This article explains the role of obstetricians and when you may require the specialist care of an obstetrician in pregnancy or childbirth.
What is an Obstetrician?
An obstetrician is a qualified doctor who has specialised in caring for women during pregnancy, childbirth and the recovery period afterwards. Their work in New Zealand normally concerns women who have complications, as midwives and GPs usually care for women who have normal pregnancies and births.
Most often obstetricians are also gynaecologists, so they also care for women with problems concerning the female reproductive system; for example, the womb, ovaries and pelvic floor. In order to practice in New Zealand they must complete 150 hours of continued education every 3 years – such as lectures, teaching and research.
In New Zealand you can be referred to a public obstetrician by your LMC (which would be free of charge) or you can elect to see a private obstetrician (in which case you would pay for their services). Some obstetricians provide both type of services.
As an indication, the current rate in Auckland for complete private obstetric care from conception through to the postnatal period is between $3,800 – $4,200. Like most things in life, this cost seems to be steadily climbing over time – 7 years ago the going rate was $1,200.
When should I see an Obstetrician?
The obstetrician in pregnancy
In New Zealand every pregnant women is entitled to a Lead Maternity Carer (LMC), who will be responsible for her care throughout the pregnancy, birth and post natal period. Your LMC can be a midwife, GP or an obstetrician (although in some areas of New Zealand the obstetricians do not work as LMCs under the public system).
If your LMC is a midwife or GP they will refer you to an obstetrician within the public sector if complications arise and they would like a specialist opinion on your condition.
You may wish to see an obstetrician privately during your pregnancy, in which case you can choose your obstetrician. You will be charged approximately $120-150 for each consult.
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An obstetrician at the birth
Some obstetricians will attend births as a private obstetrician – or if you need an elective caesarian section (for example, for twins or breech presentation). You may choose to have this done privately, so that you can choose your own obstetrician.
Elective caesarian sections are also carried out within the public sector, free of charge, by the obstetricians.
If complications arise during the birth, your midwife will contact the obstetrician on call for a specialist opinion. This may involve advice concerning the progress of the labour or the baby’s well being. This referral would be free of charge as this is part of the public health care system for New Zealand residents.
If an assisted birth (forceps or ventouse) or emergency caesarian section is necessary, this will be carried out by an obstetrician – this service is free under the public health care system.
An obstetrician in the post natal period
Following a complicated or assisted birth the obstetrician will visit you in hospital, prior to you going home.
Any complications in the postnatal period will also be referred to an obstetrician (for example, continued raised blood pressure or problems with passing urine after the birth).
How do I find an Obstetrician?
If you wish to see an obstetrician privately you can look up ‘Obstetricians/ Gynaecologists’ in the yellow pages. Expect to pay $120-150 per visit.
This link to The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has a search page to help you find a specialist in New Zealand.
Your LMC will be able to advise which obstetricians work privately in your area.
Family or friends may be able to recommend an obstetrician to you.
If you need to see an obstetrician due to a complication in pregnancy / birth / postnatally your LMC will arrange a referral for you, within the public health system.
What will an obstetrician do?
This will depend wholly upon the reason for your referral to them, whether this is a self referral or from another health professional.
The obstetrician will always begin by ‘taking a history’ – asking you about your general health, your previous pregnancies, if any, and their outcomes. Usually they will then wish to examine you, in order to diagnose your problem. This may involve them feeling your tummy, possibly doing an internal vaginal examination and listening to baby’s heart beat.
Your obstetrician may also order blood tests or ultra sound scans to gather more information about your pregnancy and well being.
The obstetrician may become responsible for your care during the remainder of your pregnancy (for example, if you have pre-eclampsia or a multiple pregnancy), or may refer you back to your LMC for the remainder of your care, with advice about how to manage the problem (for example, anaemia).
If you have a medical condition such as diabetes or epilepsy the obstetrician will care for you in conjunction with other specialists in that field.
Obstetricians also carry out assisted deliveries in New Zealand – forceps and ventouse deliveries – and caesarian sections. They may be assisted by junior doctors in their team and will work in partnership with anaesthatists and paediatricians to ensure the safest outcome for you and your baby.
Why do some women pay for a private obstetrician?
There are a variety of reasons why a woman might choose to pay for a private obstetrician. Some of these include:
- Some women with previous problems in pregnancy or birth may choose to opt for the obstetrician of their choice, from the outset
- Some women may already have a relationship with an obstetrician due to gynaecological or infertility problems, and prefer to remain under their care
- Some women prefer to give birth in the more luxurious surroundings of a private hospital
- Some people are used to paying for private medical care and prefer to do this, rather than use the public health system
- As doctors have historically delivered babies in New Zealand, some women feel more secure under obstetric care.
What can I do?
- Contact a health professional as soon as you know you are pregnant – especially if you have any medical conditions, or have had previously complicated pregnancies.
- Ensure that you are aware of your options for pregnancy and birth- (link to) Choosing an LMC may help you to decide which type of maternity care will be best for you.
- Give your maternity health professionals as much information as possible, even if you’re not sure if something is relevant. This will help them to work in partnership with you and your whanau to provide the best care possible for you and your baby.
- If you choose to have private care, do not be afraid to ask about all the possible costs, prior to the treatment.
Professional organisations and useful articles
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) web site contains information about the college, how to locate an obstetrician and information on women’s health.
To compare the role of the obstetrician with that of the Midwife, click here.
