Consultant versus midwife-led care

consultant versus midwife led care

Who’s on my team? Is Consultant or midwife-led care the best choice for you and your baby?

by Radhika Holmstrom

When choosing your maternity care, one of the key things you want to know is which health care professionals will be working on your maternity team. After all, these are the people who are going to be taking care of you when your body is going through 40 weeks of change – and will bring your baby into the world.

Each hospital does things in a slightly different way but there are three broad models available. We look at these in a bit more detail and talk to some of the professionals involved in delivering them.

Consultant-led care

If you book a consultant-led birth, the main person in charge of your pregnancy will be a senior doctor trained specifically in pregnancy and birth, including delivering babies. Many have their own specialties: for instance, premature birth, multiple birth or heart conditions.

It may be recommended that you have a consultant-led birth if there are complicating factors in your pregnancy such as a previous difficult pregnancy or birth, previous Caesarean sections, or a health condition. If you know that you want an elective Caesarean, a consultant is the right choice because they have the skills to perform one. Or you may just prefer to have a doctor overseeing you.

Under this model, the consultant is the main person you see for all your ante-natal appointments. They may conduct your tests and scans themselves; or, depending on the hospital, might refer you to other specialists for these. If your pregnancy develops complications (for instance, if you develop gestational diabetes or something problematic is detected at a scan) or you develop a condition like pelvic girdle pain, your care should remain with the same consultant too, although they may send you to see specialists such as an endocrinologist or a physiotherapist.

Your consultant is very likely to be the person who delivers your baby, so it’s important you find someone with whom you feel comfortable. Roshni Patel is a consultant obstetrician at the Chelsea and Westminster hospital. “In our hospital, the majority of consultants do the booking-in and all appointments,” she explains. “So as a patient you get continuity and you also get someone who is familiar with your medical history. You develop a relationship which helps you and you can contact us by telephone or email, so you don’t need to wait for your next appointment.

“The way I explain it is, that if a new medical problem arises, the consultant will usually be able to deal with it. Every year I probably deliver about 95 per cent of my women. We’re medically trained and often doing the same role as the midwife. It’s another level of expertise, should it be needed.”

Midwife-led care

Under midwife-led care, you’re booked in to see midwives for all of your appointments. These are health care professionals (and they are mainly but not all, female) who are trained in looking after women during their pregnancy and birth (some train initially as nurses, some may go directly into midwifery).

Your midwives won’t be the only people you see – at the very least, a sonographer will conduct your ultrasound scans – but if you have a straightforward pregnancy and a vaginal delivery, you may well stay completely within the team for the majority of your care. You won’t usually have a lead midwife but a small team of midwives whom you will get to know in the course of your pregnancy and you’ll know that it will be one of these who delivers your baby when you do go into labour. “There is always one of us on a shift, so if a woman in labour comes in, they’ll be looked after by someone they’ve met before and who knows them,” says Lucy Coe, the lead for midwife-led care at the Kensington wing of the Chelsea and Westminster Hospital.

“With this type of care, you have the continuity of a midwifery team,” adds Jenny Smith, who is the lead midwife in charge of the midwifery-led private service at Queen Charlotte’s Hospital. “You’re also getting a shared philosophy of midwifery care, from a team that holds the hand of the mum and family and walks you through the journey. You have a very strong professional relationship.”

What midwives don’t do of course is to perform Caesarean sections and they also don’t have the kind of medical specialism that can support complicated pregnancies – their focus is on low-tech birth (though that includes pain relief such as gas and air and Pethidine, and waterbirths) and holistic support. So if you’re considered to be having a ‘higher- risk’ pregnancy, you won’t usually be eligible for this kind of care. “We’re the experts in the normal pathway. If you come to us, your pregnancy doesn’t have to be totally straightforward but most of our mothers are healthy, with no medical complications,” says Smith.

Of course, complications can develop during the 40 weeks of pregnancy – and vaginal birth certainly isn’t guaranteed for every single mother-to-be. If you do need more medical expertise or a Caesarean, the exact plan varies from hospital to hospital (some steer you towards NHS provision, some towards private on-site expertise) but rest assured, you will get it. However, the one-to-one support and continuity of care means that you’re also much more likely to get a vaginal birth if other factors permit it. “We’re doing over 10 midwifery-led bookings a month and over 90 per cent are achieving a vaginal birth,” Coe reports.

Shared care

Finally, hospitals are now offering a package that combines both midwifery- led and consultant-led care in one way or another. The lead professional you book in with is the obstetrician but midwives are also available and may be delivering your baby as well. This is also a possibility if you’re planning an elective Caesarean but you’d prefer to have midwives dealing with you for the majority of your pregnancy – or alternatively if you’d ideally like a vaginal birth but you’re worried and would like the security of an obstetrician you know already on your team. It also means that if things tip you in one direction or another, there’s the exibility to handle events.

Your own choice

The most important thing is that your maternity team is right for you. Your pregnancy and your medical history may dictate a lot of that – if you have a very complicated medical or obstetric history, you’re highly unlikely to get a purely midwife-led care team; but whatever route you go down, you need to feel con dent in the team of people who are caring for you. You may feel happier dealing with a doctor with a background in obstetric medicine, or you may want a midwife who’s focused on a low-tech birth and try for a natural birth.

You also need to feel personally comfortable with the individual people who are delivering that care, because there’ll almost certainly be things you want to discuss and check over the course of your 40 weeks of pregnancy. They are not just there at the finish; they’re with you for the whole of your pregnancy, so that when you do approach the birth, you can rely on them to help you over the touchline and join you in meeting your beautiful new baby for the first time.

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