Birth Options In Newcastle and the Lower Hunter

When I went to my local doctor for a formal pregnancy test, the first question she asked was what kind of pregnancy care I wanted. I had zero clue what options even existed, let alone who or how to choose!

If you’re having a baby (or hoping to) AND you live in the Newcastle-ish area, here is the whole deal spelled out for you.

I provide 3 types of information for each location or service type: 

1. An introduction to the service and referral pathways
2. Statistics regarding births at their service
3. How much it costs.

Please note that estimated costs do not include additional support services like doulas or personally hired/purchased equipment like birth pools.

If you'd like an overall view of the maternity system in Australia, you can start by listening to this episode of the Science of Motherhood podcast titled "What you need to know about the Australian Birth System".

As someone who does both birth mapping (a type of birth preparation that plans out your choices under multiple scenarios) and birth story listening (a type of birth debriefing that focuses on helping you understand and feel differently about your birth), I'd strongly encourage you to consider what your ideal birth looks like. Consider:

Where are you?

What does the room look like?

Who is with you?

Have you got to know your care provider for birth, or are you happy with whoever is on shift supporting you?

What methods of pain relief do you want to have available to you (keeping in mind that some like the epidural are a double edged sword)?

Once you have a vision of what you want, aim to find a pregnancy and birth care provider who sees and facilitates that type of birth most often. It is much easier to work with someone who gets what you want and is confident in making that dream become reality than it is spending your pregnancy and birth fighting against the tide of an unaligned provider's usual care route, which is the one they feel most confident in managing. 

A note on statistics

Even when a provider says they support your preferred type of birth plan, it is pretty common for their tune can change later in pregnancy or even during birth, which makes it helpful to know their statistics. 

That said, stats are just stats! They can guide your care stream decision making, but do not totally dictate your experience. Birth can be great - I've done it twice! But you do need to have your wits about you going into systems that are based to serve their own needs as much (if not more than) their patients.

Please note when reading the tables regarding hospital births below that the figures shown are for "selected mothers" only. This gives a snap shot of a consistent group of patients across health services, which makes it easier to compare and monitor trends. This group includes women who are:

• 20–34 years of age at the time of giving birth
• Giving birth for the first time at 20 weeks or greater gestation
• Pregnant with a single baby
• Whose baby has a cephalic (head down) presentation
• During the period 37 weeks and 0 days to 40 weeks and 6 days gestation.

If your situation is different to that listed above, you may need to do some more digging as to what outcomes patients like you experience as each service so you can make decisions about which care pathways are best for you.

If you're a first timer, there's a chance you'll be outside this range anyway - due dates are a VERY inexact science and the average spontaneous (non-induced) labour day for first time mothers and birth parents is actually 40 weeks + 5 days. To spell that out, it means 40+5 is the point that half of babies will be born, half babies will be born at 40+6 or later. This is normal and "going overdue" is not a reason for induction without the presence of specific medical complications!

If you have been told you will be a "high risk" patient or are "going overdue", I would also highly recommend looking into the work of Dr Sara Wickham, whose books on important topics such as induction and Plus Size Pregnancy give far greater information (and in unbiased way) than most short medical consults have scope to provide.

When it comes to statistics for privately practicing midwives (PPMs), there is no data available for "selected mothers" as a separate group, so data for all births (including situations where the mother/birth parent is older, plus size, having a vaginal birth after caesarean or other "higher risk" situations) is included together. This makes it harder to compare against other provider groups, but as you will see later, the general take home message is that the PPM patient cohort are higher risk than the women represented in the other hospital-based provider stats tables here, yet their record is a whole lot better!

John Hunter Hospital

Most babies in the Hunter region are born at John Hunter Hospital (JHH), which is a major public hospital.

“The John” has three birthing zones – the Birth Suite (previously called the Labour Ward), the Birth Centre (for low risk birthing parents under the care of the JHH Birth Centre Team Midwives) and the operating theatre for caesarean births.

FYI - The Birth Centre has some (but not all) rooms with baths, and the Birth Suite doesn’t have any.

Women with uncomplicated pregnancies have the options of “shared care” (that means some appointments with NSW Health and some with their GP) or using community antenatal clinics for check ups during pregnancy. If you take this route you will birth in the Birth Suite. If you birth at the Birth Suite, it is unlikely you will have a known midwife on duty at the time of your birth. If you go through the JHH Birth Centre Team Midwives program, you have a better chance of having previously met your midwife.

You can read more about JHH options and take a virtual tour of the facilities here.

It is possible to have breech births and VBAC (vaginal birth after caesarean) at JHH (although you may have to advocate strongly for your decisions in some circumstances). If these options are denied to you by certain medical staff on duty, you can contact the hospital and request to speak with the patient liaison rep or Head of Maternity Services, and ask to be paired with supportive providers instead. [If you know you're going to be up against it or don't know who will be on duty during labour, this might be a good indication to look into hiring a birth doula.]

Specialty support teams available at JHH include:

• Birra-Li – for Aboriginal and/or Torres Strait Islander women, or women having an Aboriginal and/or Torres Strait Islander baby.
• Specialist and M3 teams – for women with complicated pregnancies and/or obstetric conditions.
• There are also Family Care Teams for mothers with special needs, the Multicultural Health Unit for families from Culturally and Linguistically Diverse Backgrounds, Aboriginal Liaison Officers to assist Aboriginal and Torres Strait Islander patients, and support for mothers with differing needs (e.g. drug and alcohol services, counselling and social work, dietetics, and physiotherapy).

Some private obstetricians also work at JHH. Your antenatal appointments would take place at their private consulting rooms, and you would birth in the Birth Suite or operating theatre. Your obstetrician would not necessarily personally attend your birth, unless you undergo a scheduled caesarean section. Gap fees would be applicable (this is on top of your private health fund fees) for the outside-of-hospital consults.

Birth stats for JHH

Data based on reports of selected first time mothers aged 20-34. Sourced from official NSW Health Stats data.

Out of pocket costs for birth in public hospitals is estimated to be $0-1500. (unless birthing with a private obstetrician, as mentioned above).

Maitland Hospital

Maitland hospital is also a public hospital. Information about birthing options at Maitland is quite similar to that at the JHH.

Midwifery care at local health clinics, shared care with your GP, specialist care under medical obstetric teams (for complicated pregnancies) and using a private obstetrician are all options for care.

Accessing care through the Midwifery Group Practice is the most likely to see you having a known midwife at your birth.

Aboriginal and Torres Strait Islander women or those having an Aboriginal and/or Torres Strait Islander baby can have their care provided by Naae-Wanni midwives and Aboriginal Health Care Workers at home, community antenatal clinics, or Mindaribba.

More info here.

Birth stats for Maitland Hospital

Data based on reports of selected first time mothers aged 20-34. Sourced from official NSW Health Stats data.

Out of pocket costs for birth in public hospitals is estimated to be $0-1500.

Public hospital birth is also available at Singleton, Scone and Muswellbrook hospitals. Those requiring specialist or higher level care are referred on to Maitland Hospital or John Hunter Hospital.

Newcastle Private Hospital

According to their website, 2000 babies are born each year at Newcastle Private Hospital. All patients birthing here are under the care of a private obstetrician, who they see for their pregnancy appointments. This does not necessarily mean their OB or a known midwife will attend their birth.

[A note that if you have conceived with assisted technologies you do not have to continue care under your same specialist. You are free to choose from any of the care options discussed in this article that are suitable to your level of risk and personal preferences.]

There are no waterbirth facilities at NPH. You can read more about the facilities and services provided on their website here.

Unfortunately, there was no individual hospital data published for private hospitals in the NSW Mothers and Babies 2022 report, but the previous three years of data are as follows:

Birth stats for Newcastle Private

Data based on reports of selected first time mothers aged 20-34. Sourced from NSW Health official data.

It is interesting to note that amongst the 20-34 year age group of low-risk first time mums, there is a private/public hospital statewide difference in birth outcomes in NSW and Australia-wide. While it can be worthwhile for some families, paying for health insurance and private obstetric care does not always guarantee more “control” over your birth experience. This is especially true if you are seeking an intervention-free birth (because private hospital staff are most used to facilitating medically managed births), or you know that your babies will need NICU or other high-level care post-birth (because these are provided in major public hospitals, not the smaller private ones).

Data based on reports of selected first time mothers aged 20-34. Sourced from NSW Health Stats official data. 

This gap also extends to breastfeeding statistics, which may be a factor you feel is important to consider. The 2022 numbers are:

Out of pocket costs for birth in private hospitals is estimated to be $2500 to $20,000. This is on top of your private health fund fees before conception, during your pregnancy and postnatal period.

Belmont Midwifery Group Practice (BMGP)

A team of approximately nine NSW Health (publicly funded) midwives operate from the birth centre at Belmont Hospital. This service is for women identified as low risk at the JHH booking in visit. Be aware that it is not likely to be directly offered to you by the person taking you through that appointment! You will probably need to ask to be referred to Belmont MGP - double check you are being referred to the Midwifery Group Practice and the Birth Centre, not just to the John Hunter's satellite antenatal clinic that operates from another area of Belmont Hospital. You may also be able to self-refer to BMGP - the earlier you are in your pregnancy the more likely, however it's worth a try later down the track too. Call the unit to find out more on (02) 4923 2108.

When cared for by BMGP You are assigned a primary midwife who you will see for the majority of your antenatal appointments at home or Belmont Hospital. They are the person who is most likely to attend your birth, but you will meet others on the MGP team during your pregnancy as well in case your primary midwife is off call when you go into labour. If you live within a certain radius from JHH you can elect to homebirth with BMGP support. More info on BMGP can be found at the Friends of Belmont Birthing community supporters website.

Monthly stats for BMGP are published on the Friends of Belmont Birthing Facebook page and their Instagram. Because these are made available separately to the NSW Mothers and Babies report, the 2023 stats are available to share with you, not just the 2022 ones. These are the numbers across all of their patients, not just the "selected" first timers:

• 79.2% spontaneous (non-induced) vaginal births (without instruments, e.g. forceps or vacuum)
• 8.8% instrumental births
• 12% caesarean section births
• 36.5% of babies were born at home
• 64% of the births at Belmont Birth Centre and at home were waterbirths

Induction of labour was not directly reported, however at least 197 of the 236 babies born under BMGP care began their labour/birth outside of JHH, meaning a minimum of 83% of their patients were not induced. 

Out of pocket costs for birth through the publicly funded hospital system (of which BMGP is a part) is estimated to be $0-1500.

Private Midwifery Care

Most people using a private midwife choose to have their pre- and post-natal appointments at home, and birth there too. Private midwifery care is preferred by many for personal and cultural reasons, and provides gold standard continuity of care. In this care model the same person will be with you for your pregnancy appointments, your birth and six weeks of postnatal care visits. Privately practicing/independent midwives have additional training compared with the majority of hospital midwives. A second midwife attends the birth as well, so there is one midwife for the mother/birth parent and one midwife for the baby if there are any complications postbirth. Those interested in the safety of home birth are encouraged to read more here. 

Many people don’t know that private midwives can work in collaboration with obstetricians and public hospitals as well. This means it is possible to have a private midwife for all your pre and post-natal appointments yet birth in a hospital if this is your preference (you will need to ask each midwife separately if this is something they do - some do, some don't).

Our region is serviced by the following privately practicing midwives, who provide thorough continuity of antenatal care, birth support and postnatal care. Different midwives will be comfortable with taking on patients with different levels of "risk", so it's a good idea to check out all their websites, interview 2 or 3 and see who feels like a good fit for your situation, family and outlook on birth. If you're interested in this model of care, I'd encourage you to do this ASAP as they only take a few families per month each and do fill up quickly!

• Helen Young - Homebirth With Helen
• Haley Weir - Nurturing Birth
• Di Longworth (pre and postnatal appts only) - Valley Births
• Bibi - Your Holistic Midwife
• Ineka Morosini - Morisini Midwifery
• Tahlia - Birth With Passion
• Heidi Williams and Tracy Pyle - Central Coast Homebirth 
• Rhiannon Tongue -The Mindful Midwife
• Haylie Shaw

Unfortunately there isn't comprehensive data made publicly available for private practicing midwives as a group in NSW. Many of them publish annual stats on their social media pages though, and as stated before these include both "low" and "high" risk mothers/birth parents. As an example, here are Helen Young’s 2022 figures.

Generally with privately practicing/independent midwives stats are around 80-95% for spontaneous (non-induced) vaginal birth, with rates of induction, C-section and instrumental births around 5-10% each.

If you are hoping for a Vaginal Birth After Caesarean, it may interest you to note that VBAC rates are much higher with a privately practicing midwife than in hospital-based models of care. 

Hiring a private midwife is estimated to cost $5500-7000, inclusive of all appointments pre- and post-natally and their attendance (and the second midwife's attendance) at your birth. You will get around $1500 of this back from Medicare. At this time you need to get a referral from your GP to the midwife of your choice to access the Medicare rebates - due to legislative changes this requirement will likely be scrapped from the start of November 2024, but double check with the midwife you choose on the current requirements.

If homebirth with either BMGP or a private midwife is of interest to you, you are welcome to join the "Newcastle and Surrounds Homebirth Community" facebook group to ask questions or connect with others who have taken the homebirth route. 

Unassisted birth

A small percentage of birthing people choose to have their babies “outside the system” without medical supervision. No data is collected on these births, but they are sometimes lumped in with the "Born before arrival to hospital" statistics (0.7% of NSW births) which doesn't give an accurate representation of outcomes for babies or mothers and birth parents. 

If unassisted/free birth is something you want to learn more about, there is a Facebook group called “Hunter Freebirth Unassisted Birth Wild Pregnancy Local Connections”.

As with all other births in NSW, you are required to register your baby’s birth within 60 days of child being born. 

[For clarity, it is important to note when reading literature about birth options that a “home birth” generally refers to birth outside a hospital or birth centre setting with a midwife. An unassisted or “free birth” refers to a birth planned to occur without involvement of a medical practitioner or midwife, even if it happens inside the home.]

What about COVID-19?

Thankfully, things seem to have settled down with this, but you will still need to be across regulations in case you or your support person(s) are COVID-19 positive at the time of your birth. Rules on support people and visitors do change however and are not consistent across maternity services or public/private health systems, so ask your care team what the situation is when you're closer to birth.

What about postnatal care?

Every service and care stream seems to have different level of postnatal follow up, and even varying levels of in hospital and post-discharge support for things you might assume as basic issues like early lactation. Locating and making contact ahead of time with a local postpartum doula (like me) and an International Board Certified Lactation Consultant (using the LCANZ Find a Lactation Consultant tool here) is a good idea. My list of go-to local and telephone-based postnatal support services, is available here. 

Check out my free guides and resources

My "Six Steps to Your Peaceful Postpartum" eGuide and printable "Essential Postpartum Contact List" free resources will help you to understand what postpartum is really like, and make a plan for the early weeks and months with your baby. Planning is essential so that you and your new arrival(s) getting all the support and TLC you need to be well. I also host a free playgroup each month and a circle for mothers and birth parents each quarter (both in Teralba) and would love to have you come along!

Do You Have Questions?

I offer birth mapping, postpartum planning and birth debrief services and would love to assist you. Feel free to book a session with me, or connect with Newcastle Birth Movement for a range of local pregnancy, birth classes and doula services.

Maternity Choices Australia and Evidence Based Birth are also valuable resources when considering your options for birth.

If you are birthing in hospital, I would highly recommend accessing Karli Smith’s hospital birth education course, and also looking into hiring a birth doula (this episode of The Great Birth Rebellion podcast discusses why they make such a big difference to birth experiences and outcomes).

Pregnancy Loss

If you are reading this, it’s likely that you’re pretty early in your pregnancy or possibly even pre-conception. Although it’s not talked about much, miscarriage, early birth, pregnancy loss and termination for medical reasons occur in around 1 in 4 pregnancies. I don’t want to scare you, but I do want you to know where you can get support if this happens to you:

• Pink Elephants Foundation - support for miscarriage and early pregnancy loss
• Bears of Hope pregnancy and infant loss support
• SANDS - Stillbirth, miscarriage and infant loss support
• Perinatal Anxiety and Depression Australia - mental health support for all parents
• The Gidget Foundation - mental health support including online support groups
• Perinatal Psychologists (local recs here)

Disclaimer: Nothing in this document is to constitute medical advice or be taken in place of individualised advice from a medical practitioner. I am not affiliated with any of the birth or maternity care services mentioned above, nor do I provide support in the birth space. Information provided is true and accurate to the best of my knowledge as at the date of publication. If you notice errors or outdated information, please contact me using the "contact" section of this website.