Women and men accessed various health services during pregnancy, IVF and surrogacy. These included antenatal care services, antenatal and childbirth classes, IVF clinics and fertility specialists, and clinics offering surrogacy services.
Parents, particularly mothers, talked about their choices and available options for antenatal care. Those living in metropolitan settings could choose between private and public antenatal care in community or hospital settings, obstetrician or midwife-led care, or shared maternity care between a hospital or birthing centre and an affiliated GP or midwife. Access to different options in antenatal care providers for people living in regional settings was more limited.
Deb described the challenges of choosing antenatal care in a small town.
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You can have private. You can go private and see an obstetrician. Or you could give birth in a public hospital in [town name] an hour and a half away. But what actually ended up happening was when we had private care and we were just going to do shared care. So we were just going to do the public system to give birth. And we ended up having our private obstetrician anyway, because he was the one on call.
And I think being down here in [town name], you have a choice of three, or maybe four. One of them was supposed to retire. I'm not sure. Three obstetricians and that's it. And two of them are married, so husband and wife, and so it's really hard to find someone that you trust. You can go north, but then you have to go to [hospital name] Hospital and we didn't want to do that. [It's an hour away] and that's a big thing. That's where we went for the ultrasound and it's a whole day. It's a big experience to go, so we didn't want to go for that.
Parents from diverse migrant backgrounds who accessed antenatal health care in Australia described positive experiences. Ajay, a migrant from India, said the health professionals and services they had encountered during his wife's pregnancy were 'excellent' while Rose from Nigeria said she felt 'supported'. A few women who had given birth to their first baby overseas were able to compare the system of antenatal care in Australia to that of other countries.
Tina compared the antenatal care system in Iran with that of Australia.
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During pregnancy there are some centres that help you, but it is not like - very organised like Australia. In Australia it is very organised, the midwives come and check, but in Iran it is not like this. You can receive the care if you got to that centre, but it is optional, you know what I mean?
You can go or you cannot go and there are some - I'm talking about four years ago, I'm not updated with the recent changes. I don't know whether they have changed the system or the system is still the same, but four years ago, or I can say five years ago during my pregnancy, this was not the common practice. You are pregnant and any time that you do have problem or you need to see a doctor, you go and see a doctor.
Obstetrician-led care?
Yes, obstetrician and in Australia you have this hierarchy of doctors like, for example, first you visit your GP and then if she thinks it's necessary, she will refer you to an obstetrician. But in Iran it was not like this.
We call an obstetrician, we make a time and maybe the same afternoon we go and visit her, and they are not really expensive, they are very cheap.
Some parents explained their reasons behind their particular choice of antenatal care. These included cost, convenience, birth preferences, and availability. Jane researched and found a reputable private obstetrician because she 'wanted to do the best' she could given she was expecting IVF-conceived twins at age 42. Several women who wanted intervention-free births chose to attend birthing centres run by midwives as they felt that intervention was more likely in a hospital setting. A few women were not able to get the kind of antenatal care they desired.
Beth was determined to have her second baby at the same birthing centre even when initially told she couldn't.
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And when I rang to book my birth into the birth centre where my first baby had been born, they said, "No, the catchment region has changed. You have to go somewhere else". And the somewhere else was somewhere I really didn't want to go. They didn't have a birth centre, they just had a maternity ward. I don't think they had any continuity of care, which the birth centre where my first baby had been born had just introduced. So you got to see the same midwife throughout your whole pregnancy, whereas in my first pregnancy, I just saw whoever was there, and also did shared care with my GP.
So I made a big fuss, and did a lot of harassing via phone and email, and made a really big annoyance of myself, and in the end, they just went, "Okay. Okay, just go away, and you can have your baby where you had it before". And I said, "Good".
Then I found out that they had a homebirth pilot programme. And I was really excited. And then we moved house, and then they said, "No, you're outside the catchment region, and there's a 20 kilometre radius for it, or 25 k". And I was like 35 or something. So I was pretty devastated about that. And I could have got my own way and paid probably three grand and had a home birth with a midwife and the birth pool in my lounge room and all that sort of thing. I just didn't have the money. I could have borrowed again, but I kind of didn't want to do that.
Anyway, I didn't have a doula the second time. My doula was interested, but I think doulas are very much a first-time pregnancy sort of thing. She was amenable to sort of turning up at the birth, but we just sort of let it slide. It just didn't happen. I had a great midwife throughout that pregnancy. And the shame was that she lives two suburbs away from here, and so both of us are like 35 kilometres from the birth centre. So she would have been perfect for a home birth. She was very pro-home birth, she was very supportive of the pilot home birth program, but we were just restricted by bureaucracy. I was so annoyed.
Many women opted for obstetrician-led antenatal care. Some women were automatically seen by an obstetrician in a hospital, while others were referred by their midwife or GP to a private obstetrician. Several parents explained that they chose a private obstetrician because they thought this would mean more 'comfortable' and 'reliable' care. Some women said they appreciated not feeling 'rushed' during their appointments with their obstetricians, and being able to talk. A few women felt that their obstetricians focused on the physical dimensions of their pregnancy and paid no attention to their emotional health.
Elizabeth felt that her obstetrician did not take her nausea during pregnancy very seriously.
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I think the obstetricians are very focused on the physical care, not so much on the emotional care. The appointments were always very brief. You were five minutes in and out. There was always a waiting room full of pregnant women waiting to go in next, so they'd feel your belly, they'd ask you a few questions, measure you - 'Yep, good to go, see you next time'. I obviously talked about feeling so ill and what can we do and with the first pregnancy the assessment was that I wasn't ill enough to require the stronger drugs and as a first-time pregnant person you don't question the obstetrician, you just say, 'Okay' [laughs] and shuffle back to your car.
And I think because they see it all the time, perhaps their sympathy levels are not as high and again it's something that's seen as just a normal healthy part of a pregnancy that you feel so unwell, and I guess the obstetricians are focused more on those really serious physical problems with the mother or the baby, you know, if the baby's not developing or the mother's got preeclampsia, all those really serious medical things that, 'I'm feeling really down because I feel so sick all the time' doesn't really factor into that at all I found. So no, there was no emotional care really at all, which I suspect was not my obstetrician so much as most obstetricians are more focused on the physical care.
Several women who experienced uncomplicated pregnancies opted for shared maternity care between their hospital or birthing centre and their GP or a local midwife. Advantages of shared care women mentioned included the ability to choose a GP or midwife located close to home or work, or the chance to build a relationship with a GP they could see during pregnancy and after their baby's birth.
Joanne had shared care between her GP and a major maternity hospital.
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So I gave birth at a public hospital and I did a shared care scheme before that during the pregnancy. So my doctor I saw more, [rather] than having to go to the hospital and that worked really well, I got with a really good system I felt. The hospital was always great when I went there. It freaked [partner's name] and I out though the first time we went for an appointment there, it's a massive waiting room full of big bellies and children running about. And we were just [laughs] sitting there, looking at each other going, 'Is this it? Is this what are we in for here?' And the kids that were running about - we were like, 'Oh god, they scream don't they, like they can be really annoying'. So it was good not to have to [laughs] go there too much, but in terms of the care it was good. And also I was happy with the hospital in terms of it being the main hospital in [city name] if anything went wrong.
Many women received midwife-led antenatal care. A few women had a private midwife, including Kirsty who hired a homebirth midwife for her first baby. Others were cared for by midwives in hospitals (supplemented by a limited number of appointments with an obstetrician) or birthing centres (midwife care only). Regardless of the setting, most women preferred continuity of care - seeing one or two midwives for the duration of the pregnancy.
Maree appreciated having continuous care from an 'amazing' midwife in her second pregnancy.
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Also we had the scans and that was really exciting. And then we found out that she had something wrong with her kidney. And so we had to have more scans and basically there was no program with the hospital, so every time I went to the hospital I had to see a different midwife who had to look up all the different information. Then I had to go to the obstetrician clinic because there was something wrong with her. And so I'd see a different obstetrician every single time. So there was no continuity of care, which I found - I didn't really think much of it at the time. It was a bit impersonal.
And then, probably just after Christmas, when I got back I had gotten on to the midwifery program which I couldn't get onto the first time because I lived too far, but they extended the radius. And that was awesome, my midwife was absolutely amazing.
Antenatal or birth education classes provided by maternity hospitals were widely accessed, especially in a first pregnancy. Parents had mixed views about the value of these classes. Josie, a mother of one, was surprised by the anti-intervention approach to labour and birth adopted by her private hospital antenatal class facilitators given her awareness of higher rates of intervention during labour and birth in private hospitals. A number of women felt that the information they received about birth was not 'realistic' - it did not adequately prepare them for birth or match their personal experiences. A few parents accessed privately-run classes facilitated by childbirth educators, for example on active birthing, and found these useful.
Sara L said that antenatal classes did not prepare her for birth or breastfeeding.
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I think it needs to be in antenatal classes, the realistic information, not just [laughs] that breastfeeding model they show you. I mean you spend what, half an hour on breastfeeding, at the class, with the crocheted breast [laughs] and the doll. I think there needs to be more focus on that rather than the birth because, let's face it, they tell you all this information about the birth, you spend six weeks doing it, and then it doesn't happen how they say it's going to happen anyway. Mine was nothing like it. No one told me your waters could break early and these things, hind waters and all this stuff can happen. Just, it was basically talking about the timing and the drugs and stuff. And half the people in my class were squeamish and didn't want to watch the video, and I was like, 'I want to watch it'.
Many parents said they would have liked more information on early parenthood in their classes, including Susanne and her same-sex partner who were upset their antenatal classes did not better prepare them for looking after a newborn.
Fred described how an antenatal class aimed at men was much better preparation for birth and early parenthood than the hospital classes he attended.
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I don't know whether it's the area that we live in but I was very lucky that I did the normal antenatal classes, which is very women-centric approach. Prior to doing that, I was asked to join a men's only antenatal group, which was probably the best thing I've ever done as a parent. And this is before I'd had kids, this is before my first child. And it was in that one that I learned there that men can get postnatal depression. I had no idea. I had no idea what the rates of it were. I had no idea what the rates of female postnatal depression were or are.
And it taught me a whole suite of skills that they don't teach in the normal antenatal classes. And that's given me a real edge on most guys. And it's not looking at it from a competitive point of view but you know, there were things that were so obvious that they were teaching us that I had no idea about and I would never have known about them. And that kind of really core set of skills like bathing and how to support your partner through the post-birth process, the years after the birth. There was just so much really good practical advice there that's really given me the skills that have helped out through this. And I used a lot of those skills during the last eight weeks, especially spotting issues with my partner and issues with myself.
Parents who underwent IVF and infertility treatments discussed the process of choosing a clinic and IVF doctor, and described experiences with other staff. Jane chose a small clinic and appreciated not being 'treated like cattle' which she thought might happen in a larger clinic. Susanne and her partner found their IVF counsellor very helpful with advice about choosing their sperm donor.
Trying IVF for a second time after her daughter died at 17 weeks gestation, it was important to
Sian that her IVF doctor have a good 'bedside manner'.
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It was unfortunate too that the IVF doctor I had at that time, he didn't have a very good bedside manner at all.
Yeah, a bit of a God complex going on with him. So I changed doctors and I changed to someone who I was recommended by a friend who was also on IVF at the time and he was amazing. They were like night and day, those two doctors, and although he never said a bad word about the other doctor, the look, the facial expressions and what he didn't say basically - they didn't get along as colleagues. That made a huge difference.
And he was amazing and I went in to see him to talk about starting treatment again but also he gave me that time to talk about losing the baby and [sighs] I don't know whether he's had people do this to him before but I actually took in some really lovely photos.
And it just really helped because we sat there and sort of I was crying and he was shedding a couple of tears. I think just my [sniffs] experience in the hospital, in the labour ward and how amazing those staff were and how amazing he was, he was feeling that loss as well and just caring for you as a person, as his patient, more determined than ever that he really wanted to have it work out next time.
Parents who successfully conceived through IVF were very grateful for this, however seeing fertility doctors and undergoing fertility treatments was commonly considered stressful or 'inhuman'. An immigrant mother from Iran, Tina became pregnant after stopping fertility treatment and thought it was because she was 'relieved of the stress' associated with intrauterine insemination.
Erin thought that going through IVF was impersonal and clinical.
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So anyway, during that time, it was another year and we still hadn't fallen pregnant. So I went back to the doctor and she was like, 'Well, if it hasn't happened now, your best option would be to go to IVF', which we just thought was, 'What?'. After having two natural conceptions, to have to go down that route. And we thought, well, we really didn't want to stop at just two. The plan was that we'd have four kids, you know. Well, that was my wish anyway. My husband only wanted two, but I always get my own way. So, IVF it was. We went for the first consult and I thought, 'Oh, this will be really easy, because, you know, hey, we've fallen pregnant before. It's no big deal'.
How wrong I was. You know, my hats go off to people that have no children, that go through IVF, because it is the most invasive, soul-destroying thing I've ever done. It's so impersonal and clinical and you've just got to check your dignity at the door. I mean, for me, I'd had kids. Had doctors, check out every orifice and it's no big deal now, because, well, once you've been through a labour and delivery there's no dignity left, is there? You've done everything. So it was confronting. It was just horrid.
Two men who became fathers through overseas surrogacy clinics talked about their experiences of the clinics they used in India. Daniel and his same-sex partner found their clinic discouraged communication between intending parents and the surrogate mother, while Matthew, a single intending father, was able to have Skype conversations with the surrogate mother of his baby.
Matthew appreciated how well the surrogacy clinic he used in India communicated with him during the surrogate mother's pregnancy.
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I investigated surrogacy in India and decided that that's what I was going to do. And signed a contract. I think it was in December, and then the following March went over to India and had organised an egg donor and an Indian surrogate and then that all sort of happened. And my daughter was conceived straight away, first attempt, which was really exciting, and nearly nine months later was born [laughs].
I got in touch with a whole lot of clinics, asked them a range of questions. The agency or clinic that I chose were people - good, really good at having lots of contact and getting back, responding to emails very quickly. And, sort of had international affiliations. So I felt quite comfortable with it. And it wasn't the doctors who were in charge, it was the agency staff instead, which I quite liked. I thought that was a nicer way than the doctors, because the other clinics, the doctors were always in charge, which meant that they were always really busy and couldn't get back to you. So at least this structure seemed - I think seemed to work better for me.
So I chose them [laughs] and then they emailed contracts and printed and signed and scanned and sent them back. And then in terms of - I got in contact with the egg donor agency, which was the same internationally affiliated services, and they gave me a list of people to look at in terms of choosing an egg donor and I think I probably got my fourth or fifth choice in the end. But that worked out to be quite well, because now the egg donor and I have contact over Facebook, which is really nice.
