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Obstetrician VS Midwife


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#51 Shelly-B

Posted 08 February 2012 - 11:40 AM

I'm really nterested in this thread, I have booked into public and private but must say when I went for my 12 week app at the public I was HORRIFIEd, I felt like a number, the Ob didn't even touch me just took notes and then rushed me out.

SERIOUSLY considering private.

HELP!!!

#52 lucky 2

Posted 08 February 2012 - 01:13 PM

Can you access midwifery led care in the public hospital you are attending, what are the other options within that hospital?

#53 Guest_bottle~rocket_*

Posted 08 February 2012 - 02:05 PM

QUOTE (wasabi-nut @ 06/02/2012, 01:38 PM) <{POST_SNAPBACK}>
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.


That is correct, that is how the private hospitals operate here.  You can only give birth in a private hospital if you are a patient of a OB who has visiting rights there.

QUOTE (wasabi-nut @ 06/02/2012, 01:38 PM) <{POST_SNAPBACK}>
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.


This has the latest statistics for births in all NSW hospitalsNSW Mothers and Babies Report 2009

Statistics Australia wide:
http://www.aihw.gov.au/publication-detail/...20870&tab=2

According to the Australia wide report, caesarean section rates are higher in private hospitals across all age groups, not just mothers aged 35+.

Edited by bottle~rocket, 08 February 2012 - 02:06 PM.


#54 wasabi-nut

Posted 09 February 2012 - 10:52 AM

Thank you so much for these links. I'm looking through them now and they are forming a good picture for me about the varied experiences from hospital to hospital.
Private Hospitals aren't looking too good on the birth without intervention front but having said that, a stat that I just read which gave me some minor relief was comparing NSP and RNS re emergency c/s and NSP came in lower at 14.7% vs 18.2%. This is more relevant to me than the stats for elective c/s which NSP was high at 33.1% vs RNS 18.2%. And although it was a bit alarming that the vacuum rate at NSP was high at 12.9% vs RNS at 3.6% you can see that this may be the preferred method to forceps which was low at NSP at 3.3% vs RNS at 8.5%.

Exactly the kind of stats I'm looking for so thanks! I know it's 2005-2009 but you can easily see patterns forming so that's good too.

Cheers


#55 Guest_bottle~rocket_*

Posted 10 February 2012 - 11:16 AM

QUOTE (wasabi-nut @ 09/02/2012, 11:52 AM) <{POST_SNAPBACK}>
Thank you so much for these links. I'm looking through them now and they are forming a good picture for me about the varied experiences from hospital to hospital.
Private Hospitals aren't looking too good on the birth without intervention front but having said that, a stat that I just read which gave me some minor relief was comparing NSP and RNS re emergency c/s and NSP came in lower at 14.7% vs 18.2%. This is more relevant to me than the stats for elective c/s which NSP was high at 33.1% vs RNS 18.2%. And although it was a bit alarming that the vacuum rate at NSP was high at 12.9% vs RNS at 3.6% you can see that this may be the preferred method to forceps which was low at NSP at 3.3% vs RNS at 8.5%.

Exactly the kind of stats I'm looking for so thanks! I know it's 2005-2009 but you can easily see patterns forming so that's good too.

Cheers


You're very welcome  original.gif .

Just remember that the reason that the elective c/s rates are higher in private hospitals is not just because some women request them. It is also because some OBs have a preference for them whereas in the public system there generally needs to be a definite clinical need for a c/s to be done.

Edited by bottle~rocket, 10 February 2012 - 11:17 AM.


#56 Melissam12

Posted 10 February 2012 - 02:42 PM

QUOTE (bottle~rocket @ 10/02/2012, 12:16 PM) <{POST_SNAPBACK}>
Just remember that the reason that the elective c/s rates are higher in private hospitals is not just because some women request them. It is also because some OBs have a preference for them whereas in the public system there generally needs to be a definite clinical need for a c/s to be done.

Elective merely means that the caesarean was done when the woman was not in labour.  It covers all caesareans performed before labour has started, whether it is the woman's choice (usually it isn't the woman's choice) or the ob's recommendation.

#57 Guest_bottle~rocket_*

Posted 10 February 2012 - 11:00 PM

QUOTE (Melissam12 @ 10/02/2012, 03:42 PM) <{POST_SNAPBACK}>
Elective merely means that the caesarean was done when the woman was not in labour.  It covers all caesareans performed before labour has started, whether it is the woman's choice (usually it isn't the woman's choice) or the ob's recommendation.


I know that, I just wasn't sure if the pp knows that.  There seems to be a common incorrect assumption that elective caesareans and "maternal request" caesareans are the same thing.  It is also commonly assumed that c/s rates are higher in private hospitals because women are requesting them, when it is actually more to do with their OBs preferring them as a method of delivery.

Edited by bottle~rocket, 10 February 2012 - 11:01 PM.


#58 Melissam12

Posted 11 February 2012 - 01:26 PM

QUOTE (bottle~rocket @ 11/02/2012, 12:00 AM) <{POST_SNAPBACK}>
I know that, I just wasn't sure if the pp knows that.  There seems to be a common incorrect assumption that elective caesareans and "maternal request" caesareans are the same thing.  It is also commonly assumed that c/s rates are higher in private hospitals because women are requesting them, when it is actually more to do with their OBs preferring them as a method of delivery.

Oh, I see original.gif I agree with you entirely!

#59 blueocean1312

Posted 25 February 2012 - 06:08 AM

QUOTE (jules77 @ 02/02/2012, 08:11 PM) <{POST_SNAPBACK}>
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


Hi,
I tried sending PM but couldn't do it. PLease can you PM me the name of your OB & hospital?
Thanks heaps

#60 blueocean1312

Posted 25 February 2012 - 06:13 AM

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.

I am going public for my second baby and have already been told there is a 24 hour discharge policy. I cannot imagine what that must feel like as a new first-time mum. I know that you get follow up visits with midwives once a day after the birth but I needed more support than that with my first baby. Going private ticked all those boxes.

Best of luck OP.


HI Shady,
I tried to PM you also but I could not send any:(
PLease can you PM me the private hospital you went to and your OB name also.
I have just found that I am pregnant and I am desparately looking for a good private hospital and OB in sydney. Any good advise will be appreciated.
Thanks Heaps.

#61 Still hopeful

Posted 27 February 2012 - 05:29 PM

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


Hi, what a story! I am not sure whether you are in Sydney, but I would be very grateful if you could PM the name of your OB? I am also looking for a no/low intervention OB.


#62 Still hopeful

Posted 27 February 2012 - 05:32 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.  

I am going public for my second baby and have already been told there is a 24 hour discharge policy. I cannot imagine what that must feel like as a new first-time mum. I know that you get follow up visits with midwives once a day after the birth but I needed more support than that with my first baby. Going private ticked all those boxes.

Best of luck OP.


Hi, can you say which hospital it was? I am also looking at hospitals/OBs and grateful for any information.


#63 Still hopeful

Posted 27 February 2012 - 05:38 PM

QUOTE (jules77 @ 02/02/2012, 08:11 PM) <{POST_SNAPBACK}>
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


Hi,

I have been trying to PM, but doesn't look like it's working. I would also really appreciate if you could PM me the name of your OB. I am also looking for a no/low intervention OB in Sydney (at POWP or RHW). Many thanks in advance!

#64 Still hopeful

Posted 27 February 2012 - 05:44 PM

Hi Wasabi-nut, thank you for your post. As you can see from my posts, I am in the same position. I want a no/low intervention birth and was leaning towards a midwifery group practice for that reason. However, I really want the peace of mind of knowing an OB (and him/her knowing me) just in case there are any complications 'on the day'. I would feel uncomfortable having to deal with an OB or a registrar in an emergency if I haven't met them before. I will be 40 years old, with my first pregnancy after years of trying, so I want the 'least stress' option. The responses to your post have been very helpful - as they have noted, if you want a private hospital, you will need a private OB. I am still a bit confused about midwives though - if I understand correctly, you will end up with whoever is scheduled on at the time and you may, or may not, have met them before - whether you go public or private. I don't quite understand the role of private midwives, so will be researching that. I am definitely going to get a doula - more research! Best of luck!!

#65 wasabi-nut

Posted 04 March 2012 - 09:02 PM

Hey Still Hopeful,
I'm about to see three different OBs all practicing at NSP this week. I had also contacted the local midwifery practice but they are yet to contact me to make an appointment. I know this is an expensive exercise but it's our first and we thought we'd go the full hog on this one and hopefully with any future pregnancies we will be better informed and will not have to spend as much money. Unfortunately NSP doesn't offer the model of having a private midwife deliver your baby with obstetric back up and my GP explained to me that this may be for various reasons including insurance. Because you have to be under OB care in NSP, why would an OB take a risk on someone else delivering under their care if that makes sense? I'm just about to do some research on some questions I'd like to ask in the next few days so that I can decide on which OB I want to go with or if I really would prefer to go in the public system with a midwife.
MelissaM gave me some very useful information on private midwives and which hospitals you can go to if you prefer that model of care. I know that at Ryde Hospital, there are a group of midwives but you get assigned one so you get to know that person through your pregnancy and they will be there to deliver your baby. Otherwise, what you assessed sounds correct- public or private you will get whoever is scheduled on during your time in hospital.
Best of luck to you too!

#66 Melissam12

Posted 04 March 2012 - 09:07 PM

QUOTE (wasabi-nut @ 04/03/2012, 10:02 PM) <{POST_SNAPBACK}>
Because you have to be under OB care in NSP, why would an OB take a risk on someone else delivering under their care if that makes sense?

Yet, this is what happens every day in private hospitals, where hospital midwives deliver the baby because the ob hasn't made it in time.

#67 meemee75

Posted 04 March 2012 - 09:10 PM

QUOTE
QUOTE (wasabi-nut @ 04/03/2012, 10:02 PM) *
Because you have to be under OB care in NSP, why would an OB take a risk on someone else delivering under their care if that makes sense?

Yet, this is what happens every day in private hospitals, where hospital midwives deliver the baby because the ob hasn't made it in time.



Very true!

#68 Missmarymack

Posted 04 March 2012 - 09:34 PM

QUOTE (OnTheJourney @ 05/02/2012, 12:08 PM) <{POST_SNAPBACK}>
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.


I could have written this post exactly myself. I found the care I recieved at a public birth centre was fantastic, and way better than many of my friends who went private (and therefore also forked out $$$).

Do you want the private hospital for the single room, plush carpets and nice meals or the care? It sounds like you are leaning towards midwife led care...

#69 JAPNII

Posted 04 March 2012 - 09:45 PM

QUOTE (jules77 @ 02/02/2012, 08:11 PM) <{POST_SNAPBACK}>
There are OB's who are low intervention - like mine.

My Ob was like this.

OP - don't assume all OBs are the same. My OB delivered all 3 bubs including my last which was breech and VB. He was there for all the births.

Two of three were induced (I was two weeks post dates in both cases and beyond exhausted) and apart from gas for the induced births and much needed pethidene for the 3rd I had no other interventions - no forceps, no epi, no c/s and no stitching.

Shop around. Talk to some OBs to get the full picture.

#70 wasabi-nut

Posted 04 March 2012 - 09:57 PM

Because you have to be under OB care in NSP, why would an OB take a risk on someone else delivering under their care if that makes sense?

Yet, this is what happens every day in private hospitals, where hospital midwives deliver the baby because the ob hasn't made it in time.



Yes I know that but I meant having a private midwife- someone that the OBmay not have worked with or trust.

Edited by wasabi-nut, 04 March 2012 - 09:59 PM.


#71 Melissam12

Posted 04 March 2012 - 10:27 PM

QUOTE (wasabi-nut @ 04/03/2012, 10:57 PM) <{POST_SNAPBACK}>
Yes I know that but I meant having a private midwife- someone that the OBmay not have worked with or trust.

Why would the ob and mw work together if they did not trust each other?  The whole idea is that the mw has a relationship (of trust, respect etc) with the ob who backs her practice.  This is a *very* close working relationship.  I understand you're quoting what you've been told and I'm not trying to have a go at you, just feeling frustrated that ill-informed GPs are spouting such rubbish and wishing that hospitals would think things through before they cite "insurance" concerns.  Mws are insured as well as obs, and hospitals don't refuse obstetricians admitting rights!

#72 Soontobegran

Posted 04 March 2012 - 11:08 PM

QUOTE (Melissam12 @ 04/03/2012, 10:07 PM) <{POST_SNAPBACK}>
Yet, this is what happens every day in private hospitals, where hospital midwives deliver the baby because the ob hasn't made it in time.


But we all know that maternity care involves much more than the day of delivery. What goes on in the preceeding 40 weeks should be what is focused on when choosing a caregiver.


QUOTE (Melissam12 @ 04/03/2012, 11:27 PM) <{POST_SNAPBACK}>
, and hospitals don't refuse obstetricians admitting rights!


They actually can.

#73 Melissam12

Posted 04 March 2012 - 11:14 PM

QUOTE (soontobegran @ 05/03/2012, 12:08 AM) <{POST_SNAPBACK}>
But we all know that maternity care involves much more than the day of delivery. What goes on in the preceeding 40 weeks should be what is focused on when choosing a caregiver.

This wasn't the point of the discussion ....

QUOTE
hospitals don't refuse obstetricians admitting rights!


QUOTE (soontobegran @ 05/03/2012, 12:08 AM) <{POST_SNAPBACK}>
They actually can.

Of course a hospital can refuse an individual ob admitting rights for a valid reason, but they do not refuse all obs admitting rights.  



#74 wasabi-nut

Posted 05 March 2012 - 03:48 PM

Oh dear, I didn't mean to offend anyone. As you know, I really want a Private midwife with Obstetric back up as a model of care for me and I couldn't understand why this wouldn't be offered at more private hospitals but when the GP suggested that a reason might be because of insurance etc and asked me to think about why an obstetrician would happily have someone else there, it made me realise that I was looking at things a little too simply as in "I want it so why can't it happen." I guess I was hoping one of the OBs that I'm booked in to see might be happy to have a private midwife there but I'm still figuring this out.



Edited by wasabi-nut, 05 March 2012 - 03:49 PM.





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