Who’s who during pregnancy, birth and newborn care

Carers during pregnancy, labour and birth may include midwives, your general practitioner (GP), an obstetricians, a GP obstetricians, a rural general obstetrician, a doula or a combination of healthcare professionals. It is a good idea to talk to healthcare professionals, family and friends about your options, and what to expect from the different types of pregnancy care available.

Depending on the model of care you choose for your antenatal (during pregnancy) and labour care, you might see only a few or all of the healthcare professionals listed below during or shortly after your pregnancy.

General practitioner (GP)

Your GP (doctor) is your first point of medical contact if you think you might be pregnant. Your GP can confirm your pregnancy and let you know an approximate due date. This first visit also gives the doctor a chance to discuss your care options and the best ways to look after yourself during your pregnancy. Your GP will speak with you about your birthing options and can refer you to a public hospital.

In Australia, general practitioners are doctors who have completed specialist medical training after their university medical degree. General practitioners promote general health and treat many different health problems across all age groups.

Some women want to have their GP closely involved throughout their pregnancy. This might be for convenience or because they have developed a close relationship with their GP, or both. General practitioners who want to provide ‘shared care’ with your hospital during your pregnancy must have extra training and qualifications. They must also have a special agreement with your chosen birthing hospital or other birth setting.

If you wish to have shared care with your GP, you will need to check if they can offer this service.

GP obstetrician and rural generalist obstetrician

GP obstetricians are GPs who have additional skills and training in women’s health and in caring for mothers and babies during pregnancy and after birth in the community. They can offer shared care during your pregnancy for when you are in the hospital setting. They can also care for you and your family before during and after pregnancy. They provide preconception care and information to improve your health for pregnancy, and after your birth they can provide further support and care for you, your new baby and family members on an ongoing basis.

In regional and rural areas GP obstetricians and rural generalist obstetricians, (general practitioners who provide GP services, hospital, emergency and obstetric care), can provide your pregnancy care in the community and hospital setting. They work as part of a team with midwives and local and distant specialist services and deliver your baby in the local hospital. GP obstetricians and rural generalist obstetricians are trained to deal with birthing risks or emergencies, such as emergency caesareans and are trained to care for you and your family before during and after birth.

Obstetrician

Obstetricians are doctors with specialist training and skills in caring for mothers and babies during pregnancy, birth and the period straight after birth. Obstetricians hold a medical degree and have undergone further specialist training to manage the more complex aspects of pregnancy and childbirth.

In a larger sub-regional, regional or metropolitan public hospital, you might see:

• an obstetric resident, who is a qualified doctor getting experience in obstetric care
• an obstetric registrar, who is a qualified doctor training to be an obstetrician
• a consultant obstetrician, who is a doctor who has completed specialist training.

If you have a high-risk pregnancy, you are likely to see an obstetrician more often. If you have a low-risk pregnancy, you might not need to see an obstetrician at all.

If you do see an obstetrician, they might:

• talk about pregnancy care and birth, answering any questions you might have
• monitor your health and your baby’s health
• send you for tests and scans
• provide information and talk to you about test and scan results
• talk to you about how to stay healthy during your pregnancy.

The midwife or resident may refer you to an obstetrician if you or your baby needs extra medical checks or care. Obstetricians are trained to deal with birthing risks or emergencies, such as emergency caesareans.

In the public health system, you will not be able to choose the obstetrician who sees you during your pregnancy or birth. If you prefer a female doctor, you can ask if one is available, but this is not always possible.

If you have private health insurance and pregnancy coverage you will be able to choose your obstetrician and where you have your baby, as long as your obstetrician has an arrangement with that hospital.

If you are having your baby in a public hospital using your private health fund, you can choose your private obstetrician if they have an agreement with that hospital.

There may be additional out of pocket costs for your private care and this can be discussed with your doctor and private health fund to understand further.

Midwife

Midwives have special training and skills in caring for women during pregnancy, labour and birth. They also care for newborn babies in the days and weeks after birth, including helping the mother with breastfeeding. Midwives can be of any gender.

Midwives will be closely involved in your pregnancy care, either at the hospital, in a clinic or at your home.

During your pregnancy a midwife will:

• help arrange hospital bookings, tests and scans
• give you healthy lifestyle advice
• do routine health checks on you and your baby, including checking your baby’s position and growth during pregnancy
• talk about your labour and birth and answer any questions you have.

During your labour a midwife will:

• help you with pain relief if you need any
• help you to relax
• listen to your baby’s heart rate
• check the progress of your labour and birth and call on extra medical help if needed
• encourage you, and give you emotional support and assurance
• help your labour progress by suggesting positions and movements to try.
• birth your baby as long as there are no complications

After your baby is born a midwife will:

• set up newborn screening tests
• talk about choices for feeding your baby and refer you to a lactation consultant if necessary
• talk to you about life at home with your baby
• offer and arrange for a home visit by a midwife to provide postnatal care for you and your baby soon after you leave hospital
• refer you to your local maternal and child health nurse who will visit you at home in the first week of leaving hospital
• organise extra services for going home if you need them
• organise referrals to specialists if you need them (for example, a paediatrician).

Midwives work on rostered shifts so you will get to know several during your appointments and hospital stay. If you are receiving care through a midwifery-led program (such as team midwifery or caseload midwifery), you will probably see the same midwife or small group of midwives each time you have an antenatal appointment and a familiar midwife from the program will be there when you are giving birth.

In the case of team midwifery, a small team of midwives (usually 6 to 8) will jointly care for you during your pregnancy, labour, birth and after the birth. In a caseload midwifery program, a known primary midwife (usually with a secondary backup midwife providing cover and assistance) will care for you throughout this time. In both programs, collaboration agreements with hospital doctors are in place, in case there are complications with the birth and care needs to be escalated.

In some hospitals, you can take in a private midwife to provide your care during labour and birth, but the private midwife will need to have a special arrangement with the hospital.

In rural areas midwifes work closely with GP obstetricians and rural generalist obstetricians to enhance yourn pregnancy care and provide your safe birthing in the local hospital.

To practice in Victoria, midwives must be registered with the Nursing and Midwifery Board of Australia.

Doula

A doula provides physical and emotional support to women during pregnancy, labour and birth, and early parenting.

The word ‘doula’ comes from Greek and means ‘woman’s servant’. Public hospitals in Victoria do not employ doulas, so they must be hired directly by the pregnant woman.

In most cases, doulas are not medically or clinically trained and doulas are not permitted to provide medical or clinical care to women in hospital.

Maternal and child health nurse

The maternal child health nurse (MCH nurse) works with families and healthcare professionals to monitor the growth and development of children from birth up until they are about 3 and a half years old. Their focus is on prevention, promotion, early detection and intervention of health and wellbeing concerns of young children and their families.

Located at council-based services, the MCH nurse can:

• give information, support and advice on a variety of topics, including parenting, child health, development and learning, child behaviour, maternal health and wellbeing, child safety, immunisation, breastfeeding, nutrition and family planning
• monitor your child’s growth and development in a series of one-on-one consultations at specific times in your child’s early years
• help with sleeping, feeding and behaviour problems
• organise parents’ groups where you can get information and have the chance to meet other parents in the local area
• tell you about other local support services
• organise additional activities based on your family’s needs, for example, arrange home visits
• help to contact specialist services if necessary, such as early parenting centres
• offer additional support and services to families experiencing difficulties.

In Victoria, MCH nurses are registered nurses who have postgraduate midwifery qualifications, then go on to do additional qualifications in maternal and child health.

Sonographer

A sonographer is a medical imaging professional who performs ultrasound scans. These use high-frequency sound waves to make an image of a person’s internal body structures.

Accredited sonographers in Australia have an undergraduate degree in health sciences (for example, medical radiation technology or nursing) and have undergone additional post-graduate training in medical sonography.

During pregnancy, a sonographer performs ultrasound scans to study the age, health, growth and position of the developing fetus and the placenta. Ultrasound is also used during pregnancy to identify if there is more than one baby, to check for developmental abnormalities, and to check whether there has been any bleeding.

During an uncomplicated pregnancy you might see a sonographer for an ultrasound scan at 11–13 weeks and then again at 18–20 weeks. At 11–13 weeks, the scan will show whether you have a single or multiple pregnancy, the age of your baby (and therefore the due date), and can be used as part of a genetic screening test for Down syndrome. At 18–20 weeks, the sonographer will check your baby’s growth and development (whether there are any abnormalities) and the position of the placenta.

If you have a multiple pregnancy, a medical condition, or have had complications during previous pregnancies you might have more scans both earlier and later in your pregnancy.

General questions for obstetricians or midwives during pregnancy

It is important that you feel well-informed about your antenatal care and have accurate expectations about what will happen when you go into labour.

The following checklist suggests questions that you might ask your obstetrician or midwife. Not all of the questions will apply to you and you will no doubt have extra questions that are specific to your situation or preferences.

• When is my baby due?
• How often do I need to see you during my pregnancy?
• Will I have scans throughout my pregnancy? When?
• What other tests will I have?
• How can I manage my morning sickness?
• Do I need to make any lifestyle changes while I am pregnant (for example, diet, physical activity, alcohol and other drug use)?
• I’m already pregnant. Is it too late to take folate? Should I take any other supplements?
• Can I continue to take my current medications?
• Can I drink alcohol while I am pregnant?
• Are there any foods I need to avoid?
• Can I share my antenatal care with my general practitioner (GP)?
• Do you offer antenatal classes?
• Should I write a birth plan? What is your preferred format?
• How much weight do you recommend I put on?
• What exercise do you recommend?
• Can I have a home birth?
• Can I have a water birth?
• When should I stop working?
• Is it safe for me to travel overseas? Up until when in my pregnancy?
• Will you be there for the birth?
• How do I know when to come in to hospital?
• How long will I be in hospital?
• How many people can be in the delivery room with me?
• Can I use a Swiss ball/beanbag/birthing stool?
• What will you do if my labour slows?
• What happens if things don’t go to plan during a homebirth and I need emergency care?
• What methods of pain relief do you use or recommend during labour?
• What if there are complications during labour?
• In what situations would you recommend a caesarean section?
• At what point would you recommend inducing labour? Do you use forceps or vacuum-assisted delivery (ventouse)?
• At what point would you do an episiotomy? Do I have to have an episiotomy?
• What vaccinations will my baby have after the birth?

Where to get help

• Your GP (doctor)
• Midwife
• Obstetrician-gynaecologist
• Maternal and Child Health Line (24 hours, 7 days) Tel. 13 22 29