I’ve been practising obstetrics now for about 15 years and during this time I’ve worked with amazing obstetricians, midwives and, yes, even doulas. Most are dedicated to the safe arrival of your little one and they hope that the experience you have in your pregnancy, labour and delivery is an amazing and beautiful one. Similarly, I have come across those who use dangerous practices that can put women at risk because of their personal beliefs about labour.
Every woman seeks someone to guide them through the journey of pregnancy and birth. While I was compiling this list of important factors to consider I came across many sites. Some were good; others had obvious agendas, with anti-doctor (describing obstetricians as merely ‘surgeons’) and anti-midwife (describing them as unsafe) opinions. Extremes do not help, and the cooperation between midwives and obstetricians is as important as their interactions with you.
Private or Public?
This is, unfortunately, a choice that many people do not have. Private obstetric care is expensive. In addition to your obstetrician’s fees, which are not really covered by private health funds anyway, the private hospital where you choose to deliver will charge you for your stay. Think of this as a hotel and you’re being charged a nightly rate for your stay. This is covered by your fund and is the most expensive part of your care.
When you choose private obstetric care, you decide who cares for you throughout your pregnancy and who ultimately delivers your baby.
In public hospitals you are allocated care depending on your risk factors. Some women have medical conditions that predispose them to having a high-risk pregnancy and will; therefore, need to see doctors in their pregnancy. If you are considered a healthy low risk woman then you will either be asked to have shared care with the hospital doctors and your GP, or opt for midwifery care.
Most public hospitals now have team midwifery care. This is a lovely model of care for women. You are allocated into a team of 8-12 midwives with one predominately seeing you throughout your pregnancy. Any one of these midwives will then be on call for your delivery, but most will try to deliver the women they have cared for antenatally.
Choosing a private obstetrician?
As most of you are aware, everyone has their own opinion about pregnancy and birth and they’re not afraid to share it! But it’s not about THEM. This is your pregnancy and you need to choose the person that you feel resonates most with you. Remember you are choosing an obstetrician because you value their opinion, not because you pay them to do what you want. Choosing wisely will ensure you feel comfortable, safe and happy.
Questions to consider:
• Do you have any pre-existing conditions that need to be monitored in pregnancy?
• How will the pregnancy affect you?
• How will your condition affect your baby?
• Have you been given any medical advice in the past about pregnancy?
• Could this affect the type of delivery you want and how strongly do you feel about this?
Choosing your obstetrician
1. Meet a few obstetricians
While it can be an expensive exercise, interviewing 2 or 3 obstetricians will help you find someone who’s the right fit for you.
2. Who do they share their on call with?
No human being can be asked to work 365 days a year, 24 hours a day. All obstetricians have colleagues they share their on call with, whether on a regular basis or for holiday cover. Being delivered by someone you haven’t met can be scary. You need to trust they share the same obstetric practices and you also feel comfortable with them. It is unlikely you will be offered to meet all the obstetricians in a group, but it is a reasonable request should you wish to.
3. Ask specifics about labour
Many women have set ideas about labour. Feel free to open this discussion early with your obstetrician to seek their opinion. Position at delivery, water birth, breech birth, monitoring, induction of labour, caesarean section and pain relief are common questions presented to obstetricians. Remember that one conversation; however, is unlikely to cover all of these topics fairly.
4. Be open to an objective opinion
Many women choose to see the intervention rates as ‘cons’ when it comes to deliveries. Having a vaginal birth also carries risk, so any practitioner – be it midwife or obstetrician – should give you a balanced opinion about the risks in your situation. Don’t ignore their opinion because of your beliefs. Ensure you weigh up the arguments well.
Just as you may prefer to have an elective caesarean section, there are others that will choose a vaginal birth. Both carry risks.
5. Rates of intervention
Asking for an obstetrician’s rates of caesareans, episiotomies and instrumental deliveries is not helpful in my opinion. Obstetricians in a private setting will have skewed numbers because of the population of women they see. Women with medical issues who require intervention seek the care of private obstetricians because of their experience or specialty. This can make these rates looks higher than the average.
6. Philosophical questions
Asking an obstetrician philosophical questions about their beliefs on birth, again, is unhelpful. Obstetricians are doctors and, as such, will consider the safety of you and your baby as their priority. They will take into account all factors and give you their opinion based on what is best for you and your new baby.
When you meet the right one you will know!
Alex Izurieta is a specialist obstetrician and gynaecologist with a particular interest in fertility, miscarriage and reproductive endocrinology from adolescence to menopause and is able to provide expert continuity of care from conception to delivery of your baby. She graduated with a a Bachelor of Medicine and Bachelor of Surgery from the University of Sydney and a Bachelor of Science in Anatomy from the University of New South Wales, and holds a fellowship from RANZCOG, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Teaching, service and dedication have underpinned appointments as a staff specialist at the Royal Hospital for women, and as a conjoint lecturer and examiner at UNSW involved with the education, training and inspiration of undergraduate and postgraduate students. Her dynamic approach, endless energy and depth of knowledge have made her a favourite of both medical practitioner and students alike. Now a mum to two beautiful girls, Alex understands the pressures of balancing work and family. Being a mum has taught her a commitment and dedication, discipline and patience, that transfer from home to work. Her drive has been to never forget your goals and dreams, and never forget to challenge yourself to be a better person, mother and practitioner.