Obstetrics-led Care

You can choose to have your care led by a doctor in both the public and private health systems. The doctors who are specifically trained and qualified to care for pregnant and birthing women are called obstetricians. Sometimes GPs who have undertaken additional training in obstetrics are also qualified to care for pregnant women, but they rarely attend the birth. Obstetricians are trained to care for women with complicated pregnancies and births. Research suggests that healthy women and babies experience higher rates of normal birth and lower rates of intervention when they are cared for by a midwife.

Obstetricians

These health professional are qualified medical doctors who have undergone extensive additional training to specialise in obstetrics. Obstetrics is the branch of medicine which deals with the care of women during pregnancy, childbirth and the postnatal period. Pregnancy and labour are not illnesses and so the specialism of obstetrics focuses specifically upon pregnancies and labours which are complicated by health risks.

GP Obstetricians

GP Obstetricians are GPs who have a Diploma in Obstetrics and Gynaecology or have completed another short course in obstetrics. GP Obstetricians can provide shared care with your hospital antenatal clinic.

Public Health System

If you choose to have your baby in a public hospital through the 'standard care' model, your care will be overseen by an obstetrician. You may only have your appointment with an obstetrician if one is on duty at the time, or if it is hospital policy to do so. The remainder of your appointments will be with one of the clinic midwives.

If you choose the shared care model involving a GP Obstetrician, your antenatal appointments will mostly be with your GP at their general practice clinic. Only a limited number of GP Obstetricians will attend you during labour at the hospital.

Obstetric-led models of care in the public health system include: standard care in a public hospital

Private Health System

You can also access obstetrician-led care by hiring a private obstetrician. These doctors have visiting rights at particular private and sometimes public hospitals and so your choice of doctor may determine which hospital you give birth in. In the same way, your choice of hospital will also determine which private obstetricians you can choose from. Some private obstetricians are extremely popular and you will need to make your decision quickly to be successful in booking in with the doctor of your choice. Your antenatal check ups will take place at their private consulting rooms. Appointments tend to be short (10 minutes) and focus upon the physical aspects of your pregnancy such as taking your blood pressure, checking your urine for protein and glucose and checking that your baby's growth is on track.

Many private obstetricians require a significant booking deposit at around 24 weeks of pregnancy. This can make it feel difficult to change your mind if you later find that the choice you have made is not right for you.

Obstetric-led models of care in the private health system include: standard care in private hospital

What does the research say about obstetric-led care?

If you have health concerns or if your baby is unwell, obstetric-led care may provide you and your baby with an opportunity to achieve the best possible outcome.

The researchers from the Cochrane Pregnancy and Childbirth Editorial Group, which is the research group that the majority of maternity professionals refer to, suggest that most women should be offered midwifery-led continuity models of care and that women should be encouraged to ask for this option.

When we look at the results of the large reviews of all the related research, we find that women who had obstetrician-led models of care during pregnancy and birth, were more likely to experience:

• a pre-term birth;

• an intravenous drip of artificial oxytocin to speed labour up;

• an epidural or any form of drug use during labour or birth;

• an episiotomy;

• or a vacuum or forceps assisted birth.

And were less likely to experience:

• a spontaneous vaginal birth;

• care by a midwife whom they knew before labour began;

• a longer labour;

• breastfeeding at six to eight weeks or longer;

• and very positive views of their care.

Obstrician-led care didn't seem to make a difference to a woman's risk of:

• having a caesarean birth;

• or, her baby dying during pregnancy, labour or after the birth.

(Sandall et al. 2013 and Hodnett et al. 2012).

References

• Hodnett ED, Downe S, Walsh D. (2012). Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub4.

• Sandall, J., Soltani, H., Gates, S. et al (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 8. Available online at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/abstract [accessed on 31 October 2013].