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Obstetrician VS Midwife


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#26 Tesseract

Posted 05 February 2012 - 01:51 PM

I think it's great that you're thinking these issues through now OP, and don't let anybody suggest that you're overdoing it or that you should just 'go with the flow' ie not plan.

I too wanted to do everything I could to ensure I had an intervention free birth. Choosing your care providers is so important for this. I had my baby through a public family birthing centre; the midwives there are there because they really believe in intervention-free birth, if it wasn't for them I probably would have ended up with an induction-epidural-emergency c-section (due to a variety of reasons) but instead I got my drug free vaginal birth.

I really do think that a private midwife is a great way to ensure continuity of care before, during and after the birth. She can also advocate for you if things dont go to plan and you need more intervention.

#27 JAPNII

Posted 05 February 2012 - 01:57 PM

QUOTE (Tesseract @ 05/02/2012, 02:51 PM) <{POST_SNAPBACK}>
if it wasn't for them I probably would have ended up with an induction-epidural-emergency c-section (due to a variety of reasons) but instead I got my drug free vaginal birth.

I am constantly irked by the assumption that induction = c/s. It doesn't.



#28 treefalls

Posted 05 February 2012 - 02:04 PM

Congratulations OP! Very exciting news:

Being your first birth, provided everything progresses normally, you are lucky enough to be in the position to choose - and that's a really exciting and fantastic thing - particularly if the cost is not an issue.

I think the thing to remember when going private and hiring an obstetrician is that you need to find one who is aligned with what you want. You can't just choose any OB and tell them 'I want to go natural' if that's not what they're into. So you'll need to shop around wink.gif

OR - you can go into a public hospital as a private patient, so you can make the most of a midwife led care program, but still choose your OB as well.

OR - you can do either of the above, as well as hire an independent midwife (IM) who may be willing to support you in the hospital environment, and who you can see for your antenatal appointments (at home! So nice original.gif) and then see the hospital OB if/when required. Then your IM can come to hospital with you for the birth and see you at home afterwards. (Note: your IM will be able to support you in hospital, but will not be able to be your "midwife" per se, unless the hospital has a program that allows and independent midwife to practice midwifery on hospital premises). There are a few IMs who are now registered as medicare providers, so you can get a rebate on the cost of having them care for you.

OR - you can plan a home birth with independent midwives. Similar to the first option, you'll need to shop around to find someone you feel comfortable with, and you might also be influenced by how close you live to a hospital.

There are statistically higher rates of intervention with private hospital births vs. midwife led care, so that's also a consideration.

Hope it all goes well and find the right care for you and your family OP!

Edit: Amended post to more appropriately reflect the role of independent midwife as a health professional as opposed to simply being a "support person" (ie. doula).

Edited by MelbChick, 06 February 2012 - 08:37 AM.


#29 Melissam12

Posted 05 February 2012 - 06:02 PM

QUOTE (Poss and Soss @ 05/02/2012, 02:07 PM) <{POST_SNAPBACK}>
My fear with a Private Midwife ... would be what happens if an intervention does need to occur ...

Eligible midwives work collaboratively with obs for this very reason!  You cannot get medicare benefits for private midwifery care without there also being a link to an ob for the minority of cases where obstetric intervention is genuinely necessary.


#30 Melissam12

Posted 05 February 2012 - 06:05 PM

QUOTE (JAPN2 @ 05/02/2012, 02:57 PM) <{POST_SNAPBACK}>
I am constantly irked by the assumption that induction = c/s. It doesn't.

No, not always, but it is more likely to lead to a caesarean, directly or indirectly.  We might not like to acknowledge this fact, but it remains a fact even still.

#31 Melissam12

Posted 05 February 2012 - 06:09 PM

QUOTE (MelbChick @ 05/02/2012, 03:04 PM) <{POST_SNAPBACK}>
I think the thing to remember when going private and hiring an obstetrician is that you need to find one who is aligned with what you want. You can't just choose any OB and tell them 'I want to go natural' if that's not what they're into. So you'll need to shop around wink.gif

OR - you can go into a public hospital as a private patient, so you can make the most of a midwife led care program, but still choose your OB as well.

OR - you can do either of the above, hire an independent midwife (IM) as your support person who you can see for your antenatal appointments (at home! So nice original.gif) and then see your OB when required. Then your IM can come to hospital with you as your support person and see you at home afterwards. There are a few IMs who are now registered as medicare providers, so you can get a rebate on the cost of having them care for you.

OR - you can plan a home birth with independent midwives as your attendants if you're having a low risk pregnancy. Similar to the first option, you'll need to shop around to find someone you feel comfortable with to be your attendant, and you might also be influenced by how close you live to a hospital.


It's a bit offensive to think of a private midwife as a support person.  Midwives are qualified and registered health professionals, not support people, and now eligible midwives are able to provide all of the pregnancy, birth and postnatal care for hospital births as well as home births, so the options in the private system are now private obstetrician OR private midwife OR collaborative care with a private midwife whose practice is backed by a private obstetrician.  There are lots of options original.gif

#32 MsBusy123

Posted 05 February 2012 - 09:37 PM

I've had two private hospital births, which were quite a bit different.  The first one was "good" in that I left with a healthy baby, but I had to have an episiotomy and suction birth (his cord was around his neck, and he was in distress).  When he was born, they took him from me after about 5 minutes so that he could be weighed etc.

For my second, I didn't really think about my first birth as being unpleasant, but my new OB put the thought in my mind that it could be much more pleasant and less invasive than my first.  He suggested that I look into hypnobirthing, and that I use an epi-no to reduce the chance of tearing.

So, I did both of those things, and I was induced (at my request) on my due date because I had gestational diabetes and a pinched nerve in my leg that was making it impossible to sleep.  My induction was only through a gel being applied to my cervix in the morning, and by the afternoon, labour was in full swing.

My OB was in and out checking on me the whole time, because he only consults from the one hospital (where his rooms are).  My labour was great, and I spent a lot of that time in the bath with my first son pouring water all over my back.

When I started pushing, it became apparent that my baby was stuck on my pelvis, because he would just not move down at all.  So, my OB got me to move around a bit to try and change his position.  He was reluctant to use suction or forceps to try and force him, because his theory was that because it was my second baby, if he wasn't coming down on his own, then he was probably stuck, and any use of force may actually harm him.  And he was right, because once I changed positions, it was only a matter of a couple of pushes and he was there.

When it came time to deliver, my OB told me to touch my baby's head, and then he said to give him my hands, and he put them under my baby's shoulders, and told me to pull him out onto my chest myself!  So, not only did my OB not intervene, he let me deliver my own baby!

I held him and was able to give him a feed for over 1.5 hours before I they asked to weigh him, and the midwife got DH to put him on the scales and bring him straight back to me.

This birth was actually an enjoyable experience that I look back on fondly.  But this OB was my third that I saw for this pregnancy.  The first one was horrendous, and left me crying after each appointment, the second one was okay, but I just didn't click with him, but with this OB I felt completely at ease with.

The point is that there are good and bad OBs out there, just as there are good and bad midwives, so you really have to do your research and find someone, whether it be a private midwife or OB, that will support your ideas of what a good birth will be, whilst keeping you and your baby safe.

Good luck!

#33 Melissam12

Posted 05 February 2012 - 09:44 PM

QUOTE (josh2003 @ 05/02/2012, 10:37 PM) <{POST_SNAPBACK}>

What an amazing story!!  Good on you for trusting your instincts and for trusting your ob to guide you to a great birth experience!

#34 treefalls

Posted 05 February 2012 - 10:32 PM

QUOTE (Melissam12 @ 05/02/2012, 07:09 PM) <{POST_SNAPBACK}>
It's a bit offensive to think of a private midwife as a support person.  Midwives are qualified and registered health professionals, not support people, and now eligible midwives are able to provide all of the pregnancy, birth and postnatal care for hospital births as well as home births, so the options in the private system are now private obstetrician OR private midwife OR collaborative care with a private midwife whose practice is backed by a private obstetrician.  There are lots of options original.gif

Really? I thought the definition of midwife was to be "with women"... and to support them no matter what their birth choices!! I'm not suggesting that their value is LESS because I've used the words "support person" ... I don't mean they are ONLY a support person, I mean that an independent midwife is an EXCELLENT choice of support person!!

This is the care that I have chosen for my impending VBAC, as I am not able to afford a home birth (requiring the presence of 2 independent midwives, at a cost of over $3,000), so I am birthing in a public hospital and my independent (registered and medicare accredited) midwife is coming with us to offer us her support. We are then eligible for a rebate on her fee if the baby is born in hospital (but unfortunately, not if the baby is born at home). It sounds like you are suggesting that I shouldn't have hired her because it's offensive to relegate her to this role (??) That's actually pretty upsetting to me - as I extremely restricted in the birth choices I can now make because of my previous CS. I am not eligible to attempt VBAC in a birth centre, and am not eligible for a hospital led home birth program. So my only choice is to either go public/private mainstream ("high risk" care), or have a home birth (at our own risk/expense). To have someone suggest that I'm denigrating my beloved IM by turning her into just my "support person" is a bit upsetting, as I feel I don't have any other choice if I want the best possible care and support for myself and my husband - but I realise that you think I'm coming from a different place with my suggestion and hope this reply manages to clear that up.

Sure, my midwife and I have an existing relationship from the birth of my first baby, but I don't think she discriminates on the basis that this would not be her "ideal" birth scenario - or because it does not make the best/maximum possible use of her skills. So, I don't think it would be offensive to her (or other qualified midwives) to suggest that they'd be a great first choice of support person for ANY birth - it's just a question of whether or not they're willing. For example, the 2nd midwife from my first birth generally doesn't attend planned hospital births, but she still came with us when things when our home birth didn't go to plan; and when I needed an emergency CS she was an AMAZING emotional support to us under very traumatic circumstances!

As the OP has said, it can appear at first glance like the choices on offer are less than ideal. Maybe she's not aware that some IMs are happy to attend planned hospital births, and I personally think it's a great thing that they are! yyes.gif

#35 Melissam12

Posted 05 February 2012 - 10:58 PM

QUOTE (MelbChick @ 05/02/2012, 11:32 PM) <{POST_SNAPBACK}>
This is the care that I have chosen for my impending VBAC, as I am not able to afford a home birth (requiring the presence of 2 independent midwives, at a cost of over $3,000), so I am birthing in a public hospital and my independent (registered and medicare accredited) midwife is coming with us to offer us her support. We are then eligible for a rebate on her fee if the baby is born in hospital

You can only claim if your midwife is intending on delivering your baby.  There are no benefits paid in respect of birth support in a hospital where your midwife is planning not to provide your clinical care and deliver your baby.  The medicare rules are quite strict on this and medicare is auditing eligible midwives.

#36 Melissam12

Posted 05 February 2012 - 11:03 PM

QUOTE (MelbChick @ 05/02/2012, 11:32 PM) <{POST_SNAPBACK}>
Really? I thought the definition of midwife was to be "with women"... and to support them no matter what their birth choices!! I'm not suggesting that their value is LESS because I've used the words "support person" ... I don't mean they are ONLY a support person, I mean that an independent midwife is an EXCELLENT choice of support person!!

Not meaning to sound offensive, and certainly a part of the midwife's role is also to provide support, merely that a registered health professional is always a registered health professional, not a support person.  Your IM is your IM, not a support person even though you are engaging her care in a support role.  

If you engaged a paediatrician to babysit your children, would you call them your baby sitter or your paediatrician who is babysitting your kids?

#37 treefalls

Posted 05 February 2012 - 11:16 PM

QUOTE (Melissam12 @ 06/02/2012, 12:03 AM) <{POST_SNAPBACK}>
Not meaning to sound offensive, and certainly a part of the midwife's role is also to provide support, merely that a registered health professional is always a registered health professional, not a support person.  Your IM is your IM, not a support person even though you are engaging her care in a support role.  

If you engaged a paediatrician to babysit your children, would you call them your baby sitter or your paediatrician who is babysitting your kids?

Sure, I get your point - but I said "you can hire an independent midwife to be your support person" - referring to them repeatedly as an "IM" in my original post.

Are you suggesting that I should have said, "You can hire an independent midwife who will support you in hospital?" not "...as your support person?" Trust me, the last thing I want to do is offend any independent midwives out there!

#38 Melissam12

Posted 06 February 2012 - 06:02 AM

QUOTE (MelbChick @ 06/02/2012, 12:16 AM) <{POST_SNAPBACK}>
Sure, I get your point - but I said "you can hire an independent midwife to be your support person" - referring to them repeatedly as an "IM" in my original post.

Are you suggesting that I should have said, "You can hire an independent midwife who will support you in hospital?" not "...as your support person?" Trust me, the last thing I want to do is offend any independent midwives out there!

Yes, perhaps "You can hire an independent midwife who will support you in hospital?"  What your midwife did to become eligible and work in private practice does not equate with merely being a support person.  This isn't intended to offend you and I appreciate you have heaps of respect for IMs and midwives in general, the bee I have in my bonnet is about midwifery being recognised as the autonomous health profession that it is, not a part of nursing, obstetrics or doulaing (is that a word??) or anything else, and a midwife is always a midwife regardless of the capacity in which her care is engaged.  Anyway, have  a great birth and I am sure you will have a beautiful and special experience original.gif

#39 ~Sorceress~

Posted 06 February 2012 - 07:18 AM

QUOTE (josh2003 @ 05/02/2012, 09:37 PM) <{POST_SNAPBACK}>
This birth was actually an enjoyable experience that I look back on fondly.  But this OB was my third that I saw for this pregnancy.  The first one was horrendous, and left me crying after each appointment, the second one was okay, but I just didn't click with him, but with this OB I felt completely at ease with.


Oh wow! He sounds wonderful wub.gif! It's really great that you were able to keep looking for the right OB! biggrin.gif Well done!

#40 MsBusy123

Posted 06 February 2012 - 08:47 AM

QUOTE (~Sorceress~ @ 06/02/2012, 08:18 AM) <{POST_SNAPBACK}>
Oh wow! He sounds wonderful wub.gif! It's really great that you were able to keep looking for the right OB! biggrin.gif Well done!

Well, I was in a bit of an emotional state by then because we had TTC for five years and we were pregnant after 5 full IVF cycles, plus I had a blood clot next to the placenta which was causing massive bleeds... so, if anything I needed an OB that a bit more positive than the first one that I went to, who told me not to get attached to the baby  ohmy.gif

#41 Melissam12

Posted 06 February 2012 - 08:51 AM

QUOTE (josh2003 @ 06/02/2012, 09:47 AM) <{POST_SNAPBACK}>
a bit more positive than the first one that I went to, who told me not to get attached to the baby  ohmy.gif

OMG!!!!  What a cold remark to make, from someone in a caring profession.

#42 Soontobegran

Posted 06 February 2012 - 09:33 AM

OP you have been given some wonderful insightful information here. I hope that you find the right caregiver and have a trouble free pregnancy, labour and birth. original.gif





QUOTE (Melissam12 @ 03/02/2012, 05:46 PM) <{POST_SNAPBACK}>
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.


Melissa, what you should be saying is that the midwife in the birthing suite 'may' be someone you haven't met before. Many of my clients I had met before during tours, information/education nights, monitoring or previous pregnancies.
Aside from that seeing a caregiver for the first time (if that happens) does not mean that an excellent level of care and connection between the midwife and the client during labour and birth can not be achieved. I do think it is wrong to infer otherwise.
I think the care that Private Midwives (such as yourself) provide is a perfectly valid and safe choice for those seeking that model of care but it isn't the only valid and safe choice.

Anecdotally I had 5 shifts of staff with my #1 and felt perfectly well supported by each midwife who was assigned to me over the 30+ hours. My Obstetrician came in to visit a couple of times, but apart from that he spent just 30 minutes with me. My care was afforded by my midwives.


Just another bit of anecdata......I had 5 inductions and no C/S, in fact 4 were totally normal deliveries that required no pain relief.






#43 treefalls

Posted 06 February 2012 - 10:33 AM

QUOTE (Melissam12 @ 06/02/2012, 07:02 AM) <{POST_SNAPBACK}>
Yes, perhaps "You can hire an independent midwife who will support you in hospital?"  What your midwife did to become eligible and work in private practice does not equate with merely being a support person.  This isn't intended to offend you and I appreciate you have heaps of respect for IMs and midwives in general, the bee I have in my bonnet is about midwifery being recognised as the autonomous health profession that it is, not a part of nursing, obstetrics or doulaing (is that a word??) or anything else, and a midwife is always a midwife regardless of the capacity in which her care is engaged.  Anyway, have  a great birth and I am sure you will have a beautiful and special experience original.gif


I've amended my original post to try and better reflect this original.gif

Thanks for your kind wishes for my impending birth experience.

#44 Tesseract

Posted 06 February 2012 - 10:48 AM

QUOTE (JAPN2 @ 05/02/2012, 02:57 PM) <{POST_SNAPBACK}>
I am constantly irked by the assumption that induction = c/s. It doesn't.


I didn't say that induction = c/s, I was very careful to say that due to a variety of reasons I believe an induction in my case would have very likely ended in a c/s.

You're right that induction doesn't always = c/s and I agree that suggesting that it does does women a disservice. That's why I was careful to include a condition on the statement. Since this thread isn't the place to be going into the specifics of why I believe an induction would have led to a c/s in my case, I left it at that.

#45 wasabi-nut

Posted 06 February 2012 - 12:38 PM

I feel like I may be going about this the wrong way. I've made appointments with 3 obstetricians even though I'm not sure that this is the model of care I am after however of the things that we are sure of, private hospital care and specifically NSP is something we feel pretty confident about as it would be the closest private hospital to us. Ideally, I would like to have a private midwife as my main birthing person (for lack of a better phrase- still getting used to all the acronyms!), someone I have all my appointments with and someone who is there during my labour with an obstetrician as a back up if there are complications. In my head, I see a private midwife as someone who is fully qualified to deliver a baby and able to judge when an obstetrician is required and for me at that point, if someone I trust professionally advises some form of intervention then I trust whichever obstetrician is there will be very capable and therefore not necessarily someone I need to have built a relationship with.
But this doesn't seem to exist at NSP. Not from what I've read on their website.
It seems that if I want to be in a private hospital, I HAVE to be under obstetric care.
And I agree that I shouldn't make generalisations as practitioners vary as much from one profession to another but I don't think my concerns about obstetricians and intervention are unfounded. Having said that I would like to get my hands on some statistics so that I am able to make informed opinions on the matter. It's too hard to judge when there are so many factors to be considered ie elective caesarians vs non, age of women who have caesarians, the median age of women in private hospitals vs public. Is there anywhere I can get that sort of data? It would be handy to narrow it down to specs that match me to help me make a better decision. For example, if the rate of intervention is higher in private due to the general age of the mothers being older or more electing caesarians etc then this may not factor much in my view.


#46 lucky 2

Posted 06 February 2012 - 01:45 PM

http://www.crikey.com.au/2008/11/19/matern...-obstetricians/
http://www.health.gov.au/internet/main/pub...es%20Review.pdf
I found these two, the first one is from 2008 and has very interesting comments if you look past the article.
Perhaps someone else will have more current links.

#47 Melissam12

Posted 06 February 2012 - 01:58 PM

QUOTE (lucky 2 @ 06/02/2012, 02:45 PM) <{POST_SNAPBACK}>

That's a bit dated, from 2008 before the maternity reform process started.

http://www.health.gov.au/internet/minister...11-nr-nr223.htm



#48 edgeofreality

Posted 06 February 2012 - 02:31 PM

My Obs was absolutely wonderful, and definitely not pro-intervention (although not anti either).  We discussed what I wanted in advance, and he attempted to honour that, even when things began to go pearshaped.  I had a very long labor, and although he offered various forms of intervention at several stages, he never pushed, instead just laying out the facts. I felt informed & in control throughout the entire process.

The same cannot be said for my experience with the midwives in the hospital.  Each one told me something different about pain relief, swaddling, breastfeeding and vaccinations and then criticised me for following one of her colleagues' approaches.  I nearly went out of my mind trying to reconcile all the contrary information, while keeping the different midwives happy.

The other advantage I had being private was I got the pain relief when I needed it.  Having discussed the pros and cons, I went in with an open mind about pain relief, but with a preference for just gas.  The pain was much worse than I anticipated, and after 8 hours of agony, little progress and some other emerging issues, I asked for an epidural.  I got one in next to no time. Friends in public hospitals for waited hours or been unable to get one.  I get that many people would consider easy access to the drugs a disadvantage, fearing that it was encourage them to 'give in' or whatever.  However, from my personal perspective, the availability of expert advice and assistance transformed what had the potential to be a long, painful, traumatic experience into something that was calm, beautiful and memorable for the all the right reasons.  I am so, so glad I chose the option where relief was available.

Earlier in the pregnancy I was wondering if my obs was worth the money. After that delivery, if I were to have another baby, I'd certainly go private again.

#49 Moo point

Posted 06 February 2012 - 02:32 PM

OP, my understanding is that you need to see an obstetrician in order to deliver at a private hospital - and yes this is the case at NSP. You could check if they'd be willing to allow you a private midwife as well, though.

I am going through the standard antenatal clinic at RNSH, am currently 21 weeks and am more than happy with the care I am receiving. I was originally doing shared care with my GP but had a few issues that came up on a blood test that could have led to complications that they were right on top of, got me to go to the specialist ob clinic for review, and although I'm considered all fine now they will continue to monitor my bloods while I see the midwives. I also have a student midwife who is with me for each appointment and will be there for the birth. The whole team are very supportive of low intervention but will have no hesitation to bring in an OB should the need arise, and they were more generous with their induction timeframes than NSP (42 weeks or longer providing all is well with me and bubs, whereas my friend was induced at NSP at 40+7 with no sign of distress or labour, baby still high, cascade of intervention and eventual c/s. Yes anecdata but this happens more often in a private hospital).

Feel free to PM me if you'd like more information original.gif

#50 White-Lily

Posted 06 February 2012 - 03:00 PM

I went public at a teaching hospital so also got the best of both worlds. MW for some of my appointments and OB for the rest. I saw the Ob more than the MW even with a low risk pregnancy.

I had an intervention and drug free birth. The OB didn't even make it in time, so DD was delivered by MW.
The hospital had recently been refurbished so all the rooms were private rooms.
I wasn't 'kicked out' after 24 hours. I was asked if I felt ready to go home after 36 hours to which I wasn't sure so they let me think on it for a few hours. By the time I had decided I was ready (48hours), baby was jaundice and needed light therapy so we were in hospital for a few more days.

The OB I saw was open to discussing my preferences in regards to the birth and was happy to just let it happen. The hospital I delivered at has a high natural birth rate.

During labour there was some talk of putting me on the drip as my waters broke first and they didn't think it was happening fast enough so there was immediately a time restriction put on me. I was firm in my decision of not wanting this unless necessary and DH backed me 100%. In the end DD decided to come quickly once labour was properly established.

After the birth I saw an OB (not mine as it was a long weekend and public hospital) twice, once on day 2 and once on day 4 (discharge) so my care was mainly MW based.
I had the MW's follow up with me at home for a few days after discharge and then the CHN after that.
After discharge DD was seen by a public Paed for various issues who we had also seen in hospital.

I can't really comment on the availability of drugs as I didn't have any. I was offered gas during pushing but that was it. So I don't know how long it would have take to get drugs had I wanted them. It was quiet on the birthing suite the day I went in so I don't know if that would have made any difference if it had of been busy?

In any case, very happy with my care right from pregnancy through to after birth care. And will be seeing the same OB/MW team and delivering at the same hospital.




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