Your Antenatal Guide
New Zealand's maternity care system offers a wide variety of
care options, and it is up to you to decide which type of care best
suits you and your baby. You will choose a Lead Maternity Carer, or
LMC, he or she is the health professional who will be
responsible for providing or jointly providing all of
your care during the antenatal period, birth and the
postnatal period. Your LMC may be a midwife, a general
practitioner (GP) or an obstetrician. Alternatively, your LMC
may comprise of a group of professionals who work together to
provide your care.
Independent midwives as LMCs
Independent midwives are qualified to care for
women who are expected to have a normal pregnancy and birth.
They may refer women to a public or private obstetrician if
complications occur. An independent midwide may be able
to arrange a back-up (private) obstetrician for labour for a charge
of around $1500.
If your independent midwife has concerns for the
wellbeing of you or your baby,
she will refer you on to an obstetrician for advice
or medical care. There are national guidelines regarding conditions
that suggest referral to obstetricians, e.g.:
• In pregnancy - multiple births, previous caesarean
section, pre-eclampsia, breech presentation.
• During birth - fetal distress, slow progress in
• After birth - post-partum haemorrhage, major
perineal and vaginal tears
Family doctors as LMCs
Although rapidly become the exception, some GPs in New Zealand
are also LMCs. They usually provide all of the antenatal care in
pregnancy, referring to an obstetrician if problems arise. They
care for women during labour and birth, possibly with an
independent midwife who works with them, or with hospital based
midwives. The postnatal care at home is undertaken by a midwife.
Unfortunately, this option which is likely to be needed once
again in the face of waning recruitment to obstetrics and
midwifery, is in danger of extinction.
Private Obstetricians as LMCs
Although obstetricians are trained to manage complications of
pregnancy, many do provide care in normal pregnancies as well. This
includes antenatal care at their clinics, intermittent attendance
in labour and birth (sharing care with an independent, hospital or
their own contracted midwife). Postnatal care is by a midwife, with
reference to the obstetrician who remains the LMC. Your
obstetrician is likely to work in practice with one or more other
obstetricians so if he/she is unable to see you for any reason, you
will be seen by one of his/her colleagues. Many women choose a
private obstetrician to enable rapid access to expert care in the
event of unforeseen circumstances e.g. dysfunctional labour or
Hospital teams providing maternity care
Some midwives employed by District Health Boards work in teams,
providing care to women in the community and in the hospital. In a
normal pregnancy, this might be a team of midwives; in a pregnancy
with complications, such as gestational diabetes, this wil probably
be a team of obstetricians and midwives working together.
These midwives are not LMCs but are employed by the District
Health Boards to work in the antenatal, postnatal and labour
What will it cost?
The following services are free to New Zealand residents and
• Maternity care provided by midwives and GPs
• Staying in a public hospital or a birth centre
• Referral to an obstetrician in the public sector, by the
midwife or GP, for advice
Charges will be incurred for:
• Birthing in a private hospital
• Some tests e.g. ultrasound scans undertaken by certain
• Childbirth education classes (although these are sometimes
• All pregnancy, labour and birth care for non-New Zealand
residents i.e. the public hospital will charge
• An antenatal visit for advice to a private obstetrician
may cost approximately $100-150 per visit.
• LMC care from a private obstetrician will cost around
$2500-$4,000 (latter figure for Auckland).
• An elective Caesarean section with a private obstetrician
(in a public hospital) will cost around $1800.
This section on choosing which type of antenatal care best
suits you has been put together by Dr Anil Sharma, an obstetrician
and gynaecologist in Auckland. www.dranilsharma.co.nz