Midwife-led care or Medical-led care: how to decide

If your experience with maternity care equates to what you’ve seen in Offspring, Call the Midwife and Love Child, it may be time to start exploring the different models of maternity care in Australia today. 

Warning: there are a lot to choose from! Deciding between having a midwife or an obstetrician lead your care is a good way to narrow down the options. So what’s the difference?

We got some insight from midwife, personal trainer and Founder of Core & Floor Restore Bernadette Lack on the matter. 

She said, “The best maternity care that exists is one that is collaborative. This means health care providers work together to provide you with individualised care to suit your needs. However, it’s important to understand how the person/profession that leads your care (a midwife or a doctor) can affect your pregnancy and birth outcomes.”

That said, let’s set the record straight on midwife vs medical-led care.

Midwife-led maternity care

We won’t beat around the bush. Bernadette straight up told us, “the gold standard of care has been shown through national and international research to be midwife-led continuity of care, otherwise known as caseload midwifery care.” This is when a team of up to eight midwives share your care and take the lead on your birth.

Bernadette pointed out that compared with medical-led care, women who have midwife-led care are less likely to experience:

  • an epidural
  • an episiotomy
  • an instrumental birth (vacuum or forceps)
  • a preterm birth
  • death of their baby.

They’re more likely to have:

  • a spontaneous vaginal birth (not induced)
  • a care provider they know in labour
  • higher satisfaction with care.

Midwives are specialists in normal birth. (Not that it feels particularly ‘normal’ for a baby to emerge from your body.) They’re trained in a wellness model, treating pregnancy, labour and birth as normal physiological events – which of course, they are (yep, even the pain!). If complications arise at any point, midwives will manage them and refer you to other health care providers.  

Mums have had great things to say about midwife-led care. Take Jade, for example. She signed up for the midwifery program at her hospital, and can’t help but sing its praises.

“I loved the midwifery program because of the continuity of care,” she shared. “It was really reassuring to me to have a familiar face during birth and helping me after my baby was born. All the midwives that helped me in my pregnancy and during the birth were amazing; they were so respectful of my wishes and I felt completely advocated for during the whole process, which was really important to me.”

So it seems there are no downsides to midwife-led care, huh? Well let’s just take a look at what medical-led care involves.

Medical-led maternity care

Doctors are trained to ‘fix things’, to treat and heal. An obstetrician will have studied and practiced sickness and disease for many years prior to specialising in obstetrics. Because of this, they often approach maternity care from the sickness model they were trained in. (So perhaps some are of the mindset, ‘let me heal you of this condition called pregnancy’.)

This approach isn’t always a negative thing when it comes to birth. If you have a unique medical history or condition, having your birth care led by an obstetrician with specialist knowledge of your condition could be a major benefit.

For example, we chatted to Katie, who has a history of chronic pain conditions and endometriosis. She said, “My doctor was amazing. I had 1:1 care that was above and beyond – including early intervention to decrease my risk of miscarriage with my particular conditions. I got to work out a birth plan that was right for me and my past surgical history.”

In contrast to Jade’s experience with midwifery, Katie was appalled that her midwives didn’t know about her medical conditions.  

“I found the midwifery care completely f*cked!” she shared. “They didn’t know what my gyn conditions were and that had very real implications for my recovery. I was in agony and collapsing from pain. We had to call my doctor who ordered a lot more medication for me.”

Of course, there’s no way of avoiding midwives or obstetricians in your pregnancy journey. They’re both essential, and should work together as a team to help you deliver a healthy baby.

The importance of trust

Staring into the eyes of a stranger doesn’t exactly put you at ease when you’re giving birth – and it certainly doesn’t encourage your hormones to get onboard. When you’ve built a relationship with your care provider, you trust in them. Trust is one of the most important factors in enabling oxytocin (that magical hormone that makes your uterus contract) to be effective, thus allowing you to pop that baby out.

Many women choose private obstetric care because they want to know their care provider during labour and birth. But we’ll burst that bubble for you right now… it’s unusual for your private obstetrician to stay with you for your entire birth and labour (unless you’re having a planned c-section). 

With private obstetric care, midwives will still look after you during pregnancy, labour, birth and postnatally. An obstetrician will only visit you during your labour for a quick cup of tea (just kidding… unless you really want tea). They might provide you with some care, but may be unable to make it or not working at the time (rude of them). Sometimes their colleagues will care for you if they’re unavailable. 

Midwives will provide the majority of your birth and postnatal care, whether you’ve chosen midwife or medical-led care. You may or may not know the midwives, and they will change with every shift change. (It’d be a bit of an ask to have them join you for all 20 hours of labour.) However, caseload midwifery care means you’ll have interacted with at least one of the midwives during your pregnancy.

Bernadette said, “If continuity of carer is a priority to you, choosing a midwife-led model of care has been shown to better fulfil this desire.”

Share this article with a mama who needs help deciding on her maternity care options!

Expert contributor: Bernadette Lack

Bernadette is a midwife, personal trainer and Founder of Core & Floor Restore. Get more excellent information on labour techniques by following her on Instagram and checking out her FREE and very helpful online antenatal classes.

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