Pregnancy and birth are normal parts of a woman's life, which may be shared with her family/whanau.

Choosing a place to give birth

In New Zealand you can choose where you have your baby and who will look after you.

Home

Attended by:

• an independent midwife of your choice

Birthing unit/small maternity hospital

Attended by:

• an independent midwife of your choice, or
• a GP and hospital midwife, or
• hospital team midwives.

Private maternity hospital or large maternity hospital

Attended by:

• an independent midwife, or
• an independent midwife and private obstetrician, or
• a GP and hospital midwives, or
• a private obstetrician and hospital midwives, or
• the hospital team, or
• hospital-based Know Your Midwife (KYM) or Domino scheme midwives.

In some areas of New Zealand, not all of these options may be available. If you have chosen to give birth at home, in a birthing unit or a small maternity hospital and complications occur, you can be transferred to a large maternity hospital.

Choosing a caregiver

The first health professional you see in your pregnancy is required to provide you with information regarding the options you have for caregivers and place of birth.

Lead maternity carer (LMC)

You will be required to choose an LMC who is responsible for organising your maternity care and developing your care plan with you. You will need to check whether your LMC will provide all of your care during pregnancy, labour and birth, and postnatally, or whether they will refer you to another caregiver for some part of your care. If you are not happy with your LMC or the services they are prepared to provide, you can change to another at any time. Your LMC or their back-up is required to be available 24 hours a day, seven days a week. Your LMC will be one of the following:

Independent midwife

• provides care for normal pregnancy and birth
• can provide all your care during pregnancy, labour and birth, and after your baby is born.

Family doctor (GP)

• provides care for normal pregnancy and birth and for some medical problems complicating pregnancy
• provides pregnancy care at their surgery, attends for part of labour and birth with an independent midwife or hospital midwives, and shares postnatal care.

Note: Some GPs only provide care during pregnancy, and do not provide care during labour and birth. They cannot be your LMC. All GP maternity care should be free of charge.

Private obstetrician

• specialises in complications during pregnancy and birth, and can also provide normal maternity care
• attends for part of labour and birth with an independent midwife or hospital midwives, and shares post-natal care.

All care provided by a private obstetrician involves a cost to the woman.

Hospital team

All your pregnancy, labour and birth care can be provided at a maternity hospital or a maternity clinic by a:

• midwifery team (eg, KYM, Domino)
• team of hospital specialists and midwives.

If you choose a GP or private obstetrician as your LMC you will also need midwifery care. You can choose to receive midwifery care from an independent midwife or a hospital midwifery team. All midwifery care is free of charge.

What does it cost?

Maternity care is normally provided free-of-charge by midwives and GPs. However, you may be charged for the following:

• a negative pregnancy urine test
• care provided by a private obstetrician
• care provided by a private maternity hospital
• if you are not a New Zealand citizen or do not have permanent residency
• some tests at a private laboratory
• ultrasound scans
• childbirth education classes
• transfer from home to hospital or from one hospital to another in an ambulance.

If your caregiver recommends any tests or treatments ask if these are free.

Information

You can find out about pregnancy, labour, birth and parenting by:

• talking to friends and family
• talking to your caregiver(s)
• reading books and magazines
• watching videos
• going to childbirth and parenting classes.

Childbirth and parenting classes

There is a wide variety of classes available. Many are free, some have a cost. It is important to find out which suits you. Classes may be offered by:

• private childbirth educators
• marae-based or other Maori organisations
• some independent midwives
• maternity hospitals
• organisations such as Parents Centre, the Home Birth Association and Plunket
• Pacific Island midwives
• college evening classes.

Pregnancy

Care during pregnancy can be provided by:

• an independent midwife at your home or their clinic
• a GP at their surgery
• a private obstetrician at their rooms
• a hospital team at a hospital or a community clinic
• any combination of the above. If you want a doctor and a midwife to jointly provide care, you and your caregivers must decide how your maternity care will be shared between your caregivers. This must be written into your care plan.

Monitoring during your pregnancy visits usually include urine testing, blood pressure checks, weight checks, listening to your baby's heart beat and checking your baby's growth. Blood tests are recommended two or three times during pregnancy. Also see: Antenatal blood tests

Care plan

Your LMC is required to help you write up a care plan. This plan documents who you have chosen to provide the various parts of your care, your chosen place of birth, and what tests and procedures you have agreed to for you and your baby during your pregnancy, labour and birth, and after the birth.

Tests during pregnancy

There are an increasing number of monitoring procedures and tests that may be offered during pregnancy:

• ultrasound scans
• glucose tolerance test (GTT) and polycose testing where diabetes is suspected
• maternal serum screening
• genetic screening tests eg. chorionic villus sampling (CVS), amniocentesis, etc.

Labour and birth

Care during labour and birth will be provided by the caregiver(s) of your choice.

• you may choose to have anyone you wish with you, including your own children
• you may choose a waterbirth.

Procedures during labour

If your labour does not proceed normally, you may need medical help. This may include any of the following:

• induction of labour or augmentation of labour (using medical procedures to start or speed up labour).
• electronic fetal heart monitoring
• drugs and anaesthesia (epidural) for relief of pain
• episiotomy
• forceps or ventouse assisted delivery
• caesarean.

This is not a complete list. During your pregnancy check-ups it is important to ask your caregiver to explain what these tests and procedures involve, and the pros and cons of having them. They may not be necessary during normal pregnancy, labour and birth. The final choice is yours.

After the baby is born?

Before you have your baby, you need to arrange good support from family and friends for after the birth. There are a variety of options available. These include:

• staying at home
• going home a few hours after the birth
• staying in hospital for a few days after your baby is born.

You are entitled to free midwifery care after a home birth or after leaving the hospital. Independent and hospital-based visiting midwives are available for five to 10 home visits to check on the health and well-being of you and your baby. More home visits are available if you need them. Other options include:

• Plunket services. Visits by or to a Plunket Nurse after hand-over to Well Child Services by your LMC. Plunket Family Care Centres for support and breastfeeding
• home support. This includes family and friends. Other services such as home help, child care and nappy services may be available in your area. There is likely to be a charge for these services. Ask your LMC to provide you with information about these services
• support groups exist for women with special needs, such as recovering from a caesarean section, breastfeeding problems, children with disabilities, multiple births and postnatal distress. Ask your LMC for information on how to contact any of these groups.
• if your baby is premature, unwell or has special needs she/he may be seen by the paediatrician. If your baby is seen by the paediatrician on duty at the hospital, there is no charge. However, you may prefer to have your baby seen by a paediatrician of your choice. There is usually a cost for this.

Your rights during pregnancy and birth

You have the right:

• to be treated with dignity, cultural sensitivity and respect at all times
• to choose your place of birth
• to choose your caregiver(s), and to change your caregiver(s) at any time
• to choose who will be present at your birth and to ask others to leave
• before agreeing to any procedures or being given any drug, medication or test, to ask about any side effects or risks to yourself or your baby. You can accept or refuse any treatments
• to choose how you will give birth and to feel free to follow your feelings and instincts during birth
• if transferred to a large maternity hospital, to be accompanied by your primary caregiver and support people of your choice
• to refuse to allow your baby to be fed infant milk formula if you choose to breastfeed
• not to be separated from your baby
• to make a complaint and to receive satisfactory explanations from your caregiver(s) and others involved in your care
• to read or have a copy of your medical records and your baby's medical records
• to have a trained interpreter if English is not your first language
• to refuse to take part in any research project or to withdraw from a research project at any time
• to refuse to allow student health professionals to provide care for you or your baby.

You have the right to choose.

For further information about Lead Maternity Carers in your area call the Ministry of Health's phone line - 0800 MUM 2 BE - 0800 686 223.

Original material provided by the Maternity Services Consumer Council. Reviewed by everybody, August 2008.