Why do some people choose a midwife and others opt for an obstetrician? Pippa Henderson discusses the maternity care available in New Zealand, and how you might choose your LMC.
Here in Aotearoa, LMC simply stands for Lead Maternity Carer – the professional contracted through the Ministry of Health to provide or organise maternity care for pregnant women and their families.
Women have three options for an LMC: a midwife, an obstetrician or a general practitioner (GP) with a diploma in obstetrics. Over the last 20 years, however, almost all GPs have withdrawn from maternity and labour care (with only a couple of GPs in Auckland still providing maternity care, and no more than 20 active GP LMCs across the country) so we’ll be focussing on the first two options here.
Independent midwives are qualified to care for women with normal pregnancies. They work collaboratively with other health professionals so can refer you to an obstetrician if complications occur. The New Zealand College of Midwives website is a good source of information on their services, but the following is a summary of what you can expect from your midwife.
Access to private obstetric care varies across the country with several group practices and obstetricians working in solo private practices based in Auckland, and a much smaller number in Wellington, Christchurch and Dunedin.
Points to ponder
There are a number of topics to discuss with a potential LMC. Their qualifications, recent experience and childbirth philosophy are a good place to start, but also whether they’ll be available after hours and throughout labour, and who the backup carer will be, if required. Don’t be shy to ask about all the possible costs prior to treatment. If you’re planning a natural birth, you could ask about their intervention rates. You may also want to discuss the place and timings of your appointments and postnatal visits, as well as where you’d prefer to give birth.
A PERSONAL PERSPECTIVE
Megan is pregnant with her second baby. For her first pregnancy, following years of fertility treatment and specialist intervention, she was after a relaxed, 'normal person’s experience', so for her, a midwife was a perfect choice. Megan admits she was probably an exhausting patient, with all her questions, comments and suggestions, but recalls her midwife being patient and kind in dealing with her insecurities. This time round Megan has a private obstetrician and shares with OHbaby! the reasons why:
Why have you changed your LMC second time round?
I started off with a midwife, the same lovely and capable lady I had with our first baby, but following several bleeding episodes, I decided to switch to an obstetrician, purely for peace of mind. Given the struggles of conceiving our first baby, as well as the added complications of the bleeding and a high risk for miscarriage, we wanted to give this 'surprise' baby every possible chance. Even though we knew choosing an obstetrician over a midwife wasn't going to ultimately change the outcome, the information and answers were invaluable.
Two sides of the coin
My midwife was approachable and kind-natured, and became someone I looked forward to seeing – a calm and consistent companion from 10 weeks pregnant until our baby was six weeks old. In the midst of a significant haemorrhage and emergency surgery, she had a wonderful bedside manner, quietly explaining what was going on. Plus, she was free.
What advice do you have for others trying to make a decision?
Don't be afraid to ask questions and share your concerns. The responses you get can help you decide if you need a different style of LMC. I got worried when I didn't know what was happening and wanted specialist advice. Moving to an obstetrician gave me the security I needed. Your needs may differ with each pregnancy and you are allowed to choose the care that makes you feel best at the time.