New Zealand's maternity care system offers a wide variety of care options, and it is up to you to decide which type of care best suits you and your baby. You will choose a Lead Maternity Carer, or LMC, he or she is the health professional who will be responsible for providing or jointly providing all of your care during the antenatal period, birth and the postnatal period. Your LMC may be a midwife, a general practitioner (GP) or an obstetrician. Alternatively, your LMC may comprise of a group of professionals who work together to provide your care.
Independent midwives as LMCs
Independent midwives are qualified to care for women who are expected to have a normal pregnancy and birth. They may refer women to a public or private obstetrician if complications occur. An independent midwide may be able to arrange a back-up (private) obstetrician for labour for a charge of around $1500.
If your independent midwife has concerns for the wellbeing of you or your baby, she will refer you on to an obstetrician for advice or medical care. There are national guidelines regarding conditions that suggest referral to obstetricians, e.g.:
• In pregnancy - multiple births, previous caesarean section, pre-eclampsia, breech presentation.
• During birth - fetal distress, slow progress in labour.
• After birth - post-partum haemorrhage, major perineal and vaginal tears
Family doctors as LMCs
Although rapidly become the exception, some GPs in New Zealand are also LMCs. They usually provide all of the antenatal care in pregnancy, referring to an obstetrician if problems arise. They care for women during labour and birth, possibly with an independent midwife who works with them, or with hospital based midwives. The postnatal care at home is undertaken by a midwife. Unfortunately, this option which is likely to be needed once again in the face of waning recruitment to obstetrics and midwifery, is in danger of extinction.
Private Obstetricians as LMCs
Although obstetricians are trained to manage complications of pregnancy, many do provide care in normal pregnancies as well. This includes antenatal care at their clinics, intermittent attendance in labour and birth (sharing care with an independent, hospital or their own contracted midwife). Postnatal care is by a midwife, with reference to the obstetrician who remains the LMC. Your obstetrician is likely to work in practice with one or more other obstetricians so if he/she is unable to see you for any reason, you will be seen by one of his/her colleagues. Many women choose a private obstetrician to enable rapid access to expert care in the event of unforeseen circumstances e.g. dysfunctional labour or fetal distress.
Hospital teams providing maternity care
Some midwives employed by District Health Boards work in teams, providing care to women in the community and in the hospital. In a normal pregnancy, this might be a team of midwives; in a pregnancy with complications, such as gestational diabetes, this wil probably be a team of obstetricians and midwives working together.
These midwives are not LMCs but are employed by the District Health Boards to work in the antenatal, postnatal and labour wards.
What will it cost?
The following services are free to New Zealand residents and citizens:
• Maternity care provided by midwives and GPs
• Staying in a public hospital or a birth centre
• Referral to an obstetrician in the public sector, by the midwife or GP, for advice
Charges will be incurred for:
• Birthing in a private hospital
• Some tests e.g. ultrasound scans undertaken by certain facilities
• Childbirth education classes (although these are sometimes free)
• All pregnancy, labour and birth care for non-New Zealand residents i.e. the public hospital will charge
• An antenatal visit for advice to a private obstetrician may cost approximately $100-150 per visit.
• LMC care from a private obstetrician will cost around $2500-$4,000 (latter figure for Auckland).
• An elective Caesarean section with a private obstetrician (in a public hospital) will cost around $1800.
This section on choosing which type of antenatal care best suits you has been put together by Dr Anil Sharma, an obstetrician and gynaecologist in Auckland. www.dranilsharma.co.nz