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July 7, 2016

What’s the difference between a midwife and an obstetrician and how do you choose who will care for your during pregnancy, birth and the newborn days?

By Victoria Wells

When you find out you’re expecting a baby, one of the first things you need to decide on is your Lead Maternity Carer, or LMC. This person will manage your care throughout your pregnancy, during labour and birth and for the four to six weeks after you have your baby.

The role of the LMC is to monitor the health of you and your baby, to help you stay well during your pregnancy and to ensure you have all the information you need to care for your newborn. An LMC may oversee all your care themselves, or share it with another health practitioner.

During your pregnancy your LMC will see you monthly initially, increasing to weekly as your due date draws near.

In New Zealand, most LMCs are midwives, but you could also book an obstetrician to look after you. (Very few GPS offer maternity services.)

About midwives

  •  A midwife is a health professional educated to degree level who specialises in providing care for women during pregnancy, labour, birth and up to six weeks after birth. The degree incorporates both theory and practice and is equivalent to a four year degree but undertaken in three years.
  •  LMC midwives often work in groups to support each other to provide 24 hour, seven day a week maternity care to their caseload of women. They will cover each other for time off for weekends and holidays.
  •  A midwife can provide all your maternity care if your pregnancy, birth and postnatal period are normal. If she is concerned at any time for the health and wellbeing of you or your baby she may refer you to an obstetrician for advice or medical care and will discuss this with you. In this instance you need to decide whether you want to use publicly funded hospital specialist services (which may be the only option in your area) or a private specialist, who will charge you for their services. In most cases your midwife will continue to provide your primary care.
  •  If your condition requires full transfer of your care to a specialist (for example if a Caesarean birth becomes necessary) then there will be a discussion between you, your midwife and the specialist. Your midwife can continue to support you, but decisions regarding your maternity care will become the responsibility of the obstetrician (known as secondary care) until your care is transferred back to your midwife.
  •  Midwives are registered with the Midwifery Council of New Zealand and must maintain their Annual Practising Certificate by attending clinical practice updates on emergency situations and elective  education on different aspects of maternity care.  Midwives must also undertake a maternity standards review every two to three years.
  • Maternity care is fully funded by the Ministry of Health so is free to all women who are New Zealand residents.

About obstetricians

  •  An obstetrician is a medical doctor who specialises in the care of women throughout pregnancy, birth and the immediate postnatal period.
  • An obstetrician must complete eight years of training following graduation from medical school.
  • Private obstetricians may work independently or as part of a group practice.
  • Obstetricians may work with an independent midwife who will assist with your care in labour
  • and postnatally.
  • In a group obstetric practice, you may select one obstetrician as your LMC, who will provide care during your birth, or you may work with each obstetrician during the course of your care, so you are familiar with whoever is on-call when you give birth.
  • The cost of private obstetric care can vary. It can be  around $4000-$5500 for a ‘package’ including antenatal checks and consultations, the birth, and postnatal consultation and postnatal midwifery care.

The professionals

Obstetrician

“In our group practice we can offer excellent care, we can take account of women’s choices around birth. It’s important to note that people don’t just go with a private obstetrician because they want a Caesarean section. It could be that they prefer to discuss their test results and screening options with a doctor rather than a midwife, for a range of reasons. Some women will book with us having had a Caesarean before and will want to deliver vaginally but feel more comfortable doing it knowing they’re being looked after by an obstetrician, rather than a midwife who would need to hand them over if they’re not progressing normally. There are a proportion of women who may have had fertility treatment or delays or are older. If their first experience wasn’t what they wanted they may prefer to change their LMC. It could be that their labour ended in a Caesarean or they had a difficult birth and would rather be looked after by an obstetrician this time. If they do book private obstetric care then they’ll know who will be looking after them during their birth under almost any circumstance… [and] 25 per cent of women in New Zealand give birth by Caesarean section (emergency and elective). There also are a fair number of people having their first baby, just worried there might be a problem and wanting to know who’s going to be there if there is. And they have 24/7 access to a doctor. People can phone every day of their

pregnancy if they’re going to worry, and can talk
to a specialist.”

Dr Martin Sowter BSc (Hons) MB ChB MD FRCOG FRANZCOG, Auckland Obstetric Centre 

Midwife

“Most women (92%) choose a midwife to provide their primary maternity care  (to be the LMC). They then have a midwife who knows them, their history, needs and expectations and who can use this knowledge to support them during the labour,  birth and in the early days and weeks after the birth.Partnership is a key concept for midwifery. The word ‘midwife’ means ‘with women’, it reflects that both the midwife and the woman work together – the midwife shares her midwifery knowledge and expertise and the woman shares her history, expectations and understanding of her body. They work together towards a common goal: that of a positive birth experience and initial steps into motherhood. This partnership is built over time, supporting continuity of care. If there are any concerns at any time then the midwife will refer and work with the appropriate health professional (obstetrician etc). Midwifery care is generally provided in the community (home or antenatal clinic) and offers options for place of birth, with continued  care for up to six weeks following the birth. This ensures that when women need support with breastfeeding and infant care during those first few transitional weeks of parenting they have a familiar face and known care provider to answer their questions.” Lesley Dixon PhD, RM, RN, MA (Midwifery), New Zealand College of Midwives

How to find an LMC:

Note that the options for LMCs will vary around the country, and could be more limited in some districts.

  •  Ask for recommendations from family, friends or your local GP, who will be aware of LMCs practising in your area.
  •  Visit the Find Your Midwife website for a searchable map of midwives in your area, and their availability.
  •  Call the Ministry of Health info line 0800 Mum2Be (0800 686 223).
  •  Contact the maternity services department at your local hospital.

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