Confused. Needing some advice please...

Hi ladies, I'm freaking out a little. Feeling a little overwhelmed. I'm 5 weeks ish pregnant. Do I have to have an OB\GYN?? We don't have private health cover. I always imagined that you just see your GP, get referrals when you need scans\tests etc, pick which hospital you want to birth at & bobs your uncle?? Probably sounding naïve but I don't really know lol..... I've also read a few threads that say they were counted as high risk because of their BMI etc & some hospitals don't accept you??? My BMI is not in a healthy range :\. I'm just freaking out a little. We did miscarry last year & I just want to make sure we follow the right steps needed. Could someone explain why\if you need an OB\GYN? & if you can just stick with your GP etc? I feel so silly asking these questions. Thanks so much x

Do you mean you don't have private health cover??

You see a GP and get a referal to hospital and then see Midwife clinics generally at most hospitals and see a Dr for 1 appt or more of medically necessary.
You generally are only out of pocket for scans as all blood tests should be bulk billed. And if a public patient in public hospital your stay and any medical cae is covered. Including theatre and epidurals etc and SCN if needed. As long as you have medicare.

Sorry little confused. Do you have private health?

If you have private health, you don't have to use it. You can still use the public system.

For private health system: visit your GP (I'd make an appointment now). They normally organise your blood tests. You tell them which ob you want to use and they will write you a referral. Call the ob make an appointment and go from there.

In SA I think only flinders and lyall Mac take all bmi's. Not 100 percent sure on that though. Your gp should be able to answer that though.

For private health I think you do shared care with a GP and a midwife (someone may know more :))

My personal reasons for using an ob were: a) I could pick whatever hospital I wanted because a private hospital means you have to have an ob. I was pretty definite on the care I wanted. B) I am one of those what if type of people so an ob was kind of an insurance policy as such for me. That being said I was fussy with my ob's and I wanted one that would let me birth how I choose.

I've heard the midwifery groups at WC are great though.

Where were you planning on birthing? Did you have any ideas on how you wanted to be cared for?

In my experience, if you're going public, you see your GP for your initial visits (checking you actually are pregnant, then the first bloods etc.) and they'll refer you to the hospital. Depending on the hospital, they'll either book you in for your first visit early-ish, or you'll keep seeing your GP until around 18w. If you end up with the latter and you want to do DS testing, you'll need to go ask your GP for that around 10-12w. Then you go back, get the results, and see midwives at the hospital for most visits. You'll usually only see an OB on certain visits or if you're high risk.

Be prepared for them not to tell you a THING. My very first BB post was pretty much exactly that - "my doctor isn't telling me what I'm supposed to do, when is this supposed to happen? When do I do this? Why isn't the hospital contacting me yet?" It's like they expect you to know what to do without any guidance. Hopefully you end up with someone better and my experience was just bad luck...

Gosh sorry. My brain is just not working. We don't have private health cover. Will read replies now, just wanted to clear that up!

You're in Australia yeah?

My experience has taught me this:-

First step is to see your gp. They will refer you to the hospital. You may be zoned for a certain hosp but if you have a preference you can ask to be refered to a different one. Whether they accept you or not depends on the hospital.

There are a few different models of care.
I dont know much but my understanding is this-
Gp shared care - your appointments are 1 on 1, spread between hosp (midwife mostly and at least 1 ob) and your gp, you will likely get a different midwife at each appointment. I stayed in 3 days after the birth of my son. No follow up after that. Was sent to the mchn and gp for any care after that. This was 5 years ago. It may have changed.

Midwifery led - you see the midwives at the hospital and only one or two visits with an ob, 1 on 1 again, different midwives each time.

Or at my hosp (mater mothers public) they also had a Midwifery Group Program - a group of 10 ish women under the care of a team of 4 midwives who see you for all appointments in a group setting. You are assigned 1 midwife from the team and the others are the backup anytime yours is off work for any reason.
I also saw an OB at around 16weeks at the hosp but that was the only hosp appointment I had.
Unless there are complications or you wish to stay for a paritcular reason they discharge you 4-6hrs after birth and follow up with you at home for the first 6 weeks post partum.
**This is for low risk only I think


Im not sure about the high risk stuff or BMI as it wasnt an issue for me.

Your gp will also calculate your EDD or send you for a dating scan if you arent sure of your dates. They will probably send you for a blood test to check your levels (iron, vit d, etc) and your immunity to certain illneses.
If you are stressed about miscarrying again you can ask for a scan to make sure everything is ok.

Before you see your gp, look up your prefered hospitals website. They should give information of the different types of care they offer so you can make an informed choice.

If I think of anything else Ill come back.

I don't have PHI either, and my two pregnancies were each handled differently. With DD (my first) I went to the GP when I found out I was pregnant and he sent me for blood tests. I saw him for the results, and all appointments after this were with him - he did referrals and results for scans, basically everything. This was GP shared care at the local medical clinic, right next door to the hospital. I only ever went to the hospital for a midwife once, at 20 weeks, and it was kind of like a booking thing, she went through absolutely everything I'dalready been through with the GP and she filled out forms.

With DS, just recently, I went through a different hospital because we'd moved. I didn't want GP shared care again because I wasn't a fan the first time, and I wasn't sure when I conceived. So I called the hospital first and they told me to see a GP for a dating scan referral then call back once I'd done that. So I saw the GP for the first and last time, had the scan and got it sent to the maternity unit of the hospital. I went and had an appointment with a midwife where she basically went through forms and kind of set me up as a patient. I had four options here - GP shared care, group midwife care, one to one midwife care, or OB care.

I chose and was accepted into the One2One midwife program, and it was the best decision of my entire pregnancy. I didn't meet my midwife until midway through the pregnancy, but I didn't need anything until then. She was absolutely fantastic and I miss her a lot now. She was so thorough, appointments were at home, and I knew she'd be the one there when our boy was born, rather than whoever happened to be on shift.

So you do have a few options, I'd call the hospital you want to use first and see what their process is.

Congrats!

The public system is much like Teni said. Definitely start with your GP, go from there.

You are only guarenteed a place at your assigned public hospital (or at a hospital they refer you to, if they can't handle your needs locally). You might be able to get a place as an out-of-area public patient at other hospitals (you can ring and ask) but they don't have to take you.

In terms of precise details of how you will be cared for, there's a few public models, but it will depend on your area and your risk category. Some public birthing options are not available to women judged to be high risk or even moderate risk. Some aren't available in all areas. There will be something for you though. These are the public models I know of (they're all billed to Medicare, other than perhaps scans):

Pre-natal with hospital midwives in a hospital clinic (probably with one or two doctors appointments), labour and birth in a hospital birthing suite with shift midwifes and a shift doctor if needed: this is the standard model for low risk women.

Pre-natal with all doctors (registrars, ie OBs in training; and/or OBs; and/or specialist physicans) in a hospital clinic, labour and birth in a hospital birthing suite with shift midwifes and a shift doctor if needed: this is the standard model for high risk women.

"Shared care" pre-natal with a mixture of hospital midwives in the hospital clinic and your GP in their usual clinic: this is available or even required (due to low numbers of midwives) in some areas for low to moderate risk women. Not all GPs have the training required to do shared care, ask yours if it's an option.

"Team midwifery" pre-natal with a small team of midwives (about 4, rotating) in a hospital clinic (probably with one or two doctors appointments), labour and birth in a hospital birthing suite with one of the same midwives who was in your team: this is available in some hospitals for low to moderate risk women.

"Case loading midwifery" pre-natal with one midwife, high chance of labour and birth in a hospital birthing suite with the exact same midwife who did your pre-natals: this is available in some hospitals for low to moderate risk women.

Pre-natal and labour and delivery at a birth centre, which is a more home-like natural birthing-friendly environment, and which typically don't have doctors on-site. Some are on the same grounds as a hospital, some are not very near hospitals. These are available in some areas for low risk women. You will generally need a doctor's approval to be a birth centre patient, and you would be transferred to a hospital clinic if you develop pregnancy complications and to a hospital ward if you need an OB's intervention in labour or birth.

Homebirth with a caseloading midwife. A very few public hospitals offer homebirths to low risk women with a doctor's approval, again with transfer if complications develop that can't be handled safely at home.

All of the team midwifery, case loading midwifery, birth centre and homebirth programs are popular. Some hospitals actually allocate places in them by lottery. If one is available at your assigned public hospital, find out when you need to apply for it to get in! When you've read about women being risked out for BMI, it's usually from one of these options and will depend on the hospital's policy. The "standard" options will remain available to you. No one gets kicked out into private care! (In fact, sometimes private carers kick out their highest risk patients into public hospitals!)

Another option is a homebirth with independent midwifery care :)

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Another option is a homebirth with independent midwifery care :)

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Yeah, I agree, I didn't list that because it isn't public/free. (Although most private health plans don't contribute anything to it, with a few exceptions.)

I didn't read all the above replies in detail, but in case this wasn't covered...
In the public system, if all seems to be going to plan you will mainly see midwives (or your GP if you do shared care)
But if ever there is anything wrong or risky they will arrange for you to see one of the hospital obgyns. It might not always be the same one, but don't feel like you won't get to see the specialists if you need to.

I use a private ob, but that's mainly so I can choose the hospital and dr that delivers my baby. I would actually much rather a midwife or GP model of pre-natal care! No point seeing the ob for all the routine visits in my opinion!

Thanks so much ladies. I feel much more at ease now. Feeling a little silly for asking these questions but as we got our first BFP at 8/9DPO (2 days before our wedding). We managed to get an appt the day before the wedding. My HCG was 15 & progesterone was 15.5. Have been testing every day & have beautiful progression. No point in testing anymore as the tests are sucking out all the dye from the control line :). Have been on our honeymoon ever since, so was just getting all frantic. Finally we'll be home tomorrow so will make an appt for follow up bloods, referral for dating scan & referral to the hospital. I went on their website & have researched their options. Thanks so much again :grouphug: