Midwife vs Doctor?

[CityGirlintheCountry]

Hi MNs, my DP and I were discussing antenatal care in Surrey where we now live vs our respective home countries (Asia and Southern Europe). He was adamant that we should be seen by a doctor or at least have our case looked over by a doctor, and was taken aback and i think a little worried to hear that antenatal care here is almost 100% midwife led unless there are complications. To clarify, we would 100% be seen by a doctor not a midwife in our home countries, but I'm also aware that millions of women have given birth through the NHS system, so it's more about the experience and getting reassurance than about quality of care.

His specific concern is that midwives are trained to notice common/obvious anomalies, but doctors have extra training to pick up anything that could be a red flag.

I've read enough on MN to know that this can differ slightly between NHS trusts, so wanted to poll the group. Trying to decide if it's worth the extra £££ to get a private review or maybe ask for an OBGyn consult at our hospital.

If you've had both a midwife and a doctor, which did you prefer and why?

For me the midwife will put you onto consultant care if there is any reason to, I can't see that a doctor would do anything (assuming low risk etc) at antenatal checks that the midwife does, such as urine, BP etc, because it's a standard protocol.

As you say the only way you'll access a doctor here is either if a midwife considers it necessary or if you pay for it, and I wouldn't be happy paying for someone to dip my urine and check my BP when I know that my midwife would pass me onto a doctor if they had any concerns anyway.

I have my issues with my maternity care this time round but instill don't feel inclined to opt out of the system- I had doctors involved at the appropriate times in my last pregnancy, thanks to my midwife, and I will access a consultant in a few weeks with this one, again down to midwife referral.

I'm not sure what your partner thinks a doctor can/will do differently to a midwife tbh but it's your money at the end of the day!

It doesn't sound like your husband knows much, if anything, about the training of midwives. Midwives in this country are highly trained, autonomous practitioners who have incredible high standards of training. The RCOG and the NMC provide huge amounts of guidelines to both midwives and Drs about which births might be deemed high risk and need to be referred on to Drs.
I am a paramedic and I'd definitely have an experienced midwife over a trainee (already qualified as a dr for many years by this point) obs & gynae Dr.

You have ultrasounds here and if anything flags up on them then you get seen by specialist foetal medicine doctors.
Likewise bp and urine checks and if anything flags up you see a doctor.
If you have any medical problems or there are signs of anything abnormal you see a doctor.
You won't benefit from paying privately to see a doctor, as if things are going well you don't need one. If things are going wrong, you'd be doctor led anyway.
A midwife is trained in normal, which means that they really good at spotting things which aren't normal and referring them on.

Doctors won’t do anything differently. Midwives are specifically trained to pass you over to a doctor if necessary, they understand their medical limits and will never take a risk as far as I’ve experienced. Midwives are trained in everything to do with pregnancy and birth and doctors deal with their specific areas so it’s all one big interconnected team really.

Those red flags that your husband is worried about- those are what the midwives are trained to spot. They are experts in normal, but refer to a doctor as soon as they suspect anything is not as it should be. It's your money, but I wouldn't pay to go and see a doctor if I was healthy.
Pregnancy is part of normal, physiological health for low risk women. They don't see doctors because they and the baby are healthy. The minute anything else is suspected, that is when the doctors are the experts. X

Thank you for all the input, it's really helpful! My guess is in his home country, you either have nurses or doctors, and that's it. They have equally vital but very different roles within healthcare, and neither of us knows enough anything about the training midwives in the UK go through.

Is there something (on RCOG maybe?) that talks about their training? That might help reduce his worry. Ultimately I know this stems from him being worried about me, so I'm trying to emphathize and not start the fight that my nasty 12-wk hormones want

Although the majority of women are midwife led, please don't be concerned that this means you won't see a Dr if you need to.
My midwife says I can contact her at any time between appointments with any concerns - and you also have your GP.
I had a concern about some medication that I usually take (when not pregnant). I rang my GP to ask her advice and she wanted some clarification from Obs & Gynae, so she rang the consultant at our local hospital, discussed my situation with him and rang me back with the answer.
I am midwife led, but there is access to Drs should you need them.
But in general, midwives are the experts in their field over the doctors!

There is some info here on Midwifery training - they still have to do a 3 year degree... and actually, it's all focused in one area rather than a brief overview of lots of fields of specialism!
www.rcn.org.uk/professional-development/become-a-midwife#:~:text=To%20become%20a%20midwife%20you,instead%2C%20which%20takes%2018%20months.

I had midwife led care for our 1st. Only issue I had was high blood pressure in 3rd trimester. Care was fine.
2nd was measuring large so I was moved to consultant led care, he was over 4.5kg which automatically puts me high risk on all pregnancies now. Had a set of twins, there is a twin clinic at hospital for those, all consultant led and scans at every appointment. Added on previous cesarean to my high risk list from them.
Biggest difference is I am seen at hospital by midwives then a doctor briefly, downside is sometimes I've waited over 3 hours to be seen by the doctors.
Honestly being under midwife led care in the UK is pretty good, you don't get much extra from seeing the doctors. Unless you have complications you are better off with the midwives.

You'll be forwarded to a consultant if you need one. If the pregnancy is midwife-led throughout, it's because it's low risk and there's nothing that a Dr would be concerned about.

As someone with a degree in midwifery, midwives are trained to recognise and promote normal birth. They are the experts/specialists in that. If ANYTHING deviates from normal, a doctor will be involved, without question.

To me, paying for a private doctor is not necessary, however it's your prerogative. It's just a money making exercise for them. If you want to have a normal delivery, a midwife is your best bet.

www.nmc.org.uk/standards/standards-for-midwives/standards-of-proficiency-for-midwives/

I'm a midwife. UK midwives are very different from many around the world, we are autonomous practitioners in our own right. I trained for 4 years to qualify initially. 4 years of "just" midwifery, In the 20+ years since I qualified I have studied constantly and am now very highly qualified (arguably more so than many of the doctors I work with), in addition to working and gaining practical experience. Midwives are experts in normal pregnancy, this allows us to be experts in recognising when something is wrong and when to refer to the medical team, who are the experts in complicated pregnancies/birth. It's not either/or, we all work together in the same team but each group are the specialists in their area. Despite the horror stories you hear, for the huge majority of women pregnancy is a normal, healthy process. For that you want a midwife, she/he will refer you if ever necessary. You will still have scans/bloods/monitoring as required which the midwife is more than capable of interpreting - the midwife will plan this care and will not hesitate to refer you to the right person should the need arise. Good luck.

Sorry but your husband obviously knows nothing about midwifery training. I've given birth elsewhere too so I can tell you with certainty that they are as trained if not more so in the care of pregnant women and giving birth than most drs who barely see you (care was by non specialist nurses mostly). If anything is flagged up you are referred to a specialist dr.

Midwives aren't the same as nurses as pp have explained. If anything triggers the need for review by a consultant, it will happen.

The quality of mw care varies, as can consistency of seeing the same mw, but that's no different to any other branch of NHS treatment.

His specific concern is that midwives are trained to notice common/obvious anomalies, but doctors have extra training to pick up anything that could be a red flag

I’m a midwife. We are the experts in normality and low risk pregnancies and births. We are very highly trained to to detect any deviation from normal and refer appropriately. We’d then work in conjunction with the doctors. The midwives standards and midwifery education standards are what you need to read if you want more info on training, etc.

Whilst I agree with PP that midwives in UK are highly trained professionals and I of course, trust them, especially when it comes to the birth... it's quite worrying for someone who comes from a country where antenatal care is consultant led and with ultrasound scans every 6 weeks or so, to check the baby is developing well.

It's quite a shock to the system to rely on a midwife to feel your belly and measure it with a tape measure. My last scan was at 20 weeks and now noone is going to look at the baby until birth?!

I'm in Northern Ireland but all my pregnancies were high risk so consultant led. However in my 2 successful pregnancies it was hands down the midwives that saved my dds lives on more than one occasion.
Dd1 I was discharged from my 4th stint in hospital (this one for preeclampsia) that morning and waiting for medication from the pharmacy to arrive. The midwife spotted that I was full of energy and restless (had been extremely ill all pregnancy) I was rushed to delivery and had her at 32 weeks EMCS, she would not have made it a few hours later.
Dd2 (not my 2nd pregnancy but second to make it to my arms) on the ward to be induced on the Monday, just before midnight on Friday night I felt funny, like I did with dd1, nurses said wait for doctor next morning, midwife listened, put me on the monitor, up to delivery right away, she even stayed on shift an extra hour because dd2 was almost out and she wanted to see us through.
Also it was my community midwife who finally got me sorted after 6 months of complications and hospital visits and infections after Dd1 by driving me to hospital herself, bypassing A&E and marching us up to the ward herself, demanding it be taken seriously and sorted now, she wasn't leaving until it was. (She was 4ft 2inches and the loveliest woman but could be formidable when necessary!) I cried when she retired after Dd2 if I ever had a another (unlikely now) I always told her I'd be begging her back

I’m a student midwife. I understand your worries but honestly, midwives are trained for 3 years within an inch of their life! We are autonomous practitioners. They are experts in pregnancy and labour care - if they need to refer you to consultant care, they are able to recognise and do that. They are very different to nurses and very specialised.

His specific concern is that midwives are trained to notice common/obvious anomalies, but doctors have extra training to pick up anything that could be a red flag.

What anomalies does he think a doctor will be able to pick up that a midwife won't?

Unless you have a condition where you are already seeing a specialist or in certain other well laid out circumstance, you don't need to see a consultant and have any extra tests.

Plus all healthcare practitioners in the UK are trained to escalate issues that they can't treat. Whether they do or not depends on the individual practitioner. In addition there are some checks built into the system which when you are pregnant healthcare practitioners ensure they do.

For example in my area you have one appointment with a GP as part of your antenatal care for your first baby.

The GP will check your blood pressure, dip your urine and listen to your bump exactly like midwives do with your appointment with them. However the advantage over midwives for me in having this appointment is I got an infection 24 hours before my appointment so I got my GP to prescribe antibiotics.

If I had seen a midwife I would have been told to make an appointment with a GP for a prescription.

When a GP prescribes for a pregnant woman they check whether she actually needs the drug and whether they can give a particular drug or they have to give an alternative. (The checks may involve them contacting a specialist for advice.)

Once the prescription is written the pharmacist seeing that you are pregnant will also check that you are allowed to have the drug. They can refuse to give it to you and refer you back to the GP.

I work in healthcare (not a midwife though) and my first choice would always be midwife-led antenatal care unless they found something high risk. The midwives in this country are the experts in low risk pregnancies and births. They're also experts in detecting when something might need additional input (eg a doctor) and know who to involve and when.

What does your husband think this doctor is going to pick up on or do beyond what a midwife will do? Pregnancy is a condition not an illness.

Do you have underlying health issues in which case you'll be under Dr care anyway if it makes you high risk? Are you an older mother, high BMI, heart condition, IVF baby etc etc.

Your bloods will be taken, you'll have scans that check everything from growth to fluid and blood flow across the placenta, you might have a glucose tolerance test, they'll listen in to babies heart beat.

What else do you think you'll get if you go to a doctor? Genuinely not sure what you think they'll pick up on if you're a healthy low risk pregnant woman.

Our midwives are bloody amazing and highly qualified. I would opt for their care every day of the week and trust that if they spotted an anomaly I would be referred as necessary.

@UKmumtobe

Whilst I agree with PP that midwives in UK are highly trained professionals and I of course, trust them, especially when it comes to the birth... it's quite worrying for someone who comes from a country where antenatal care is consultant led and with ultrasound scans every 6 weeks or so, to check the baby is developing well.

It's quite a shock to the system to rely on a midwife to feel your belly and measure it with a tape measure. My last scan was at 20 weeks and now noone is going to look at the baby until birth?!

I think this is where his worry stems from, in a nutshell!

Is this your first pregnancy? If so, you will be seen by a GP on several occasions as part of the low risk normal antenatal pathway. If there are any concerns about anything, you’ll be referred to either an obstetrician or fetal medicine specialist. Despite what you may have read, the NHS is very risk adverse.

@Bogofftosomewherehot I'll be 39 at my due date, so yes to older mother, but so far no other issues.

Again, he comes from a country where pregnancy is fully consultant led, so its understandably worrying to hear that my entire pregnancy will be led by "nurses" (in quotations here as I do realise there's a difference, but don't know enough to articulate those or to reassure him that I will be getting all the care I need

We didn't know enough about MW training to differentiate between the MWs and nurses, but I'm at least a little better informed now thanks to PPs.

@BlueSurfer yes, rookie FTM here, can you tell?

so far my GP has been spectacularly unhelpful and uninvolved (par for the course pre-pregnancy so no change there tbh)