How important is an obstetrician?

[Babyluv]

Hi girls,
I just found out my 1st obs app is $200 and then at the 3rd app it's $1500 i will get some back from Medicare but I'm starting to wonder how necessary an obs is?
What will I get from an obs that I wouldn't get without one?
Is there a diff between the care my baby will receive at birth?
Will I miss out on necessary pre natal care?
Who had an obs and who didn't and what were your experiences, would you make the same choice again?
Thankyou ladies

[Lulu]

I can't see the point of having an Ob unless you have complications with your pregnancy.

[Arimeh]

I had an OB with my first and second pregnancy because I wanted to go to the private hospital on the sunny coast, as the public hospital didn't have a very good rep when it came to maternity and i would have done anything to avoid having to go there.

But since I elected to have my first baby by c-section, you sorta need an OB for that - and you don't really get to "elect" to have a c-section if you don't go private - well with most hospitals anyway.

I had DD2 with an independent midwife in an independent birth centre, and if I knew with DS what I know now - I wouldn't have had an OB at all - I would have gone with a birth centre like that one I had down here in Tas.

[Indadhanu]

If you are going private I think you HAVE to have an Ob.

If you go public it's unnecessary in a normal pregnancy.
If you have a complicated pregnancy and would prefer continuity of care then I'd go for an Ob.

I went public, no problems during pregnancy, and when I needed an Ob at the endof my labour the hospital just called the Ob on duty, who came in and also performed the emegrgency c/s, and the hospital paed and midwives did the once over on Jazz after the c/s. I think thats all a private Ob would do, as they aren't a labour support person IYKWIM. Oh and the postnatal care, which was done by my midwives. A hospital Ob never saw me or looked at my c/s wound after I left the operating room, the midwives were great with that and an Ob would have seemed like a bit of overkill.

[~me~]

If you gave a good midwife system in the hospital you are going to give birth then as Lulu said you probably wouldn't need an OB.
I think under the MW system you still see an OB once during the later stages of pregnancy.
I had an OB for all my pregnancy's. I went private so I think I had to have one? I went private as I wanted to stay in hospital as long as I could. So this was 5nights.
I probably could have done without as mine were all non complicated pregnancy's and births. It was what I felt comfortable with.
What I did like about an OB as I was pretty much in control of how I wanted things to go (baby co-opereating of course). Most MW are like this too, although I had a friend who went public without an OB and the MW were not great at listening to her and her needs.

Some hospitals now have the KYM (know your midwife)scheme which is fantastic, you get to see the same MW through the whole pregnancy and she/he will be there at the birth too. Worth investigating.

Also..the amount you are being charged by your OB is very reasonable. Before this new change 1st Jan most OB'S were charging double that so perhaps the new system has done what it intended it do and bring the price down OB's charge and make them more available and give people a choice of MW care of OB care.

I look forward to hearing everyone else's experience's.

[Arcadia]

I didnt see one at all. My gp organised all the blood tests and then I had an independent midwife from 14 weeks (which isn't cheap but so worth it...I got 6 weeks worth of after care also and she was an LC so helped with all the breastfeeding stuff too).

You should be able to do shared care with your gp to keep costs down.

Have you considered a homebirth or midwife lead birth? (I ask with trepidation in case you think I am a homebirthing evangelical)

[~mamaspice~]

The best way to help you to decide on what type of care provider to have would be for you to read about the "Obstetric View" and the "Midwifery View" of birth, and go with whichever resonates better with your own beliefs. Google Obstetric View and Midwifery View and you should find definitions. Better still I can highly recommend an Australian Book called: Better Birth - the Definitive Guide to Childbirth. I sooo wish I had have read that book before I had my first baby.

Based on what you've mentioned about your management fee being $1500, you'll get about $460 of that back from medicare. When you factor in all your out of pocket antenatal costs, any gaps for scans and bloods, hospital excess, gaps for paed or anaesthetiest fees, it would be feasable to say you will be out of pocket approx. $2-3000 going private. IMO about the best part of going private would be getting your own room at the hospital.

FWIW, I went Private with DD, but I'm going public this time around. I much prefer midwifery lead care and if you can go to a hospital that has a "Know your Midwife" program" I'd definately pick that over a private OB any day.

Best of luck with your decision.

[Lulu]

When you factor in all your out of pocket antenatal costs, any gaps for scans and bloods, hospital excess, gaps for paed or anaesthetiest fees, it would be feasable to say you will be out of pocket approx. $2-3000 going private. IMO about the best part of going private would be getting your own room at the hospital.

Never, ever assume private covers means you get your own room!

I had a great Ob for my 1st, a lovely man.....but I didn't need him

[fionas]

I had an ob because I wanted to use my private cover - I never get sick and don't like the idea of paying for it for 30 years (because it makes sense tax-wise) and never use it. Plus, I'm an anti-social witch who hates sharing a room at the best of times so wanted a private room. Plus, I'd had a few depersonalising experiences in public hospitals with previous miscarriages, didn't like being treated like a number, didn't like waiting around for hours to be seen and wanted to see the same person throughout not whoever was on duty.

But that's why I chose one. Are they necessary? ABSOLUTELY NOT!

If I had my time again and if I knew I was going to have an uncomplicated birth, I'd either go a homebirth or with midwifery care (and look into having a private room because I know I wouldn't sleep in a shared room, just me).

As it is, I'm having an elective caesar and don't fancy a rigmarole of trying to lobby for this in the public system especially when we will be moving house late pregnancy so I'm staying with my first ob.

[~Raven~]

An OB is only really important if you have a high risk pregnancy or elect to use the private system. If you want to go private then you need to have an OB. Unfortunately they go hand in hand as there is no midwife led care in the private system

An OB will give you continuity of care and in most cases will be there for the birth but it's not a given.

So from there it's a matter of deciding where you want to birth and why and going about and finding your care providers that will support you in your choices!

Speaking from a personal point of view, with my first birth I went private due to the reputation of the local public hospital after speaking with friends who had been there. Due to that choice I had to engage an OB who I was happy with and I chose to see him again for subsequent PG's. A public hospital with midwife led care did open up in my area when I was expecting my bub #3 but due to complications with my 2nd birth they didn't accept me because they are a low risk facility. This had a lot of bearing in my "choice" (wasn't really a choice TBH) to go back to my OB and private hospital for #3 and then again for #4.

I feel like one of the few that has had good experiences with an OB Make sure you know what you want and talk about stuff early on in regards to how you want your birth to go. Not all OB's are the same and it's important to find out early on if they will support your choices. If he/she doesn't then find one who will!

ETA forgot to mention the fees! A lot of how much you get back depends on your medicare safety net which accrues from Jan-Dec. Find out how much yours is (they vary a lot depending on your income and if you get any centrelink benefits) and if you go past it, which is quite easy once you pay for scans and appointments, you get the majority of any further Drs fees and some tests refunded for anyone on the medicare card.

[Peg]

i've had 3 children (14, 10, 4yrs) and i did not have an ob with any of them. I went thru 'shared care' with my first two and midwife care with my 3rd. Even though i had 3 c-sect, I had no pregnacy complications and so there was never a need to see an ob...until delivery time of course.

I am now seeing an ob for my current pregnancy because I have some specific requests with regard to my next c-sect so i wanted to make sure that those requests were met. As a public patient i would have to accept which ever ob was on duty at the time of my delivery and I wouldnt have an opportunity to make sure he/she knew my specific requirements.

But for healthy normal pregnancies and labor, a private ob would not be necessary. A lot of women dont even get an ob at their delivery unless things are not going well. So its really up to you. The cost is due to going private...so its not really because you will get better care IMO.

I also have $2,000 confinement fee to pay along with the regular $70 checkup fee. I havnt paid that fee yet but im curious to know what happens to that money if my Ob is not available for my delivery or i loose the baby in the meantime (im only 22 wks)...i'll be asking that on my next visit.

[*Beema*]

Most pregnancies don't require an OB, unless you want to chose the hospital you birth in (ie Private or Private Patient in a Public Hospital), you want to chose the OB caring for you.

I would definitely look into the Birth Centre/Midwife programs in your area.

OB feees can be very high and you don't get as much back from Medicare now

I chose to go with an OB with my first pregnancy as I thought it was what you did and I wanted to birth in a private hospital. In the end it was thr right decision for me as I have an abnormal uterus and had a few complications during the pregnancy and ended up having a prem and ended up delivering in a public hospital, but my OB was there for the delivery.

This time I have gone back to my OB as I am a high risk pregnancy, her support was great her fees reasonable and for me it is the right decision and I have many more complications this time around and am getting the close attention I need, but I don't fit into the "average" as such.

And if you can go through a MW program they will assess your "risk" as such and if it is low, and they have room your will go through and should something arise and change your risk you will be referred through to an OB through the public system, with the only difference being you may see different one each appointment, but the group of midwives would be consistent in the MW program

[Roryrory]

Like the others have said, whether you have/need an OB depends largely on the model of care you feel most comfortable with.

For my first, I was initially scared and saw childbrith as a possible life-and-death moment for me and the baby, so I insisted that I needed an OB. He was the "expert", after all (DH thought I was being ridiculously paranoid but let me go on my merry way). But during the pregnancy I came to feel that birth was natural, unlikely to lead to death, and a could be managed in a non-medical manner. But I had done my cash already and ended up in my chosen private hospital and OB-led birth. It was "safe", medicalised and produced a good result.

By the time number two came around, I was a full convert to the "birth is natural" vibe and went though a midwife-led model of care with the Family Brith Centre at the Mercy. It was a totally different experience, but the care provided was no less "sound" by virtue of it being delivered in a public setting.

This time I am planning a homebirth with the Sunshine Hospital's HB program. Again, a totally different model of care, but one which is no more risky to me or the baby than having an OB in a private hospital (in fact, on many measures, it is a SAFER one!)

So I think it comes down to comfort levels. If you are fearful of the birth process, you probably will want an OB to steer your boat - if you believe in your heart it is a natural thing that your body knows how to do, you will most likely choose a midwife-led model of care. But your level of comfort has A LOT to do with the level of education you seek out about pregnancy and birth.

[Loula]

For me i chose an OB mainly due to being in the IVF system for so long, (7 years) and felt comfortable with someone in that role taking the lead,

I found it very helpful with my anixety and after so many losses the fact that i could send him an email and he would reply straight away and also being able to see him when i needed, somtimes my appointments were 3 weeks apart.(while i was bleeding from 4 weeks to 15 weeks) Hi mannor has helped me to feel a bit better about things.

Now I am 25 weeks i look back and think gee ive spent a lot os cash! but as my friend said to me i may need his expertese towards the end of the pg again.

I was happy to birth in a public hospital, and i have chosend a private hospital attached to a public as the public fecilities are usually better, with regards to special care ect. but i felt with this pg after so long i wanted someone i could call and they would be there to answer, and i wanted it to be the same person every time so i wasnt getting conflicting information

my OB is also very pro natural del and VBAC also high risk

GL

[Alina0210]

I'm pregnant with my 3rd baby and have never had an Ob. For a trouble free, no problems pregnancy then why would you go to an Ob who is technically a surgeon.

The only thing I have paid for is ultrasounds at 12wks and 20wks which I did get some back from Medicare.

[black_rose]

I had an ob for my first as we wanted to private and I had the phi so we made the most of it. For us it was money well spent dd was born by emergency c sect 6 weeks early, breech with dislocated hips and hip dysplasia so we had acess to a great pead and after care when she was home. With dd2 she almost came at 35 weeks but with the support of my ob we got to 37 and I had a vbac. He was also able to find me help with spd when my physio wouldn't treat me at 22 weeks.
So we are with him again for no 3 given that I have pre term laboursr I wouldn't to go through the public system.
My thoughts are that it's hard to know when you may run into problems first time was a dream run until my waters broke at 34 weeks, if you have doubts use an ob.

[Babyluv]

Wow thankyou so much for your responses ladies, I guess I will need my Ob afterall as I'm going private, wasn't aware that was a necessity in private. Also good to know he is reasonably priced, I had no idea.

[JellyBean]

For a normal, low risk pregnancy? Not important at all.

Its important to remember that OBs are ultimately surgeons by trade. They are the experts in surgical birth (aka c-sections). And thank goodness we have them for TRUE emergencies (albeit much rarer than the statistics would have us imagine).
However, they are widely criticised by birth advocates for their tendency to favour and 'groom' women with otherwise normal pregnancies for intevention that leads to c-section (ie artificial induction, stretch & sweep). Something else to consider is that they also get paid more for c-sections.....

If you anticipate and desire a normal birth, than I'd personally recommend going with those who specialise in normal birth - midwives. They will be the ones cleaning up your sick and helping you to the toilet if you end up with a c-section anyway!! OBs get the credit and all the $$ but the midwives are the angels who stay by your side before and after, helping you to establish breastfeeding and check your stiches etc. If something does appear during pregnancy that will put you in a high risk category than the midwife will refer you to an OB.

I also just believe that birth should be free. It is a natural process and a part of life. The way i see it - why should i pay some guy in a white coat 3 grand 'in case' I need him - when i am so desperately hoping that everything goes well and he will be left twiddling his thumbs? I'm the one doing the hard work - if anyone gets paid it will be me, thankyou!!
Whatever you decide - make sure you read the book listed in my sig!!

(PS - you can get your own room in public hospitals too - or even better - look into Birth Centres - there is a thread on them here somewhere).