While it might be an easy choice for some mamas-to-be, choosing between a midwife or an obstetrician can also feel like an overwhelming decision to make.
Here are some key points that might help if you’re pregnant, or planning a pregnancy, and figuring out which route you’d like to take for your care.
First things first, mama. Whether you decide to have an obstetrician or midwife care for you during your pregnancy and birth, remember it’s YOUR choice - nobody else’s. There’s no right or wrong way to go (unless, of course, you have specific medical needs that require certain care, or you’ve been advised otherwise by a doctor). Your care during pregnancy should be a judgment-free zone.
You may have noticed some people in your life find it easy to make decisions about their pregnancy care and have very specific ideas about whether to have a doctor or midwife. Perhaps for you it’s a bit confusing and overwhelming - that’s completely understandable and normal, mama. There is a lot to think about during pregnancy!
To break it down, in New Zealand, pregnant women typically have three choices for their main carer - or Lead Maternity Carer (LMC). These are a midwife, obstetrician and in less-common cases a general practitioner (GP) who is trained in obstetrics.
Generally your LMC will care for you during pregnancy, your labour, birth and then for about four to six weeks after the birth as you adjust to life with a newborn baby.
You might find it’s a good thing to make a decision about your LMC earlier in pregnancy, simply because you’ll have peace of mind about your care and what to expect - and can have consistency in your essential appointment and checkups from the start.
While there are many similarities between a midwife and obstetrician, there are some things to keep in mind. In this high-level breakdown, we summarise the key differences between a midwife and an obstetrician to help you make an informed choice about the best care for you.
WHAT'S THE DIFFERENCE BETWEEN A MIDWIFE AND AN OBSTETRICIAN?
Midwives are qualified in caring for women who are experiencing a ‘normal' pregnancy free from complications, whereas obstetricians are qualified with specialist skills for more complicated pregnancies and births.
A midwife needs to have completed a four-year Bachelor of Midwifery, whereas an obstetrician must complete six years of medical school to become a doctor, followed by about eight years of practical placements. Obstetricans can also perform cesarean sections and use birth tools or aids, such as forceps and vacuums if required during birth.
There’s also a big difference in your out of pocket costs. Usually an obstetrician will cost you between $3000 and $6000, however if your LMC is a midwife this will be free under the public health system.
If you’re being cared for by a midwife and need specialist care, you’ll usually go through the hospital and this will still be free.
MIDWIFE CARE DURING PREGNANCY.
A midwife is a trained and registered health professional - they are experts in providing women with care during pregnancy and birth. (After completing their degree, they’re then registered with the Midwifery Council of New Zealand and are required to have an annual practising certificate.)
Most women in New Zealand will have a midwife as their LMC.
The cost of your midwife is covered by the government under the public health system (for NZ citizens and permanent residents), and you can usually choose between a private practitioner or a midwife who works out of a hospital. Your midwife will work alongside any specialist medical teams if you do need extra care during your pregnancy.
The approach your midwife will take is usually one of a partnership - midwives believe in working closely alongside the pregnant woman to ensure she’s comfortable and that her individual needs are being met.
Libby Cain, leading NZ midwife and lactation consultant says this partnership model is very important.
During your pregnancy, your midwife will see you for regular appointments to check on you and your baby’s well being. They’ll often see you at a midwife clinic, but sometimes this can be at a hospital or your home.
In your first trimester you’ll have a full assessment and a care plan will be put together. Your midwife will arrange the booking of your hospital or birthing centre, and she’ll be with you during birth and labour. Your midwife will also discuss any recommended screening tests, blood tests, or other tests with you - and will discuss the results of these tests with you and make any referrals to specialist care providers if you need it.
At your appointments, your midwife will check your abdomen to check the baby’s growth, listen to their heartbeat, and your blood pressure is checked regularly.
Midwife care will also involve talking with you and preparing you for each stage of pregnancy, breastfeeding and parenting, as well as personalised postpartum care for six weeks after birth.
You may receive free care from a public obstetrician if you are referred by a midwife or your LMC, otherwise opting for private specialist care could see you between $3000 and $6000 out of pocket.
In New Zealand, some women may choose to have a private obstetrician as their LMC due to previous medical history, because they’re older, or have had past pregnancy complications. However some women simply feel more comfortable and secure having an obstetrician and specialist care - or perhaps prefer to give birth in a private hospital.
Obstetricians are medical experts trained to provide you with specialist care if complications arise during pregnancy and birth.
You’ll usually get more scans if you’re seeing an obstetrician, and depending on the specialist and their expertise, some will even perform a scan at every appointment. It can be a more ‘medical’ approach to care - which for some women is extra comforting and others more off-putting.
The model of care you’ll receive and the things discussed at each check up usually depend on the reasons you are seeing an obstetrician (i.e. whether it’s due to a high risk pregnancy, or simply personal preference).
Your private obstetrician will also attend your birth, and they are able to carry out an assisted birth if necessary.
SOME QUESTIONS TO CONSIDER.
Still wondering how to choose an LMC? These are some questions you may like to ask:
- Will you be my main carer?
- What happens if you’re not available for my birth?
- How many visits and check ups can I expect during pregnancy?
- How many scans / ultrasounds will I receive?
- What happens if I need advice or I have a concern in between appointments?
- Do I visit you in a clinic or do you come to my home?
- Are there any additional costs?
- Do you have a specific philosophy or idea about birth?
- What are your thoughts on a birth plan?
- What sort of postpartum care do you provide?
OK, BUT WHAT ABOUT A DOULA?
Essentially, a doula is a trained, non-medical companion who assists and provides both emotional and practical support to the expecting parent (and family) before, during, and after childbirth.
In recent years, doulas have become increasingly popular in both Aotearoa and Australia for women and families who are seeking more support, and for those seeking a birth without medical intervention (however, the right doula should never judge any of your decisions, whether that’s to have pain relief or otherwise).
The role of a doula is to serve as an advocate for the expectant mama. Doulas can help you prepare for labour, birth and beyond - and some doulas offer a full service including pregnancy planning, pregnancy support, birth support, and postpartum support.
Their role is not to provide medical advice (and importantly, unlike midwives they do not perform any medical tasks, tests, or assessments), rather it’s to support you and be there for you in all aspects of your pregnancy journey.
A doula is often someone who’s had children of their own, and may have a background in healthcare. They’re naturally caring, good listeners, and have lots of useful information to help you.
While the role of a Doula is not to replace that of the partner, it can be an immense help and additional support for the mum-to-be - even helping to support the partner, too! For some, a doula is not necessary, whereas for others it could be a total game changer.
SO WHAT'S RIGHT FOR ME?Remember, there’s no right or wrong in terms of an ideal birth plan and birth support crew - every woman is different.
Some of the main factors you might want to consider are the style of care you’d prefer, your budget, any potential medical concerns that might impact your pregnancy, where you’d prefer to give birth as well as your carer’s qualifications and experience.
If you’re still tossing up between a midwife, obstetrician or GP as your LMC, have a chat to your doctor, speak to your local hospital or a few non-judgemental friends or whanau who’ve gone down a few different paths.
And most importantly mama, enjoy the ride.