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Common questions

Pregnancy, birth and your health cover

This fact sheet is designed to help MBF members and their families be better prepared for the healthcare experience if they are expecting a baby.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and perhaps with other healthcare professionals in the team caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading will also help you make more informed decisions.

The birth experience: your delivery options

The birth experience is both uniquely personal and universal. Reading, talking with your healthcare team and speaking with others who have given birth are important to help you understand what is ahead of you and to decide what is right for you.

Some women like to formulate a written 'birth plan' in consultation with their healthcare team - doctors, midwives or both - detailing the support they would prefer throughout the labour and delivery including, for example, what (if any) pain management they would prefer, positions for labour and birth, support people and perhaps even specifying particular desired music. If you would like to plan ahead in this way, be sure to inform and educate your support people, midwife or doctor.

It is also important to understand that sometimes events do not go according to plan and to be open to and aware of your alternatives.

Types of delivery

Essentially, you should understand the possible types of delivery about which you might have to make choices. If this is your first pregnancy, it is most likely your pregnancy will lead to a vaginal delivery. However, there are circumstances that can't be anticipated and others that can which might make a Caesarean Section more likely. Your GP, obstetrician or midwife should explain these to you early in your preparation during pregnancy.

Many women and/or couples attend antenatal classes. While delivery options might be discussed in a group, it is probably best to talk over your personal circumstances with your doctor or midwife in learning what you need to know to effectively contribute to this decision.

Caesarean Section is usually advised to women if there is a perceived risk to mother or baby of going on to vaginal delivery. Sometimes the risk is absolute. At other times, there may be a relative risk, such as if you have had a previous Caesarean Section, or may have had medical problems with a previous delivery. It is in these situations that you should learn as much as you can as to the benefits and risks to you and your baby of choosing different options and discuss these with the healthcare team in advance.

If you have had a previous Caesarean Section, you should understand the different risks and benefits of either a subsequent Caesarean Section or vaginal birth after Caesarean (VBAC) and how they relate to your individual circumstances. The relative risks of each option has changed if you have had a prior Caesarean Section, but you may still be able to try to experience labour and delivery.

Vaginal delivery

A vaginal delivery may be either straightforward, when the baby is born with minimal intervention, or assisted, with help from forceps or other assistance.

Barring complications, vaginal delivery is usually considered both safe and most appropriate for mother and baby, offering the best opportunity for speedy recovery and the ability to enjoy a new family life, including strong bonding and successful breastfeeding. Many women feel that vaginal delivery is the optimum birth experience.

Depending on how much assistance you feel you might desire or how 'natural' a delivery you would prefer, there is often the option of a vaginal delivery taking place in a birth centre where the atmosphere is usually more that of a home or in the delivery suite of a hospital. Both these options allow for almost immediate access to assistance if it is required.

Other couples actually opt for birth at home. This option is in some ways similar to the conditions in a birth centre but due to the lack of immediate access to emergency care for mother or baby, it is rarely advocated by doctors in Australia due to safety concerns.

Caesarean Section

When a Caesarean Section is performed, the baby is removed via a surgical incision to the uterus. Although very common and safe, it is considered to be major surgery requiring epidural (spinal) or, in some cases, general anaesthesia and takes place in a hospital operating theatre with a full surgical team in attendance.

Most certainly, Caesarean is a vital surgical technique that has saved many lives, both of women and infants, and it is essential for many women. Nevertheless, as major surgery, Caesarean carries with it a number of risks including those associated with anaesthesia, an additional risk of infection over and above the normal risk for pregnancy and delivery, and risk of complications in future pregnancies.

In addition, recovery from Caesarean is slower than from a vaginal birth and time spent in hospital can be longer. A woman may experience more difficulties caring for her new baby and with other everyday tasks as the scar and associated bruising reduces her mobility for a while longer after the surgery. After a Caesarean, pain, bruising and scarring to the layers of the abdominal wall and uterus can continue to affect daily life for several weeks.

Australia's rate of Caesarean Section is high compared to many countries and is still growing. In 1994, it was already considered high when 19.4% of all births were delivered by Caesarean. In 2003, it was 28.5%. Further, women who are privately insured have a 30-40% rate of Caesareans. While this trend is happening elsewhere in the developed world, the reasons remain unclear and the benefits or drawbacks for the community and for individuals are being closely watched.

As there are specific risks and complications of Caesarean Section as well as benefits in terms of safety in many cases, you should make sure that, when you talk with your health team, you are given enough information about these risks to be able to consider them. You should also take the time to understand why and when, in certain cases of emergency or high-risk situations to you or your baby, your birth plans might have to change to ensure a safe outcome.

Vaginal birth after Caesarean (VBAC)

It was formerly considered that, after a Caesarean Section, all future births would also have to be via Caesarean: 'once a Caesarean, always a Caesarean'.

However, it is now well recognised that many women can safely give birth vaginally following a previous Caesarean. This is termed 'vaginal birth after Caesarean' or 'VBAC'.

Although underlying conditions and reasons may have required a Caesarean during the previous delivery, many doctors and midwives now encourage many of these women to attempt what is termed a 'trial of labour' depending very much on the individual circumstances of the woman concerned. This involves going into labour, with the aim seeing whether this will proceed to a vaginal delivery. The labour is monitored extremely carefully and, if problems occur, a Caesarean may still need to be performed.

If you have had a previous Caesarean, discuss the option of a VBAC with your doctor or health carer so your feelings are known from the outset. Ask about his or her views on you having a trial of labour and the reasons behind them. If, for some reason, you are not able to be comfortable with the outcome of these discussions, you have the option to seek a second opinion before you make your own final decision.

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Where to have your baby

Most birth-related health carers will be associated with one or more hospitals with labour and delivery facilities, or a birth centre attached to a hospital. Most obstetricians or midwives will recommend a particular facility and you will usually be able to tour it in person before the birth. Remember to discuss with your doctor whether full hospital and emergency facilities are on hand, should they be required. This can be important, especially for the wellbeing of your baby.

If you and your partner prefer the more home-like environment of a birth centre and there is one in your area, then visit the facility and ensure you are comfortable with the environment. At the same time, make sure you have a plan for what will happen if any complications or unanticipated risks develop during pregnancy or labour.

Higher risk deliveries, such as twins, where the placenta is in the way of the birth canal (placenta praevia), maternal high blood pressure, etc, should always be in a place where medical assistance is most easily accessed. This is usually a hospital delivery or theatre suite.

Call MBF to discuss your choice of hospital or birth centre. Some birth centres are not hospitals, therefore, your delivery may not be covered under your hospital cover or only limited emergency assistance may be available.

It is also important to remember that, if the hospital or birth centre you choose is an MBF Network hospital, you will minimise or eliminate your out-of-pocket expenses for your hospital stay.

After the birth: your hospital stay

How long you stay in hospital after the birth will depend on your birth experience, the health status of you and your baby, your doctor or other health carer's recommendations and where you live (to ensure the availability of follow-up care from a midwife after early discharge).

It is generally recommended that, so long as there are no complications, you get home to a familiar environment, away from the possible risk of infection associated with hospital, as soon as possible. After a straightforward vaginal delivery, this may be in one to three days. If you leave within the first two or three days, the hospital may organise a specialist midwife team to pay you daily home visits for a short while to check in and, if necessary, assist with any issues you may have with breastfeeding, ensure that you are healing well, generally help and answer your questions about care of your baby.

For clinical or other reasons (for example, after a Caesarean or complicated delivery), your doctor may decide that you should stay in hospital a little longer.

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Questions to ask your health carers

Choosing your healthcare team is particularly important during pregnancy. Whatever combination of care you opt for, you need to feel comfortable and well supported in your choices. Your decision about who cares for you may depend on the answers to many questions. Here are some to consider.

To the GP/referring doctor:

  • Why have you chosen this health carer (GP, obstetrician or midwife) to refer me to?
  • Do you know how many babies this person has delivered? How many babies does this carer deliver each year?
  • Which women's hospital, hospitals or birth centres is this health carer associated with?
  • Do you know anything about the other members of the healthcare team if I go to this doctor (ie. other obstetricians in the practice who may be called if your chosen doctor is unavailable)?
  • Do you know if this doctor charges a gap that Medicare or my health fund won't cover for inpatient services? Is there someone just as suitable that is more likely not to charge a 'gap' or charge a much smaller gap above the medical fee? Even so, the most important thing when you choose your doctor should be on the outcomes you can expect and their experience, suitability and expertise to your particular situation (ie. encourages natural birth, good surgeon in case of Caesarean, has specific interest and expertise in women with diabetes or high risk pregnancy, etc.)

To the specialist health carer (GP, obstetrician, midwife). Note that not all questions will be applicable to each member of the team. For example, a GP would rarely perform a Caesarean and a midwife would not perform one; however they may recommend you for one under certain circumstances. You may wish to ask them again closer to your due date.

  • How many babies have you delivered? How many do you deliver each year?
  • Can I expect to see you on each scheduled check-up visit? If not, who will I be seeing?
  • If, at any time during my pregnancy, I am worried about my health, my baby's health or go into labour, what should I do?
  • How do I contact you? If you are unavailable, who should I talk to or contact?
  • I have thought about the type of delivery I'd like. Is there anything I should be asking you that I should also think about or that might make me think otherwise?
  • What percent of your patients experience important complications after delivery, like bleeding, infection and pain?
  • What is your Caesarean rate? Under what circumstances are you likely to recommend a Caesarean for me? How does your rate compare with the average? Is there a reason why your Caesarean rate is different to the average?
  • Can I prepare and review a birth plan with you that you will support?
  • Do you deliver at more than one centre? If yes, where would you recommend I have my baby? Are there a number of birth facilities that I could choose from? Would you recommend any in particular and why?
    • Does the facility you recommend charge a booking fee? Is it refundable or non-refundable?
  • Are you likely to attend the birth? Do you have leave scheduled for the weeks around my due date? Who would be likely to attend if you are unavailable?
  • I would like to have my own support people at the birth, whether it is a vaginal delivery or caesarean. Is that's OK? How many people are allowed and do you have any thoughts on this?
  • Can you explain how much my care throughout my pregnancy is likely to cost, including the prenatal testing that you would expect me to undergo? How much of this fee will Medicare pay?
  • How much will you charge for my birth-related inpatient services?
    • Do you charge a gap that Medicare or my health fund won't cover for inpatient services? You should choose your doctor first on the outcomes you can expect and their experience and expertise, but as the gaps for obstetric care vary considerably and as there may be several options available to you, it is important that any out-of-pocket costs do not come as a surprise and that you have considered and accepted them in advance.
    • I understand a booking fee is not paid by Medicare or MBF. Will you charge me a booking fee?
  • If I choose to request an epidural or need any other anaesthesia, is there an anaesthetist you recommend? Does the anaesthetist who usually works with you charge a gap? If so, how much should I expect that to be?
  • If my baby should need treatment, is there a paediatrician that you recommend? For what sort of conditions might the hospital or paediatrician need to transfer my baby to another hospital?
  • How long do you expect me to be in hospital?
  • What is my expected recovery time?
  • What restrictions, if any, would you expect me to have for my everyday activities during my pregnancy? After the birth (ie. driving, lifting heavy objects)? If so, how long will I need assistance?
  • Have you got an information sheet that might help me get my partner, my house and myself ready in advance for bringing my baby home? For example, where can I get my car fitted for the baby capsule?

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What MBF pays toward pregnancy and birth-related services

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect in terms of your health cover, hospital and medical costs. Always check with MBF before you go to hospital.

Your hospital costs

With the exception of MBF Budget Hospital and MBF HealthSmart cover, MBF hospital cover helps pay for pregnancy and birth-related services provided that:

  • they are given to you while you have been formally admitted in a hospital;
  • they are treatments for which Medicare pays a benefit;
  • they are not an Excluded Service under your level of cover; and
  • you've met all the standard conditions of your membership (for example, serving the relevant 12-month waiting period under an appropriate level of MBF hospital cover).

Selected MBF hospital cover will pay for the following treatments and services so long as you are formally admitted to the hospital:

  • shared accommodation (or private room if available),
  • labour ward, delivery suite or birth centre costs,
  • surgery related expenses including operating theatre, and intensive care if needed,
  • most drugs supplied as part of your inpatient hospital treatment, and
  • most therapies such as physiotherapy, when provided by the hospital and associated with your delivery.

MBF does not restrict the number of days for which a benefit will be paid whenever there is clinical need for mother or baby.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that obstetrician and other doctors' charges will be part of your medical costs.

Your medical (doctors') costs

If those caring for you during pregnancy and birth are doctors, each will charge for his or her services. Ask your doctor to explain the costs of your delivery including their own fees, any fees that other doctors involved in the delivery might charge, and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. Obtaining this information is extremely important before any planned hospital admission.

Remember, there may be more than one doctor involved in the procedure. These may include the obstetrician, an anaesthetist and paediatrician. You may not meet them all in person.

Each doctor will charge for his or her services. See Going to hospital and Gap and informed financial consent for a guide to these costs.

Key things for you to know about medical costs and your health cover are:

  • Private health cover does not pay for the services of a midwife.
  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap'- an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment, ie. anaesthetist, paediatrician, etc., are 'no gap' doctors. So you may have to pay gaps for some doctors' services, but not others. Ask your obstetrician or specialist to advise whether you are likely to encounter gaps from these doctors and approximately how much. The gap may vary according to the treatment you or your baby may require, so being given an exact figure is not likely.

Remember, doctors are independent of MBF and can decide where or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

Other costs relating to your treatment and recovery

Depending on your level of MBF extras cover, MBF can also help with the cost of:

  • antenatal and postnatal classes;
  • complementary therapies such as remedial massage; and
  • gym membership fees through MBF Living Well Programs cover (restrictions apply).

If you have MBF extras cover, you'll enjoy greater value when you visit MBF MemberCare providers. At our MBF MemberCare network of providers, you can receive at least 70% of the charge back on selected services, up to the annual Limit of your cover.

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Useful resources about pregnancy and childbirth

More about going to hospital, MBF Network hospitals, no gap doctors and MBF MemberCare providers

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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