OB vs GP vs Midwife?

[xStephx]

Hi all, excited to be pregnant first time. Found out for sure on Saturday 6th January, but have known inside for a couple of weeks (sooo hungry, period-type pains for 2.5 weeks, and crazy pregnancy dreams). I feel queasy and get sore breasts and PMT every month so that wasn't much of an indicator!

Anyway, I wish I could tell you when I am due, but I unfortunately can't remember my last period, and my cycle ranges from 28 days to 35 days. For the couple of months that I temperature tested, I seemed to ovulate betweenday 18-24, but was all over the shop too. I *think* I remember shopping for pads on 8th December, but I'm not sure if it was a proper period, or if it could have been implantation bleeding? And if it was 8th December, then I wouldn't have ovulated until at least Dec 22nd on the early side, and I'm sure those crazy period-type pains started before then. I just really can't remember. Which is weird because I've tracked every period for the last 10 years. But wouldn't you have it that when I got lazy (or maybe relaxed!) I'd conceive.

So we went to the local GP straight away, got a bunch of blood work, urine sample, and have booked in for a dating ultrasound on the 18th to try and figure out how far along I am. It's definitely a bit weird not knowing, but I feel pretty relaxed about everything.

The only thing that I don't understand is what to do next. When we pick up the blood results tomorrow the GP said we need to have decided on a hospital (I want a birthing centre) and an OB so he can write a referral.

Well, I can check out the hospital recommendation thread for that, but what on earth happens next? Do we need an OB? Can we just have a midwife? Or a GP? If we pick a hospital are we allocated a midwife? Or do we have to find one ourselves? Or does the hospital have a GP we need to use?

I've read that a lot of people feel that an OB is not necessary, so would like views on that too. Anyone have any thoughts on what the next steps are?

[~Saram~]

Congrats on you pg and don't feel too bad about forgetting your last period I can't remember mine either it's just that it's on fertilityfriend but I keep forgetting everytime someone asks (ie dr, midwif etc)

As for what next depends if you are going public or private? I went private with DS and chose an OB who looked after all my pg care and I delivered at the closet private hospital. With this pg I was living in a remote area without a private hospital so we found a GP who was qualified to deliver and he looked after my pg care (until 16wks when we moved) and would have delivered as at the local base hospital. If you go public it depends on the hospital and area you live in. some have midwife programs, others you just see whoever is there for appointments and on the day. HTH a little

[Janie]

Firstly, do you have private health insurance with Obstetric cover? If not then forget about going private. If you do it's another thing to consider.

Certainly many (probably most?) people go public, usually under midwife care. If you have a normal healthy pg you will just see the midwives for each visit. If they think you need to be checked by an OB they will organise that. Otherwise you will be cared for during your pg and labour and delivery by midwives. Whether or not you see the same midwife each time I think depends on what sort of program your hospital has.

There is also shared care which is as Sarah described above.

Hopefully Kelly or Alan or someone will come in and explain more to you about midwife care, I'm not exactly qualified!

Good luck with your decision

[Alan]

Steph
First congratulations on your pregnancy. Research ha shown that if you choose an OB you are more likely to get more medical interventions that if you choose a Midwife. Brenda Manning made a post recently ( I wish I knew how to put a link here) in her post she said that OB’s consider pregnancy and birth to be abnormal until proven otherwise. Midwives consider pregnancy and birth to be normal until proven otherwise. Your choices may be limited by the hospitals policy. However at a number of hospitals you may only see the OB once or twice if everything is normal. Where I currently work we do not have an OB in town, we have GP’s with some training in OB’s and are able to deliver babies, but in almost every case the Midwife does it all.
It’s a little late here and I am a little sleepy so I hope this makes sense. If you need any more information just post your questions and I will answer what I can

[xStephx]

Hi Alan, ~Saram~ and sezjm,
Thanks so much for your responses and well wishes! We have private health cover so options are open which I'm grateful for. Thanks also Alan for your insights into the philosophy behind midwifery vs OB. I would love to work with one or two midwives throughout the pregnancy, so might ask at our nearest hospitals about their programs. I'll see if I might be able to book in to tour them tomorrow; or maybe just go to the RPA here in Sydney where a few of my friends have gone, and check out the birthing centre.

Thanks again!

[mrsmac]

My ob was fantastic, he said at the start "pregnancy is not an illness, I am just here to help if anything goes wrong" He was so supportive and very reassuring, I broke my foot at 28 wks and had to have surgery and he visited me in hospital a number of times while I was in for that. (Just my 2c worth defending obs)

[BellyBelly]

hehehe you don't need to defend Obs mrsmac we don't hate them here at all and they do have an important place in the system. Everyone has a choice in what care they feel they need, personally I feel that they need not be the first in line for care. as pregnancy and birth does go well the majority of the time especially when there is no interference where it's all normal. But if you have a system where you can get Obstetric care through private health cover and not midwifery care, more are going to go for it, because they can. There is of course also the fear epidemic driving more consumers to this sort of care. Also if you have those trained in things that go wrong in pregnancy and birth to take care of you, they are going to be looking for things going wrong (midwives will do this too of course, but its a bit different!). Not all Obs are like that, but IMO I would like to see Obs doing what they do best once something is deemed to be complicated, not before. Midwives are great, you spend most of your labour with them, so if they can be there when you spend so much time with you already, it's great... an Ob will only be there if things go wrong.

I think once midwifery is back on the private health agenda which should be soon, more women will do it, and see the benefits of it. Consumers do drive the market.

Still then, everyone is entitled to the carer of their choosing. The thing I am more passionate about is women educating themselves, because then it wont matter what care you have because you would be educated in your options, choices and giving birth.

[Mumintaz]

Well, I'm doing something completely different to my previous pregnancies. This time, I'm going shared care with my GP and the hospital (if they will let me). After years of searching, I've finally found a gem of a GP who is as excited about my pregnancy as I am and who cares for me on a genuinely personal level, to the point where he will often ring me to see how I'm going and follows up on each and every issue to the nth degree.

I know that I can see him at short notice and that if there is anything he feels needs to be investigated, he will refer me to the appropriate person/people/caregiver.

I am confident that by doing this last pregnancy this way, my baby and I will be getting the best of care available to us in the current climate of health care.

Lisa

[Karina]

I decided to go to our local public hospital and go through their midwife program. I've only had to go to about 4 appointments so far as they decided I am "low risk". They also have a relatively new maternity section opened in 2003 which is very modern and has lots of high tech stuff and a nicu. I've read its an excellent hospital.
I decided against the private hospital nearby as the Obs there dont seem to take new patients often and you literally have to book in at the moment of conception, and their fees are just ridiculously high (like $5000!!) and our private health insurance doesnt cover much of it even though we have the top cover inc obstetrics. I also got told they dont deliever babies that come very early and you and bub get transfered to the public hospital anyway.
I didnt really think an ob was necessary - I figured that the midwives are highly trainined and should there be an issue, I will still be able to see an ob at the public hospital.

[xStephx]

Hi Karina,
Which hospital do you eventually choose? It sounds great! I'm going with the RPA (Sydney) as the birthing centre sounds great and the midwife I spoke to couldn't be more helpful or friendly. Looking forward to going and checking it out.

[Karina]

Steph I decided to go to Royal North Shore in Syd. Theyve been great so far, so I am really happy I chose there. I am going through their midwife program and for my appointments I see any midwife who is available
(the hospital just allocates one), which is good because it might mean I may have already met the midwives who will help deliver my bub.
Hope you continue to have a good experience with RPA. My mum tells me its a reallly excellent hospital. Do they have a birth centre there?

[xStephx]

Hi again Karina,
Yes RPA has a birthing centre with 9 birth rooms apparently, although we are yet to go visit. All the reports sound good. Same team midwife care model that it sounds like you have. There are 6 midwives and hopefully you meet them all over the 9 month period so that you know the one that is there when the little one decides it wants out. Only issue so far is that appointments are a bit tough to get, and I have to wait until 12-15 weeks and use a GP in the meantime. I'll have to go on the hunt for a good GP as I'm not so excited about the medical centre and it's random doctors! Sounds like Royal North Shore is going to be great. We'll have to compare notes.

[Josephine**]

Hi Karina

Thanks for the information on RNS. I am 7 weeks with my first baby, and am currently in Melbourne, but will be moving to Sydney at approx 28 weeks. Will I have to book with RNS to deliver publicly, and will it be too late to get involved with their programs? I have private health cover but I've heard the costs at North Shore Private are very high. I'm a bit confused at the moment as I have to find an ob for appts in Melbourne, then transfer to Sydney. Any advice appreciated.

[amyjean]

Hi there Karina,

It sounds like you have quite a bit of experience with RNS and its programs. I am 6 weeks pregnant with our first and have just booked in for the Midwifery Group Practice program at RNS where you see only 1 midwife throughout your pregnancy and then they deliver your baby. They said its only for 'natural' births which has me a little concerned - I don't want an epidural by i do want access to other pain killers if need be. Do you know anything about this program e.g. is this program in the birthing centre

Sorry so many questions.

Thanks Karina.

[becmc]

Personally I would avoid an ob unless you have or develop a medical condition requiring more specialised treatment.
I am having a vbac this time(vaginal birth after caesarian) and there is no way I would ever consider having an ob again.
Midwives all the way for me!!!!!!!

[Karina]

amyjean, RNS is really great. I missed out on the Group Midwifery practice because they only started it just before my baby was born (well thats what they told me!)
If you go to the birth centre, you can have pain relief, but only gas and pethidine. They would not normally give you epidural unless they believe you need it (eg to lower blood pressure and things like that). You ight be able to get moved to the labour ward if you need more powerful pain relief. I didnt go to the birth centre, I went to the regular labour ward. The birth centre is nice though - double bed and your DH can stay with you!


josephine, North Shore Private is lovely (looks like a 5 star hotel, lol),but the Obs there charge huge gap fees (like $4500!! ) and their obs book up really really fast so you might have missed out by now. I went to RNS (public) as a public patient and they were fantastic. Book in soon though as they get really busy! You should still be able to get involved in their programs though - they cant really turn you away or anything, but if they cant accommodte you in their post-natal facility, they will move you to Ryde or Hornsby or whichever other hospital is closest to your home.

I also agree with becmc, i didnt choose to have an Ob because I felt I would get great care by Midwives, which I did. If I were to develop some medcal condition during my pregnancy I would be allocated an Ob through the public system anyway.

[Josephine**]

Hi Karina
Congratulations on the birth of Claire, you must be very excited.
I am going to RNS public, didn't want to be out of pocket thousands of dollars. The staff at RNS have been great, I missed out booking into their midwife program but the obs I've seen was friendly.
cheers Jo