Normal pregnancy? Leave it to the midwife

September 27, 2010

Consumer champion and money-saving guru from the Irish Times, Conor Pope was a guest on George Hook’s Newstalk show the other week. The topic was the cost to middle class parents of bringing up a child.

Conor pointed out that before the child is even born, most middle class parents pay between €3500 and €7000 to secure the services of an obstetric consultant – private health insurance does not cover this cost. Apparently you need to get straight on the blower the moment you see the little blue line appear in the pregnancy test window if you want to get the obstetrician of your choice.

Now this topic is a bit of a personal bugbear of mine. Why are women with straightforward, healthy pregnancies attending obstetric consultants for routine antenatal care and normal deliveries? Do they really need to shell out thousands of euros to have a highly trained consultant tell them that their blood pressure is fine, the baby’s heartbeat and growth are normal and that their blood sugar levels are no cause for concern? That is a midwife’s job.

The Royal College of Obstetricians and Gynaecologists in the UK lists the following definitions on its website:

  • Obstetrics deals with problems that arise in maternity care, treating any complications of pregnancy and childbirth and any that arise after the birth.
  •  Obstetricians work alongside midwives, whose speciality is usually normal pregnancy and delivery.

 In other words, during a straightforward, healthy pregnancy and delivery, there is no need for a woman to see hide nor hair of an obstetrician.

My first child was born in London 11 years ago. Private health insurance is relatively uncommon in the UK and I, like the vast majority of women, relied on the NHS for my antenatal care. Most of my antenatal visits were to the midwives clinic at my local health centre, with a couple of GP visits in between. I usually saw a midwife called Mandy, a reassuring and warm Welsh woman.

Everyone is assigned a consultant obstetrician, but only sees him or her if problems arise during the pregnancy. Because I had a history of hip problems, I was referred once to the hospital so that the obstetrician could confirm I was capable of having a normal delivery.

On the day of delivery, I was delighted when Mandy arrived on shift towards the end of the labour, and welcomed my son into the world. There was no doctor in the room. A breezy registrar had appeared shortly beforehand to check in on us, announcing that “if baby hasn’t appeared in the next 10-15 minutes I’ll be back to ventouse”. That did the trick. Ten minutes later Mandy was handing us our first child and it was wonderful to be attended by someone I knew and trusted.

Back in Ireland a few years later and expecting my second child, it seemed I had committed a terrible middle class faux pas by failing to take out private health insurance. A lot of people’s first response to my news included the question “Who is your consultant?” They seemed almost embarrassed to hear that I had thrown myself at the mercy of the public system, and I was given grim warnings about the endless queues I would face at the ante-natal clinics.

They were right, the queues literally stretched up and down the length of the hospital corridors. However, I never had to join those queues. At the end of my initial booking visit I was offered, almost as an afterthought, the option to attend a midwives clinic, as I was in a low risk category. This was apparently not a very popular option as I wouldn’t be seeing a doctor for routine care, but I jumped at the chance. At every subsequent visit I walked past the seemingly unending lines of women waiting patiently for a doctor, till I reached the door marked ‘Midwives Clinic’. Here, I never waited more than 10 minutes to be seen and was soon on my way home, passing the same women still queuing on my way out.

That was in 2002. Since then, a handful of midwife-led clinics have opened and a few hospitals are offering ‘domino care’, where midwives visit mothers before and after the birth in their own homes. These services are still very limited however, and are only available to public patients.

This seems to send out a clear signal that midwife care is somehow a second-best option. Of course there are many reasons why women need to see an obstetrician during pregnancy and childbirth. Older mothers, multiple pregnancies, high blood pressure and many other risk factors  require specialist care. Many women probably feel that they are not prepared to take any chance with the wellbeing of their precious child, and they want the reassurance of a familiar face at the birth. But if they were offered the chance to be cared for by a small team of midwives in their local area, one of these midwives would be there for them on the day. And of course at the first sign of a problem at any stage during pregnancy or labour, the midwife can call in an obstetrician.

I don’t know how this system of over-dependence on obstetric consultants and under-valuing of midwives has arisen here in Ireland. It seems an awful shame, not to mention a waste of money. After all, for most women, pregnancy is not an illness. If and when we get the long promised universal health insurance, perhaps everyone will be offered high quality community midwife care, with obstetric consultants available for those who need them, regardless of ability to pay.

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2 Responses to “Normal pregnancy? Leave it to the midwife”

  1. We went public and had the best of experiences. It was just midwives for 99% of our time in labour, efficient doc just breezed in right at the finish to steal the glory. If we’d paid X thousand to go private and had the same experience we’d have said it was money well spent.

  2. Spot on! I much preferred the level of care and concern I had from my midwife on my second pregnancy – on the first one, the OB> was only interested if I had problems – I regularly queued for 2 hours, for a 1 min consultation. It does seem to be an unnecessary cost, and burdensome part of our healthcare system. No to mention the medicalisation of a healthy function.

    Anna

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