2 midwives vs. doctor / midwife

We are planning a home birth for our first baby, due in June next year.

I had planned to use a midwife (Jan Ireland) as my lead carer, and to attend the birth. Now, Jan uses a second midwife for home births, to support her.

Last night, I was at my GP, who often works with Jan (Peter Lucas). He mentioned that I could either have the 2 midwives, OR have him, with Jan as his support. He said that, while he supports either choice, he feels that there is some arguament for having a doctor attending a first home birth.

I need to decide within the next ten weeks as, if he is NOT going to attend the birth, he cannot continue to provide care until after the birth (insurance reasons).

SO now I am trying to decide whether I want Jan plus another midwife, or Peter plus Jan? Ideally, I want Jan as the 'lead midwife', delivering the baby, but I am starting to wonder if it might be nice to have Peter there too, as it is a first baby?

Personally, I'd stick to the midwives.

He's a GP. Is he specialised in childbirth? If not, theres no huge advantage over having him there compared to two experienced and specialised midwives. I doubt he could do more than what your midwives could do.


ETA:

:

---

I need to decide within the next ten weeks as, if he is NOT going to attend the birth, he cannot continue to provide care until after the birth (insurance reasons).

---

If he's a GP why can't he provide shared care at his practice leading up the birth? Sorry if this is naive, but I'm a bit confused lol.

Ahh yes sorry I forgot to say! He is a pregnancy and birth specialist GP, he has delivered over 3000 babies, many/most of whom were at home! He was a pioneer of the home birth movement in Vic in the 70s, he is very experienced with HB. In fact, I would say he is one of the only doctors in Aus that attends home births...

I agree with leash. I'd rather have people there supporting me who do this as their sole job - more experience, than a GP who deals with other complaints as well, and may not be as specialised.

FWIW - I'm having two midwives for a VBA2C - no doctors allowed. I don't even have a GP at the moment!

ETA - sorry, I just read your last post. I would still go the midwives.

My MIL had him and a midwife for 4 (i think) of her births, and speaks very highly of him.

Have you talked to Jan? She might be able to tell you how she works with Peter, and how she works with another middie.

Yeah I'd probably still go the midwives. But since you want Jan there regardless, why not ask her opinon?

Kate - do you know if your MIL found him to be fairly hands off? I am not interested in having him there if he will insist on internal examinations etc... I am very keen to hear anythin your MIL might have mentioned!!

But I get the feeling he will pretty much stand back and let it happen? I just checked his bio, over 5,000 births wow!

Leasha the question re. providing shared care is a really good one. Basically he said that his insurers will not allow him to be part of the shared care if he knowingly then allows the woman to birth without any medical support people (of course, insurers do not recognise midwives!). Basically, he would be liable if anything went wrong at the birth.

He is working hard to change this - he is in full support of midwives in private practice. He is happy for me to go either way - with him or without him.

I am curious as to what the advantages might be of having him there... I think I need to ask him about what he sees as the advantages, and also ask Jan what she sees as the disadvantages. They do work together all the time!

I havnt read any posts as im in a bit of a hurry but i had both in hospital and both times i only had 2 midwives!! no doctors either time!!!

So i dont see how it could be any different having a home birth?? id definatly still go the 2 midwives :) :)

Hmm! Intestesting! I just spoke to my aunt, who had a home birth in 2002 (VBAC). She had Jan as her midwife, and it was a really great birth I'm told...

BUT she just said, "oh, and so I had Jan and Peter Lucas" which I never knew! Apparently Peter Lucas just sort of popped in at the end, made tea for everyone, took some photos, and helped with a twisted cord!

She said it was actually great having him - just that reassurance that she wouldn't have to transfer, because even if she had a bleed, or needed some low level intervention, the doctor was on hand. But she said he was so, so totally hands-off!

Plus you get heaps back off his costs from Medicare which is nice. So I am leaning towards having both of them now :) I will make an appointment to chat with them together :)

Hi there, I had Jan and another midwife (Gaye). I honestly don't see the need for a GP. Both Jan and Gaye were fully qualified nurses and had attended thousands of births themselves. They had also birthed ten babies of their own between them.

I am so jealous you get to see Jan. I love her more than anything. She popped over the other day to say hi and it seriously made my month!

Wishing you all the best. PM me if you want to chat. I had a very successful homebirth last year, and it was my first baby.

All the best.

I think there are both good and bad points. If you have a really homebirth-supportive GP who is hands off, it can open all sorts of doors for you - for a start, it makes it much easier for the midwives to organise certain things, like blood tests if you have a rhesus mismatch or other niggly things that can result in a really unnecessary hospital visit. I don't really know how useful they'd be during the actual birth - I'm wracking my brains to try and think of anything a GP could do that a midwife couldn't, and I can't really think of anything - maybe give syntocinon if you were one of the very unfrtunate few to have a post-partum haemorrhage, but most midwives carry this and will give it in an emergency anyway, with or without a medical order. It's basic midwifery practice.

The only other benefit I can think of is that if you transfer to a hospital where your GP has visiting rights, he can remain your primary physician.

If it were me, I would go with the midwives only. As you want Jan as the leading midwife, then there's your answer there :D Good luck with the decision.

It sounds like it would be a good outcome either way. I've read about Peter Lucas and it's good to read positive stuff about Jan, as I was going to contact her when it's our time again. Do you feel comfortable with Peter? Is there a cost difference?
It may also help your family etc if you tell them you'll be having a doctor and a midwife. (Not wanting to disrespect midwives, who are more than capable, of course).

GL - looking forward to hearing how it all goes.

by him being there with Jan, would it be him catching? or Jan still doing the primary care and catching and him just sort of hanging around as her backup?
good luck with making the choice, so lucky you have that sort of professional support around you to give you what you really want!!!
go with your gut, and what you will feel most comfortable. Have you met Jan's backup midwife? maybe meet her and see what you think you can get from her, comfort and support wise.
basically it is what you feel will work best for you, what and who you are most comfortable with and who you think will provide you with what YOU want and not take over the situation.
good luck!!!

:

---

I think there are both good and bad points. If you have a really homebirth-supportive GP who is hands off, it can open all sorts of doors for you - for a start, it makes it much easier for the midwives to organise certain things, like blood tests if you have a rhesus mismatch or other niggly things that can result in a really unnecessary hospital visit. I don't really know how useful they'd be during the actual birth - I'm wracking my brains to try and think of anything a GP could do that a midwife couldn't, and I can't really think of anything - maybe give syntocinon if you were one of the very unfrtunate few to have a post-partum haemorrhage, but most midwives carry this and will give it in an emergency anyway, with or without a medical order. It's basic midwifery practice.

The only other benefit I can think of is that if you transfer to a hospital where your GP has visiting rights, he can remain your primary physician.

---

Yes Michael this is sort of what I have been tossing up - what are the advantages of having a GP? I think I need to meet with Jan seperately, and ask her... And also ask Peter Lucas.

I guess I need him to refer me for any tests - 20 week ultrasound etc. Midwives cannot do this right?

:

---

It sounds like it would be a good outcome either way. I've read about Peter Lucas and it's good to read positive stuff about Jan, as I was going to contact her when it's our time again. Do you feel comfortable with Peter? Is there a cost difference?
It may also help your family etc if you tell them you'll be having a doctor and a midwife. (Not wanting to disrespect midwives, who are more than capable, of course).

GL - looking forward to hearing how it all goes.

---

Tashy it is cheaper to go with Peter as lead carer, because I get loads back from Medicare. But TBH it's not really a deciding factor...

It would definately help with family!!! Not mine, but DH's - we haven't even told them I'm pregnant yet (waiting til end of 1st trimester) but I KNOW they will freak the heck out about HB!

My MAIN concern is - I want a successful HB. I do NOT want to transfer to hospital. Am I less likely to need to transfer with a GP? E.g. if something really goes wrong, is there anything he can do that might help avoid a transfer?

:

---

My MAIN concern is - I want a successful HB. I do NOT want to transfer to hospital. Am I less likely to need to transfer with a GP? E.g. if something really goes wrong, is there anything he can do that might help avoid a transfer?

---

Honestly, no. You are least likely to transfer to hospital with an independent midwife who screens her clients appropriately for risk factors. I don't think having a GP there would make any difference. In fact, having an experienced midwife as opposed to a less experienced GP, the midwife is at an advantage because she is more likely to notice the very early signs of a potential problem, and help you manage that, rather than not noticing until complications occur.

The GP and midwife you are looking at are both very experienced, with Peter Lucas who

:

---

has been a general practitioner for 35 years...and has attended in the order of 5000 births as a specifically trained General Practitioner. Peter has wide experience with hospital deliveries and planned Home Birth.

---

and Jan Ireland

:

---

who has been involved in hospital births, birth centre establishment and home births for 30 plus years.

---

I don't think the experience of either professional is in dispute. I think it is really important how comfortable you are with your health care providers and how they work with you.

(Quotes are from the Clinic they work at, found through Google)

Given their background, I don't think it would make a difference which way you went - so I'd go with whomever you feel most comfortable with.

It would be interesting to see how the changes being brought through re: medicare and midwives affects things. I think it may soon be that midwives HAVE to work with doctors. I'm not sure - I'm not understanding what is going on.

Just a quick update :) We have gone ahead with the IM, Jan, and couldn't be happier!

We've had a couple of appointments (on the sofa lol) and are really happy with our choice.

Sounds like a great option to get a choice as to who you have!

All i would have said it that the thing that is going to make you transfer or not is going to be the limit of equipment, NOT skills. There is nothing a GP could do than a skilled MW!