of sickness or holidays and will attend your birth alongside your primary midwife. All appointments will either take place in the comfort of your own home, or at their place of business. As well as facilitating home births, most private midwives also have admitting rights to King Edward Memorial Hospital and Fiona Stanley Hospital. This means that if you choose to birth in hospital, or a transfer is recommended during your home birth, your private midwife can still care for you on admission. If you are transferred to a unit where the midwife does not have admitting rights, she will remain with you but in a support person role. This, however, is ever-changing in the current climate of Covid-19 restrictions and vaccination mandates, so it is best to discuss this with your chosen private midwife before booking.
Food for thought:
+ Private midwives enable women who have been deemed ‘high risk’ by other organisations to birth at home and receive midwife-led care, which has been linked to better outcomes for mother and baby.
- This does come at a cost - privately practicing midwives charge a fee for their services, usually between $4000 - $10000, but you may be eligible for partial rebates through Medicare for aspects of their care. If this figure comes as a shock to you, I think it is important to weigh up the financial investment against the long-term benefits of receiving continuity of care from a midwife you have built a trusting relationship with and who is highly skilled at facilitating physiological birth.
Doulas
Find a doula in your area here:
o https://doulatrainingacademy.com.au/find-a-doula/
Doulas provide you with continuity of care during pregnancy, birth and beyond so you feel truly supported.
DONA International defines a doula as “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible”.
Doulas are non-clinical professionals and their services do not replace maternity care from a registered healthcare professional. Doulas work within a scope of practice, and I feel it is important to emphasise the main aspects of this – doulas are unable to carry out any clinical assessments of mother or baby, cannot prescribe medication and cannot provide medical advice. Doulas support women during labour and birth at home, in hospitals and birth centres, and some doulas attend free-births also. Most doulas also offer extensive postpartum support options, an area in which our current maternity system is woefully lacking. A recent Cochrane review of the evidence demonstrates that women who hire doulas for labour and birth support are less likely to have a Caesarean; less inclined to ask for medical pain relief; likely to have a shorter labour and more likely to be satisfied with their overall birth experience.
Food for thought:
+ Doulas are employed by YOU. They remain completely objective and will support you regardless of the birth journey you choose.
- Doulas charge a fee for their services, ranging from around $1000 - $5000 depending on the level of support you require. There are no Medicare or private health rebates for doula services. If cost is holding you back from hiring a doula, it may be worth looking into student doulas as they often charge lower fees in exchange for the experience. Again, this comes down to the value you place in the many proven benefits of hiring a doula versus the short-term financial outlay.
Public Hospitals
If you choose to birth in a public hospital, your GP will refer you to the one which falls within your geographical area - click here to find out which hospital you will be referred to. If your pregnancy is straightforward, your antenatal appointments will be with a midwife. If there are any complications or the midwife has any concerns, these will be discussed with you, and you will be referred to an obstetrician for review. During your labour, most of your care will be provided by midwives. If you have seen an obstetrician during your pregnancy then the doctor on-call may pop in to see how you are doing and depending on the situation, may be present or assist with the birth. Midwives are experts in normal pregnancy and birth and if everything is progressing well, you will remain under midwife-led care until you are ready to go home.
Public Hospitals in the Perth Metro area (north to south):
Joondalup Health Campus, Joondalup.
Osborne Park Hospital, Stirling.
St John of God Public Hospital, Midland.
King Edward Memorial Hospital, Subiaco.
Fiona Stanley Hospital, Murdoch.
Armadale Health Services, Mount Nasura.
Rockingham General Hospital, Rockingham.
Food for thought:
+ Being in a hospital can provide feelings of safety and reassurance, knowing that help is there if needed.
- Ultimately, hospitals are large organisations and have guidelines and policies in place which inform midwives’ and doctors’ practice, which may vary slightly depending on which hospital you are booked into. It is important to remember that these are not law, and you cannot be forced to follow these recommendations. However, being in a hospital environment can make advocating for your choices difficult, especially if they contradict medical advice.
Private Hospitals
If you choose to birth in a private hospital, then you can choose which one you would like to book with regardless of where you live. A referral from your GP is usually required. You can either choose your hospital and then the GP will refer you to one of the obstetricians, or you can choose your preferred obstetrician and the GP will refer you directly to them. Please keep in mind that your chosen obstetrician is subject to availability, so it is a good idea to research a few options just in case your first choice is fully booked. Generally speaking, most women who choose this option have private health insurance. It is important to check with your health insurance provider what aspects of pregnancy and birth your policy covers to give you an idea of any out-of-pocket costs and whether there is a waiting period for maternity care claims after joining the fund or adding pregnancy care to your existing policy. It is possible to birth in a private hospital without insurance, just be aware that the financial costs will be significant. You will have to pay for each appointment, including scans. These costs may be covered by your private health fund, or you may be eligible for a partial rebate through Medicare. At your first appointment with the obstetrician, it is important to ask for clear information on their fees. Private obstetricians require a pregnancy management fee which can range from $3000 – $5000. Birth can be unpredictable, and any complications will likely increase your costs, for example if your care requires the services of an anaesthetist or if your baby requires any medical care after the birth. This government website contains objective information about private health insurance and may be helpful - click here.
Your antenatal appointments will be with your chosen obstetrician, usually at their private consulting room. During labour, you will be cared for by the hospital midwives and your obstetrician (if they are available) will be called in for the birth. Women who give birth in private hospitals normally have a longer stay during the postnatal period, ranging from 3-5 days. Your care after the birth will be provided by the hospital midwives, with a follow-up visit from your obstetrician.
Private Hospitals in the Perth metro area (north to south):
Joondalup Private Hospital, Joondalup.
Peel Health Campus Private Maternity Ward, Mandurah.
Food for thought:
+ The general facilities and services are likely to be more ‘luxurious’ compared to public hospitals and include the option for your partner to remain with you for the duration of your stay.
- It is important to note that obstetricians are experts in managing complications and sadly they rarely witness normal physiological birth, therefore the likelihood of experiencing medical interventions such as induction of labour and instrumental births is very high, especially in a private hospital.
To Sum Up…
Did you realise just how many maternity care options are available in the Perth metro area? There is a lot of information here to digest but choosing the right maternity care provider for you is an important decision. Ultimately, the pathway of maternity care you choose will influence your birth experience.
Now it’s over to you…!
My name is Mel Howells and I am a doula who has trained with the Doula Training Academy. Every pregnancy and birth are different, and no two women will experience the same journey to motherhood. The philosophy which underpins my services acknowledges every woman’s uniqueness and my work is tailored to meet your every need. If this resonates with you and you want to learn more about what I offer, please feel free to send me an email at mel@serenebirths.com.au or reach out to me via social media on the links below. I would be honoured to walk alongside you on your birth journey. If you would like to find out more about my offerings, please click here for packages or contact us.
Sources and Further Reading:
This is your birth - choose what feels right for YOU!