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?

@BlueSurfer

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.

I have to say this isn't the case in every area- I have to see my GP at booking (to access midwifery) and I won't have anything to do with him again unless I have a non-pregnancy illness or as PP said I need antibiotics for something the midwife picks up in urine. I've seen the practice nurse for my jabs but other than that my surgery hasn't been, and isn't expected to be, anywhere near my antenatal care. If all goes well I won't see a GP until our 6 week postnatal check.

I’m currently pregnant with DC3 and just wanted to echo what others have said about the role of midwives in the UK.

Across all 3 pregnancies, so far I have seen a consultant when I had a bleed at 20 weeks, when I had reduced movements (to discharge me basically) and for one session when I was referred for being an oldie and then discharged. I saw my GP for a UTI and the nurse at my GP’s for the whooping cough jab. So basically anything outside the run of the mill, you see the relevant specialist, with midwives the specialists on routine care. Also gave birth in a midwife led unit and didn’t feel that a consultant would have added anything as they were entirely straightforward births.

I appreciate it might seem odd if you’re used to different healthcare services but it’s totally standard here.

In my experience the midwives have been very good and thorough and haven’t hesitated to refer you to specialists if it’s needed or there is any question mark. My GP has also been involved at times to prescribe medication. It’s a very joined-up system so it’s hard to fall through the cracks. In London you would have to pay a fortune (£20k +) to access private consultant-led care and the care would be almost identical to what you would receive from midwives for free through the NHS. I investigated it at the beginning of the pregnancy but I didn’t think it would offer sufficient value to justify the price.

Have you considered employing an independent midwife as an addition to the NHS midwife-led care? That’s what I have done. The reason is that the downside of NHS midwife care is that you don’t necessarily see the same midwife all the way through your pregnancy and birth (although check with your trust as it might be different where you live). You might see a few different people antenatally and then have someone new attending you at the birth. It was really important to me to develop a relationship of trust with a single person who I knew would be with me all the way through - plus the research shows that continuity of care is associated with better outcomes for mother and baby. My independent midwife is in touch with the NHS team so again it’s all connected. She will be with me at the NHS hospital when I give birth to act as an advocate. It’s around £5k, so much cheaper than a consultant and gives me that continuity of care I want that unfortunately the NHS can’t provide.

I'd opt for midwife over a doctor here any day to be honest. Obviously if moved on to consultant care then that's fine but from what I know midwives have far more experience with pregnancy here than doctors do

I was under ‘consultant-led’ care in my last pregnancy for risk factors (and am again this time). I know lots of women will have different experiences but my experience was that I saw the consultant twice during my pregnancy and had an extra scan done be a sonographer at 37 weeks.

My point is that I found the NHS experience was still very much midwife-led even though I was supposed to be consultant-led. There was no consultant present at the birth or anything (well until it came to stitching me up but that was for different reasons). It didn’t make very much difference at all.

But I do understand the point you’re making - antenatal care is delivered very differently in other countries.

In one part of Surrey that I lived in it was routine to see the GP for one of the antenatal appointments. Worst appointment I had. Took ages to find heartbeat and didn't explain anything useful like the head was engaged.

In my first labour I was moved under the consultant once labour started due to concerning signs. My midwife still led my care and her decision making meant I avoided unnecessary pain - doctor wanted me on the drip, she monitored first and showed why I didn't need it.

@MissChanandlerBong22

I was under ‘consultant-led’ care in my last pregnancy for risk factors (and am again this time). I know lots of women will have different experiences but my experience was that I saw the consultant twice during my pregnancy and had an extra scan done be a sonographer at 37 weeks.

My point is that I found the NHS experience was still very much midwife-led even though I was supposed to be consultant-led. There was no consultant present at the birth or anything (well until it came to stitching me up but that was for different reasons). It didn’t make very much difference at all.

But I do understand the point you’re making - antenatal care is delivered very differently in other countries.

Whereas I had the opposite. Fetal medicine specialist did all of my scans and my routine midwife appointments were dropped because I saw the obstetrician so many times that they weren’t deemed necessary. It was a relief to leave hospital with my baby and know I wouldn’t be going back. However, having also had many other midwife appointments over my pregnancies, I found many of them provided excellent care and were far more empathetic and kinder than the consultants.

Would rather a midwife than a dr ANYDAY

@CityGirlintheCountry you may not be interested and that’s fair enough, but have a look at this link. This is a university local to me, it just shows how trained they are.

www.southampton.ac.uk/courses/midwifery-degree-bsc

I’m quite passionate as obviously as a student midwife it’s hard sometimes to hear (in this country) that it’s misunderstood and mistaken for general nursing. Completely understand your DP being from somewhere else and it’s different in his country. ☺️

Tell your DH to look up pregnancy outcomes by country. Obviously I don’t know what country he is from but often more intervention does not mean better outcomes. Comparing UK vs US you can see that. The US have way more medical contact time but worse outcomes.

I was consultant led due to MH. I saw the consultant once, they wanted to check my medication and refer me to Perinatal mh services but my gp had already done both of those things. I then only saw my midwife and the Perinatal mh team.

If my mental health deteriorated or other complications had arisen I would have had further appointments with the consultants.

Since having my baby we have had issues with reflux and allergies by far the most helpful person whilst navigating this has been our health visitor and the least helpful our GP.

There are so many factors that go into making a good medical practitioner, one of which is rapour and you can't predict that. I have a really good relationship with my hv. She has seen us in the home all through covid and has listen to my concerns seen first hand the behaviours that were causing us problems. Our gp on the other hand just quoted the paeds rejection letter over and over again and we only have phone appointments.

he is worried over nothing.

if you have to see a dr/consultant it's because midwife or sonographer has flagged up a problem.
out of 8 pgs I only saw consultant twice, one baby had to be ELSC, the other was a MC.

stop worrying.
(and yes, it was strange for me at first as well, in Hungarian you see your OB-GYN once a month and they are supposed to deliver your baby!)

Just to give the other side of things, I’m British but live in a country where all antenatal care is doctor led. You pick an OB/GYN at the beginning of your pregnancy and you see them for all appointments, tests, the delivery itself and then your post natal care.

I’m currently 33w with DC3 and see my OB every 3 weeks. It was every 4 weeks earlier on in the pregnancy and will soon increase to every 2 weeks and then finally once a week. At every single appointment I have an ultrasound where she listens to the baby’s heart, takes measurements and checks the placenta and the cord.

I find this really reassuring - to me it’s really strange to think that after 20w in the UK you probably won’t have anyone look at the baby again. Not saying it’s right or wrong, better or worse.

However what I will say is that a one off trip to a doctor is not necessarily going to be that helpful. They can only tell you the situation at that moment in time - where do you draw the line in wondering if any new ‘issues’ have cropped up since your appointment?

@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?!

This isn't the case for all trusts. I have no idea how much mine is in the minority, but we have a 36 week scan as standard as well. Hopefully this will become the standard across the UK one day. You can also have growth scans while still being under midwife led care.

I'd 100% be happy to be under midwife led care for future babies. But then I've never known any different.

@BlueSurfer 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.

This is interesting! Do you know approximately when?

I’m a FTM - no GP contact at all yet, I referred myself to the midwife team and I’m now 17w and haven’t seen my GP since. Or met my midwife yet!

It does feel strangely hands off.

@TakeYourFinalPosition what the PP said about the GP certainly isn't the norm where I am in England, I've explained what I get in my earlier post.
However you should have had two midwife appointments by now, maybe by phone, and I also saw a different one after my 12 week scan both pregnancies. This is the normal schedule www.nhs.uk/pregnancy/your-pregnancy-care/your-antenatal-appointments/

@TakeYourFinalPosition you should have seen your midwife by now if you are 17w

I'd be interested to hear from posters who come from countries who have regular scans/doctor checks after 20 weeks how that care is paid for ie does the dr charge you or insurance for each appt or is it free at point of care ?

Also how do your countries compare to Uk in terms of maternal outcomes?

www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries

@CityGirlintheCountry

You may also want to read that link, it says:
The World Health Organization (WHO) recommends midwives as an evidence-based approach to reducing maternal mortality.10 Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care

I'd be interested to hear from posters who come from countries who have regular scans/doctor checks after 20 weeks how that care is paid for ie does the dr charge you or insurance for each appt or is it free at point of care ?

Also how do your countries compare to Uk in terms of maternal outcomes?

www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries

@CityGirlintheCountry

You may also want to read that link, it says:
The World Health Organization (WHO) recommends midwives as an evidence-based approach to reducing maternal mortality.10 Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care

@BlueSurfer

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.

This must vary from place to place in the UK. I've had three babies, and never been seen by a GP for the pregnancy.

My midwives were great. I had three healthy, low risk pregnancies, and they saw me through and with healthy babies in my arms.

I would check your local hospital's Care Quality Commission report as well, and incorporate that in your decision. They have reports specifically for maternity services, and you can see how issues of safety, care, etc. are addressed. It is all public. Some are inadequate, or require improvement, while others are good.

In my experience, if shit hits the fan, things can move quickly in the NHS to get you the specialised care you need. When something went wrong in one of my pregnancies, I was in a specialised hospital in London within a week.

If you simply need more reassurance, you can also pay for reassurance scans privately.

Get him to come to your first midwife appointment and he can put all these questions to the midwife.

She will be well used to answering and hopefully it will reassure him.

@TakeYourFinalPosition, please call the community midwife team in your location, and say you have not heard from your midwife once in your pregnancy, and you need this fixed asap.

The threshold for extra scans is quite low, slight dip in growth on bump measurement equals an extra scan, unsure about dates = extra scan, double check its not breech = extra scan.
I had extra scans in both pregnancies

@CityGirlintheCountry would highly recommend the Milli Hill book ‘Give birth like a feminist’ for some really interesting background and stats on midwife vs ob-gyn care...

I’m on my third baby and have only ever seen midwives-both during antenatal care and during labour. After the baby is born there’s a routine check with a GP (mainly for the baby!) but honestly that’s been completely pointless box ticking exercise.

As others have said, Midwives do normal pregnancy, and Drs/consultants appear when anything out of the ordinary arises