The midwife & the obstetrician: Which one is right for me?
Congratulations on your pregnancy! This is a wonderful and exciting time in your life. You may have been planning this pregnancy for some time, or maybe the pregnancy was a complete surprise. Either way it is now a time of planning and preparing and one of the biggest decisions you will make is to decide ‘who will be my go to for antenatal care, labour and birth?’.
In Australia, we are very fortunate to have many options available to pregnant women. There are both public and private options with either midwifery led care or obstetric led care. But which is the better option? Who do you choose to ensure you have a healthy pregnancy and a safe, intervention free birth?
Why do I need antenatal appointments?
The purpose of antenatal appointments is to regularly assess the progression of your pregnancy, the growth and development of your unborn baby and to provide early intervention in the event that a complication has arisen. Early intervention = improved health outcomes.
The World Health Organisation (WHO) recently released its guidelines on ‘Recommendations on antenatal care for a positive pregnancy experience’ with their aim being that every pregnant woman and newborn globally receives quality care during the antenatal and postnatal period.
The 5 key recommendations for a positive pregnancy experience are:
- Nutritional interventions
- Mother & baby assessment
- Preventative measures
- Addressing common physical symptoms (such as morning sickness, heartburn & leg cramps)
- Health systems providing quality service to pregnant mothers.
The WHO’s recommended minimum number of antenatal visits with a qualified midwife or obstetrician is currently set at four, provided they are strategically placed throughout the mother’s pregnancy. However, this number has been identified mainly for pregnant mothers in developing nations. You will find that most antenatal care providers within Australia (be they public or private) will have their own recommended antenatal appointment schedule which outline between eight and eleven antenatal visits.
What are my antenatal options?
The most common options available to pregnant women in Australia are:
- Midwifery led care in a public birthing hospital (supported by an Obstetricians)
- Midwifery Group Practice in a public birthing hospital or birthing centre
- Obstetric led care in a private birthing hospital
- Private practice midwifery care either at a clinic or a home visiting service
- Shared care – GP led antenatal care supported by the public birthing hospital
Not all options are readily available in all areas, however midwifery care in a public setting, obstetric care in a private setting and Shared Care with a GP are the three most common options available nationwide.
Difference between midwifery led care and obstetric led care:
Midwives are excellent in the provision of care to low risk women from pre-conception through to 6 weeks postpartum (after the baby is born). In Australia midwives are either Registered Nurses who completed a two year post-graduate university course or a three year undergraduate course. Midwives are highly trained and highly skilled health professionals, who often have additional qualifications such as Advanced Life Support in Obstetrics, Lactation Consultancy and water birthing.
Obstetricians are qualified medical doctors who have completed an additional six years specialised training to become a Fellow with the Royal Australian & New Zealand College of Obstetricians and Gynaecologists. They are both highly respected and specialist surgeons who take the lead in care of medium to high risk women and provide medical or surgical intervention during a birth that has deviated from the norm.
Where midwives and obstetricians differ further is in their mode of care to women and families. Midwives provide care that is woman focused. They openly encourage women to be active participants in their antenatal care and birth planning and will stay with the labouring women throughout the labour and birthing process. The word, Midwife, after all is old English for ‘With’ (Mid) ‘Women’ (Wife).
The obstetric model of care is highly medicalised with the focus of the women’s care being around assessment and planning. The pregnancy is not generally viewed as a normal and healthy progression in a women’s medical history, rather it is viewed by the obstetrician through a medical lens. The obstetrician generally won’t remain with labouring women, but will regularly review their labour process (with the midwives) and will attend the delivery.
So which do you choose?
There is no right or wrong answer to this, however having an antenatal care provider that is right for you and your family will make a big difference in your pregnancy and birthing outcomes.
First, look at the options available in your area. Are they conveniently located, what are the costs associated, what have you heard from other mums about the service. As with all things in life, a high price tag doesn’t always mean high quality. Listen to word of mouth and trust your gut.
Next, have a think about what are you looking for in a care provider. Do you want someone who will listen to you, include you in the decision making and guide you through your pregnancy in a way that is natural and empowering? This would be the midwife option. Or, do you want care that is clinical, assessment focused and medicalised. This would be the obstetrician option.
A common concern for mothers, especially first time mums, is the worry ‘what if there’s something wrong with my pregnancy? Should I book in with an obstetrician just in case?’ My advice to the mums I work with is that children will always cause us to worry, from the moment they are conceived and through into their teen years (and sometimes beyond.) Be kind to yourself, listen and trust in your body and assume your pregnancy is low risk until you have been advised by a medical practitioner or obstetrician otherwise. If issues arise that cause your status to change you will be referred to the appropriate health professionals such as the obstetricians or neonatologists.
Finally, no matter what you choose, you are not locked into a binding contract. You are free to change antenatal care providers if you are not happy or comfortable with the service you are receiving, be it free in the public system or at a premium price in the private sector. Your antenatal care provider should be addressing all five recommendations from the WHO, as outlined above, including ‘providing a quality service to pregnant mothers’. My other advice to mums I work with, when it comes to your kids always be the Mama Bear.
Written by Samantha Lewis - Midwife