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Obstetrician VS Midwife


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#1 wasabi-nut

Posted 02 February 2012 - 06:02 PM

Hi there,
I just found out that I'm 5 weeks pregnant and my hubby and I are very excited. I read a book about a year ago when we first thought we would start a family but have since stopped because of information overload. There's no end of research on the internet so I thought asking other mothers- to-be might be a good option. We have private health care and like the idea of being in a private hospital. The additional costs of going with an obstetrician is not a major concern for us either. However after reading a bit online, I now have a bit of a skewed view of obstetricians and seeing as I won't be seeing one for another 6 weeks or so I was hoping someone would be able to give me their thoughts about my concerns. I would like to have as natural a birth as possible with as little intervention as possible. I'm leaning towards a midwife but would like to have the comforts of private hospital care. It seems to me that obstetricians are skilled in complicated births and I'm worried that if I were to go with an obstetrician, the decision for intervention, caesarian, forceps, epidural etc would be made too easily and quickly. It doesn't seem to me that it's in the interest of an obstetrician to promote and stand by a natural birth and the rate of intervention seems higher in private health care. My SIL wanted a natural birth and ended up with a caesarian because it was deemed that she had laboured too long and that it was starting to be a "risk" for the baby. I know that these are things I can discuss with an obstetrician when I go to see them but any thoughts?
It's also a bit difficult discussing this with hubby because he comes from a very pro-western-medicine (if I can call it that) family and therefore their philosophy generally is "why suffer when you don't have to? why not embrace technological advances?" and they are a bit snobbish on anything public. I just feel that when it came to it, if I went with an obstetrician and during labour, my mind weakens, there would be no one there to keep me focussed on going through with no intervention.

Thanks

#2 Melissam12

Posted 02 February 2012 - 06:18 PM

Congratulations.  You could choose private midwifery care (maximum chance of a natural birth) for a planned hospital birth as a private patient, but with obstetric back-up.  There are a few such models springing up.  It would be perfect for what you are looking for.

#3 Nobody Cool

Posted 02 February 2012 - 06:29 PM

...

Edited by AryaStar, 04 February 2013 - 06:42 PM.


#4 WinterIsComing

Posted 02 February 2012 - 06:31 PM

I think you have an excellent grasp on what can happen in private care and this is exactly what happened to me. I can't say enough good things about the after care in private hospital. It's like being in a hotel with every need being professionally catered to. Also very nurturing, every midwife is absolutely lovely.
I made a big mistake of not hiring a doula to coach me through a long and arduous labour, or even a private midwife. Pain relief was mentioned early and frequently and in the delirium of labour my determination and preparation on its own was not enough. If you have $$, hire extra help for labour. Your OB isn't going to be there until the end, if at all, so your extra help won't get into his way.

#5 WinterIsComing

Posted 02 February 2012 - 06:37 PM

QUOTE (Shady Lane @ 02/02/2012, 07:29 PM) <{POST_SNAPBACK}>
Melissam12 makes a great point - it sounds like the best of both worlds.

Just something else to consider: don't just think about the antenatal care and birth side of things. I went private to have my first baby as well and I am so glad that I did.

I had a five day stay after the birth. The assistance with breastfeeding and having that time to rest and recover with the full support of the midwives 24/7 is invaluable while you are learning to deal with your new baby and are at your most exhausted and vulnerable. It is not just about having a fancy room to yourself as some might say.

So very true.



#6 Mrs JayKay

Posted 02 February 2012 - 06:56 PM

My OB is great, and although he has a list out the door for elective c/s is very supportive of my desire for a vaginal delivery

Keep in mind that you'll have midwives for most of your labour and OB for 20 min at the end, all going well.  It was actually the midwives who I had the most issue with.  They initially told me I couldn't have pethadine at all and were very very pushy that I should have an epi, (I didn't),  they stretched my cervix while checking how dilated I was without asking for my consent, which I will never forgive, and they kept trying to get me into positions which I didn't want to be in.  

I delivered a nearly 4kg baby who was posterior in 4.5 hours with no intervention, just guidance from OB.  A couple of stitches.

So, find the right OB and hospital for you, and enjoy the 5 star environment!  But look into a private midwife as well.

#7 Blossom73

Posted 02 February 2012 - 06:58 PM

I gave birth at RPA through the public birth centre, and left hospital after 48 hours as they have a policy of assistance though the early discharge program. I had a midwife come see me at home for 4 days after the 48 hours.

To be honest, I got more rest at home than on the private ward, which had a high amount of Mums who had just had c-sections and who needed much more care than I did.

Having said that, I knew I wanted to try and avoid interventions, and did not want to pay $6k for an OB, but I know that every mum is different, and everyone's choice is important. As a PP said, a private midwife might be the way to go - I found all the midwives I met through my pregnancy awesome and caring.

#8 jules77

Posted 02 February 2012 - 07:11 PM

There are OB's who are low intervention - like mine.

No VE's during pregnancy; very open to birthing in whatever way I wanted; looked at me like I was crazy when (in a state of pre-birth anxiety) I asked whether a c-sec was a better option "you do NOT want a c-sec Jules!!!" he replied; got my DH to help deliver our baby and more.

I would go private again, even though I've had 2 very normal, 'textbook' pregnancies and births. Excellent post birth care, great hospital food and a well baby nursery available if I needed a few hours sleep without bub.

If you're in Sydney OP, feel free to PM me and I can let you know the name of my OB and hospital

#9 wasabi-nut

Posted 03 February 2012 - 02:16 PM

Thank you all so much for your advice and quick replies. I like the sound of a private midwife but know very little about it so I guess it's back to researching online. My GP didn't really mention this option. Sorry to sound ignorant but I am pretty new to all this, but how many people do you need to be there during your labour? There was a mention of midwives...
I like the idea of a familiar person being there whether it's a case load midwife or a private midwife or a doula (must research this too). Am I right in thinking that if I went with an OB in a private hospital, I would be attended to by the midwives there (whoever's on call) and this person might keep changing during the course of labour?
And thanks also for bringing up the point of post labour care. That is something I would be interested in in a private hospital.



#10 Melissam12

Posted 03 February 2012 - 04:46 PM

QUOTE (wasabi-nut @ 03/02/2012, 03:16 PM) <{POST_SNAPBACK}>
Am I right in thinking that if I went with an OB in a private hospital, I would be attended to by the midwives there (whoever's on call) and this person might keep changing during the course of labour?
And thanks also for bringing up the point of post labour care. That is something I would be interested in in a private hospital.

Yes, the midwife in the labour ward would be someone you have not met before, and they work in shifts so there may be a few who look after you.
Re Postnatal care, private midwives provide this - usually in your home - for 6 weeks.

#11 lucky 2

Posted 03 February 2012 - 11:32 PM

With other models of midwifery care within the public system such as team or FBC you may very well know the midwife who is caring for you and they often rotate through the different areas of care, ie antenatal clinic, birth suite and post natal ward. It is not necessarily only with employing a private midwife or an OB that allows you to know your birth attendant.
Unfortunately all of these models of care vary btn hospitals so you have to check with each on as to what is offered.
The bulk of women do birth in public hospitals and enjoy excellent and caring midwifery care during their stay.

#12 Lokum

Posted 05 February 2012 - 08:44 AM

It's just that it's such a short stay.

I loved my private hospital stay. I believe plenty of those who say they hated hospital, and jsut wanted to get home, and it was noisy and not restful - were in public hospitals.

If they'd had a nice big private, sound-proofed room, with a nice, big double bed for their DH to stay, they might have never wanted to leave! I stayed 6 days, and I was glad. We had trouble BFing, and DS could not attach at all. He was low birth weight, and I could not get the hang of hand expressing.

My milk didn't come in to Day 4-5, and he couldn't even get colostrum from me. If I didn't have hospital midwives helping me hand express, learn to use the hospital grade pump and generally support me, I can guarantee DS would've been fully formula fed by the end of the first week.

I was a text book private patient - in my 30s, IVF conception, ended up with emerg c/s as baby was in distress. You could regard me as a statistic - but my baby WAS low birth weight, skinny as a rabbit, and he had stopped moving. My excellent pre-natal care from my OB detected he wasn't doing well, and her quick actions meant he was born in time.

The c/s was not nearly as bad as I thought it would be, and I'm seriously considering an elective next time. I much prefer to focus on how competent, calm and together DH and I felt when we left hospital.

I also love that despite a rough beginning, DS was breast fed until 15 months. That's more important to me than c/s versus VB, and I swear it was the 5 night stay which facilitated that.



#13 lucky 2

Posted 05 February 2012 - 10:27 AM

QUOTE
I swear it was the 5 night stay which facilitated that.

That's great you have the length of stay that led to such a great outcome, that would be ideal for every family. That's what I hate about the public system with its short length of stay, the inflexibility at times.
It suits some women to get out of there quick though if you have issues establishing bfing you will usually still get sent home in 48 hours, in those cases the baby would be well, if baby or mother were at risk then they would have an extended stay because there are criteria for extra stay.
It's all about funding and use of resources, criteria, conditions, numbers and I'm not saying that is all bad. The public health system is massive and they are always tweeking how it functions, trying to get the resources where they are needed to bring about the best use of our tax dollars to optimise the health and wellbeing of the whole population. It just isn't perfect unfortunately. It is a work in progress (or regress in some situations, ie closure of Birth Centres and reduction in models of care that women rate highly).



#14 Poss and Soss

Posted 05 February 2012 - 10:55 AM

I found the standard of care from the hospital midwives both times generally pretty poor - so a midwife led team would be my idea of hell sad.gif

My Obs, on the other hand, was superb <3 Had two great experiences with him, where everything went pretty much according to plan. He certainly was not an interventionist - with his help I was able to deliver naturally despite having a 10 pound + baby, a long labour and hypertension. Second delivery was completely drug free with another big bub.

There were a heap of reasons I chose an Obs - one of which is that I wanted to know that my wishes were paramount and that these would be known and would be taken into consideration as much as possible.

The first time the midwife aftercare was so poor, and inconsistent, that I hired a private midwife who works with my Obs to give assistance the second time around. I didn't need a lot of help but it was good to have that extra care there the few times I needed it.

#15 OnTheJourney

Posted 05 February 2012 - 11:08 AM

I'd go with your gut.  We went with public hospital based midwife-led care despite having private health insurance (our concerns were similar to yours in regards to obstetrician-led care) and I couldn't have been more satisfied.  While there are obstetricians who support low intervention birth, they seem to be the exception to the rule, although this will depend on where you live and the options available to you.  And if a short post-natal hospital stay is all that your hospital offers, then you can save the obstertrician's fees, and hire a private lactation consultant and/or doula to assist you with post-natal care for much longer than a week.  Private midwives also offer these services.  Good luck with your decision.

Edited by OnTheJourney, 05 February 2012 - 11:10 AM.


#16 Sassenach2

Posted 05 February 2012 - 11:30 AM

I don't know your age OP, but some obstetricians are worried about first time mums over the age of 35, getting into trouble and therefore they like to order c-sections for these mums, as usually they have been through IVF and they have been through so much stress, that OB's want to be absolutely sure (as they can be) that mum and bub are safe during the delivery. Private hospitals are wonderful with sound-proof rooms and wonderful staff (they make the hospital what it is). Beautiful meals being brought to you and you don't have to lift a finger, just look after your baby. I could imagine being at home and trying to rest and hearing all the other toddlers/kids in the house making a noise and then who-ever is looking after you at home, wanting to know what to cook and where things are and all you want to do is sleep. Give me Private Hospitals every time. eexcite.gif

#17 JAPNII

Posted 05 February 2012 - 11:31 AM

I shopped around for an OB when pregnant with number 1. I found one who was very skilled in many things including low intervention births.

I had 3 kids - all VBs (including no.3 who was breech) with this OB.

I was induced (by mutual agreement at approx 42 weeks) with the first two and only used gas. I was not induced with no 3 and used pethidine (at my request - glad I did because giving birth breech is not a picnic).

I tore but was not stitched.

The midwives in the private hospital I was in were generally great but I really loved my OB.

Please don't make generalisations. Shop around. Ask questions. Do your homework - but I will also say this - I think a lot depends on your body as to how easy or not it is.

#18 Aquarium

Posted 05 February 2012 - 11:47 AM

I really think you should take the time to go and see several ob's. I'd say the majority of ob's are just as keen to see a natural birth as much as a mid wife would be. And i don't agree ob's are more likely to intervene, esp if you have requested them not to. That's the good thing about ob's, they will follow your birth plan while it's safe to do so.

I had three midwives looking after me during my 12 hour labour, and I was glad when they changed shifts. New midwife, new strategies to help me progress. But I tell you, when it got to the delivery, and my ob walked in, I was absolutely overwhelmed to see him. The midwives were excellent, but he took the delivery and the process to a whole new level and my baby was delivered into very safe hands.

To me an ob is worth every penny! Not just the delivery but the after care too, he was excellent.

#19 Melissam12

Posted 05 February 2012 - 11:57 AM

QUOTE (OnTheJourney @ 05/02/2012, 12:08 PM) <{POST_SNAPBACK}>
While there are obstetricians who support low intervention birth, they seem to be the exception to the rule,

very true!

QUOTE (OnTheJourney @ 05/02/2012, 12:08 PM) <{POST_SNAPBACK}>
if a short post-natal hospital stay is all that your hospital offers, then you can save the obstertrician's fees, and hire a private lactation consultant and/or doula to assist you with post-natal care for much longer than a week.  Private midwives also offer these services.

An LC can only help with breastfeeding issues; they don;t do general postnatal and neonatal care.  Also, a doula cannot provide any care at all as they are not health professionals.  A private midwife would be the first port of call and she can refer to an LC if needed.


#20 Melissam12

Posted 05 February 2012 - 11:59 AM

QUOTE (JAPN2 @ 05/02/2012, 12:31 PM) <{POST_SNAPBACK}>
Please don't make generalisations. Shop around. Ask questions. Do your homework

Wise words!!


#21 Melissam12

Posted 05 February 2012 - 12:02 PM

QUOTE (Aquarium @ 05/02/2012, 12:47 PM) <{POST_SNAPBACK}>
I really think you should take the time to go and see several ob's. I'd say the majority of ob's are just as keen to see a natural birth as much as a mid wife would be. And i don't agree ob's are more likely to intervene, esp if you have requested them not to. That's the good thing about ob's, they will follow your birth plan while it's safe to do so.


The majority of obs might be keen to see a natural birth, as much as a midwife, but it is an indisputable fact that private midwives have much higher rates of normal and natural birth than private obs.  Being keen and actually achieving are very different.  Midwives, too, are keen to see women follow their birth plans so long as it is safe to do so; when the plan is for a natural birth, a midwife is much more likely than an ob to see that plan eventuate.


#22 ~Sorceress~

Posted 05 February 2012 - 12:11 PM

QUOTE (Aquarium @ 05/02/2012, 11:47 AM) <{POST_SNAPBACK}>
I really think you should take the time to go and see several ob's. I'd say the majority of ob's are just as keen to see a natural birth as much as a mid wife would be.


They're just not as good at it laughing2.gif .

OP, if you think you'd like more support post-partum, a private midwife could help arrange that or you could hire a post-partum doula original.gif . The longer you're in a hospital, the longer you're exposing your baby (and yourself) to hospital infections ... my personal preference would always be to arrange the support I need to be delivered at home original.gif .



#23 Kiki M

Posted 05 February 2012 - 12:16 PM

It is completely possible to find an OB that supports natural birth. My own OB said that if I had come in asking for an elective CS, he would try to convince me not to have one.  After the birth of my DD, he said he could have performed an episiotomy - but he didn't want to do something uneccessary when I only had a small tear requiring three stitches.

There is also another well-known OB in Melbourne who has an amusing nickname due to his very strong preference for vaginal deliveries without intervention (and he is by all accounts very good).

On the other hand, I don't know if OB care was all that neccessary for me. The money I paid for my antenatel visits - which was basically check BP, check heartbeat, any questions - may have been put to better use, as any midwife in the public system can perform these basic checks. If I had a high risk pregnancy, maybe it would have been worth it. But is sounds like the $$ aren't really a concern for you.

I did however, enjoy having my own room in a private hospital and the small comforts that they provide, and given that my PHI was totally covered by my employer, on balance I was  happy with my decision.

Don't be anxious about finding an OB that supports your wishes; just do your research and make sure you discuss it with them. Equally, others have suggested that a combination of midwife care and private hospital may be the way to go - I didn't know this was possible but certainly worth looking into.



#24 lucky 2

Posted 05 February 2012 - 12:37 PM

QUOTE
An LC can only help with breastfeeding issues; they don;t do general postnatal and neonatal care.

There are some LC's who will offer this sort of service privately if they are in fact RN/MW/IBCLC and have chosen to provide this type of comprehensive service for post natal women.

#25 Poss and Soss

Posted 05 February 2012 - 01:07 PM

QUOTE (Melissam12 @ 05/02/2012, 01:02 PM) <{POST_SNAPBACK}>
The majority of obs might be keen to see a natural birth, as much as a midwife, but it is an indisputable fact that private midwives have much higher rates of normal and natural birth than private obs.

Well of course Obs have higher intervention rates than private midwives. Private midwives can't do a CS so anyone going private and wanting a CS will need to be under the care of an Obs.

My fear with a Private Midwife, in a public hospital, would be what happens if an intervention does need to occur (e.g. if an emergency caesar becomes necessary)? I have no doubt that the private midwife would attempt to advocate my wishes to the on-call registrar or Obs - but essentially it would be up to them how they did things.

I much preferred to have a relationship already with my Obs, with a set game plan, and contingencies, in place. But that's me - I like to have all bases covered. Not getting my 'monies worth' out of an Obs was fine by me. But knowing he was there if anything went awry, knowing we had a game plan should the worst happen, and knowing I had the best person I could monitoring me gave me a lot of peace of mind original.gif




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