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?

@KidneyBeans

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

Where I live, all expats have private healthcare. My OB/GYN connects with my insurance company on all bills and whilst there is a ‘cap’ on how much my policy covers for maternity care, it’s insanely high so it’s not a concern.

I don’t know what the maternal outcomes are like compared to the UK (can’t really find anything online) but a few observations just from my own experience and that of my friends:

• things like gestational diabetes, thyroid issues etc get picked up a lot more as they are tested for as standard
• the c section rate is much higher for a mixture of reasons - a) it’s a lot more acceptable here to simply ‘chose’ to have one, b) things like breech or large babies are picked up a lot more due to the increased scanning rate and c) there is far less appetite for attempting a vaginal delivery where there are any ‘risk’ factors eg breech baby because doctors do not have the legal/financial support of an organisation like the NhS behind them should something go wrong
• doctors here are a lot less keen on letting you go overdue. 7 days seems to be the absolute maximum that doctors are happy with, including doctors that are western/western trained

Hi!
I'm not here to judge gps but wanted to share my own experience. The gps I have had to speak to about certain things in both my pregnancies have been very unsympathetic and rushy (just made that word up but it fits lol). They have shunned me away when I really needed them. I'm sure there are many gps who are wonderful and helpful, but I'm yet to find one.

Midwives on the other hand that I have had the pleasure of meeting have been incredible! If I were to be told that procedures were changing and in pregnancy I'd have to be looked after by a gp id be gutted!

Midwives here in the UK are trained and know exactly what to look out for! And like many have said if anything is of concern you will be sent to a consultant etc with the additional midwifery care too!

Honestly I am sure you will be looked after so well! And if midwives are worried about anything else that they cannot help you with they will ask for you to call your gp.

Once you do go into labor they are honestly incredible! They do everything to make sure you're okay! The drs on the other hand (again my experience) come in don't even say hello boss the midwives about and then bugger off!
The midwives for me were just outstanding.

I'm sorry if I sound like I'm judging all gps im really not! Just sharing my experiences in both my pregnancies. Maybe I should change drs surgery 😂

All the best xx

I began my maternity care in the UK and at 17 weeks i moved back to my home country. Here care is shared between your gp and the maternity unit, you have no set midwife, you just see whoever is there on the day . I'm on duel care between consultant and gp here now but being honest I preferred the UK system where I was consultant and midwife. I feel like an annoyance ringing the gp for small issues while with the midwifes you rang left a message and they rang you back next day and no question was too small or silly.

I’m a dr.

Midwives are the appropriate professionals to deal with normal birth.

I’m high risk so had to have an obstetrician overseeing me but I hired my own midwife to take care of the birth as I know which profession is best placed to manage a normal delivery. Had I required any intervention it would immediately have been taken over by a doctor, as is appropriate.

Thanks @PrimeraVez
Are you able to say where you are?

What are the comparative rates of gestational diabetes etc as you say these are picked up more where you are? Are you in a population where these issues are more predisposed?

Interestingly all of the things you mention would result in increased revenue for the doctors involved. That's generally a conflict of interest that we don't have to worry about.

I’m in the UAE so a country with a majority expat population. And yes, I completely agree that doctors are acutely aware of what generates more income for them - private healthcare is a double edged sword in that respect - on one hand I genuinely feel lucky to have such easy access to specialists (I would very rarely go to a GP here - I would always go directly to a dermatologist for a mole check, to my endocrinologist for anything related to my thyroid etc) but also they do love to run tests for anything and everything that I think can cause unnecessary worry.

@KidneyBeans

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'm in Ireland: our maternal mortality rate is lower than the UK, and you have a choice with public healthcare. You can be midwife led, through a domino scheme, or consultant led. (I think that standard model is shared care where you also have GP appointments. Also, the choice to be midwife led depends a bit on geography). At your hospital appointments, midwives will do urine sample/BP, then you're called in to see consultant (or more frequently, junior doc under the consultant depending on your case) Whether you get scans after 20 weeks depends a bit on the hospital: my understanding is you will often get a quick scan at most future appointments if consultant led. At my last app, which was around 16 weeks, she did a quick scan, even though officially scans are just 12 and 20 weeks. Its all free under the public service but a lot of people choose to go private as it means seeing the same, actual consultant at all appointments, costs circa 5-7k (assuming you have health insurance to cover the hospital stay at birth) and officially it means having that same consultant at the birth though its not guaranteed and I don't imagine happens all that often, and means you will probably have a private room.

If you're public, and you're midwife-led, they will be in the room unless anything goes wrong: that was what happened to me and basically consultant & lots of other people appeared as if by magic (an alarm went off not in the room!) when needed. I haven't given birth consultant-led yet, but I think basically its mostly midwives who are there, and you're occasionally checked in on by a consultant and they feed back and suggestions are made. If intervention is needed, they appear.

Its v similar to the UK system from what I understand, but a bit more consultants seen as standard.

I chose to be midwife led my first birth, as I was low risk, and I found the public system excellent. Similar to the UK I think midwives do a huge amount of specialist training but also know when to bring in consultants if they're needed. If they're not, you get more attentive and personal care from midwives IMO. So I really wouldn't worry, though its always difficult being in a system that isn't your own