Choosing a Lead Maternity Carer

This article explains the role of the Lead Maternity Carer – LMC – and factors to consider when choosing an LMC.

Women in New Zealand have several options open to them regarding their maternity care. These options should be explained to you when you first make contact with a doctor or midwife in your early pregnancy.

What is a Lead Maternity Carer (LMC)?

This is a health professional who will be responsible for providing or organising your maternity care through pregnancy, birth and the post natal period. These health professionals may be midwives, general practitioners (GPs) or obstetricians. When you choose an LMC you will be informed whether they will provide all of your maternity care themselves, or whether they will refer you to another health professional for part of your maternity care.

Independent midwives as LMCs

If your LMC is an independent midwife she may provide all your care throughout pregnancy, childbirth and for 6 weeks following the birth. They are qualified to care for women in normal pregnancy and birth. She may refer you to another midwife for post natal care or to an obstetrician if complications occur.

GPs – your family doctor as your LMC

Some GPs in New Zealand are also LMCs. They usually provide all of the care in pregnancy, including some minor problems; referring to an obstetrician if serious 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 often shared by a midwife.

This option is becoming limited in New Zealand, as many GPs have discontinued maternity care and no new GPs are providing an LMC service. However, your GP will remain available for you throughout your pregnancy for non-pregnancy related problems.

Private obstetricians as LMCs

Obstetricians are doctors who specialise in managing complications of pregnancy, childbirth and the post natal period. They can also provide care in normal pregnancies and some women choose to have an obstetrician LMC for normal pregnancies. They will usually provide your antenatal care at their clinic, attend part of your labour and birth (sharing your care with an independent midwife or hospital midwife) and again share your post natal care with midwives.

Hospital teams providing maternity care

Some midwives employed by DHBs work in teams, providing care to women in the community and in the hospital:

• there are schemes such as ‘Know your midwife’ that are solely midwifery teams
• there are also teams of midwives and obstetricians who work together to provide care to women with more complicated pregnancies (for example – with diabetes or raised blood pressure)

There are many variations on the above – talk to your chosen LMC to find out what each one’s expectations are of maternity care and who will provide it for you. The options will also vary in different parts of New Zealand and may be more limited in some districts, particularly in rural areas.

Hospital midwives

These midwives are employed by the District Health Boards (DHBs) to work in the hospital, but not as lead maternity carers:

• they provide antenatal care to women who are in hospital for part of their pregnancy
• they support independent midwives and doctors during births
• they provide post natal care to women in hospital.

How much will LMCs cost?

The following services are free to New Zealand residents and New Zealand citizens:

• Maternity care provided by midwives and GPs. This includes antenatal care, labour and birth care and postnatal care.
• Staying in a public hospital or a birth centre is also free
• Referral to an obstetrician in the public sector, by your midwife or GP, for expert advice on secondary care (complications in pregnancy, birth or postnatal period)

Charges will be incurred for:

• Birthing in a private hospital
• Some tests – tests at a private laboratory, ultrasound scans that are not medically indicated
• Childbirth education classes (although these are sometimes free of charge)
• All pregnancy, labour and birth care, if you are not a New Zealand resident.

If you choose to seek the care of a private obstetrician there will be charges for this:

• An antenatal visit may cost approximately $120-150 per visit.
• If your obstetrician is on call to attend your entire pregnancy and birth then this may cost $2000-3000 (although in Auckland it may be as much as $4,000)
• An elective Caesarean section with a private obstetrician (in a public hospital) may cost approximately $1000.

Please be aware these costs are a guideline only – ask your obstetrician for their costs before hand.

In some city clinics there is also a shared care option. This is where you can  choose a combination of caregivers, typically a midwife and an obstetrician. You will see the midwife most frequently, but the obstetrician is always available for consultation or to attend the birth.

With this option you are still required to choose and register with a lead maternity carer (usually the obstetrician). This person may work in co-operation with other care providers but they will have primary responsibility for the co-ordination and are expected to provide the majority of a woman’s care.  Shared care helps reduce the cost of private obstetrics for parents.

Which LMC should I choose?

In deciding which individual practitioner to choose for your LMC there are some questions you may wish to ask:

• Find out about the midwife/ doctor’s recent experience – how many births they have attended in the last 5 years, what were the outcomes.
• Ask them about their qualifications and how they remain up-to-date within their profession
• Ask about their intervention rates – this may be of particular interest to you if you are planning a natural childbirth
• Ask them who they would send to an emergency at home and how they could deal with an emergency before you get to hospital – for example, what equipment they carry and who they have as back-up in the community.

Often LMCs are recommended to women by friends or family. We are all individuals, however, so it is good to ensure that you are confident in your choice of health professional.

For further information on health professionals who may be your LMC, see our articles Midwives and Obstetricians and General Practitioners

To read about your options for the birth see our article Where to Give Birth

Useful LMC websites

www.midwife.org.nz/index.cfm/LookFor

The New Zealand College of Midwives website also contains excellent information on what to expect from your midwife.

www.maternity.org.nz

The Maternity Services Consumer Council website contains a section summarising the Choices for Childbirth