Experiences of health services during pregnancy, IVF and surrogacy

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.

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.

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.

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.

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.

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.

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.

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.

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'.

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.

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.