Hospital obstetric team
Most women who find they are pregnant with twins are referred to the hospital obstetric team by their LMC. These teams consist of obstetricians, obstetric registrars and midwives who work together to manage more complex pregnancies, based on a plan of care for your pregnancy and birth. These teams are experienced with multiple births and have a wide breadth of knowledge to draw on, to help you through your pregnancy and birth. If your local hospital does not have an obstetrics clinic, you may need to travel to a clinic at a larger hospital. You may be eligible for a travel allowance.
In this situation, your midwife LMC may continue to provide care alongside these services if this is something you both want, or your care may be transferred entirely to the hospital obstetric team. Some LMCs will prefer to transfer you to the hospital team when a pregnancy becomes complex, and no longer be involved in providing maternity care.
It is important to note that a range of other health professionals may also be involved in your care, if needed—including sonographers (who do your ultrasound scans), Maternal Fetal Medicine Specialists, Physiotherapists, Dieticians, Anaesthetists, Paediatricians, Neonatologists or Maternal Mental Health experts. These people provide specialist expertise based on the circumstances of your pregnancy and the health of your babies
When receiving hospital-based obstetric care, it is not unusual care to see a different obstetrician, obstetric registrar or midwife at each antenatal appointment, during the labour and birth, and postnatally. This means there may be little continuity of care from one health professional. You may also have longer waiting times at the busy hospital clinic. Additionally, you will not necessarily know the midwives or specialists providing your care during labour and birth. If you are uncomfortable or unsure about this system:
- Talk to your obstetrician to explore how continuity will be provided by the team, and what steps they take to ensure each specialist is familiar with your case history and notes
- You may be able to find out when a particular obstetrician has their clinic, and aim to make your appointments on that day
- Keep you own notes of what has been discussed at each appointment so you can refer to these if required
- Request continued participation of your original LMC in your care to help provide continuity.
A private obstetrician
You may choose to have a private obstetrician as your specialist. This may increase continuity of care from one health professional throughout the pregnancy and birth. Care by a private obstetrician will cost between $3000 and $4000. A hospital midwife or an independent midwife contracted by the obstetrician will be involved in supporting you during labour and birth. If the obstetrician uses the services of a hospital midwife for the labour and birth, they will sub-contract an independent midwife to provide your postnatal care when you return home. The majority of obstetricians work within the public sector and there are many regions where there are no private obstetricians, so this option may not be available.
There are also options for shared care, with your original LMC (independent midwife or GP) working with either a private obstetrician or with hospital-based obstetricians. Some hospitals do not encourage shared care, but it is still a legal choice for you! Part of the process of transfer of care is a three-way discussion between yourself, your current LMC and the specialist to discuss your care. During this meeting you need to consent to the transfer of care—and this is the time for you to clearly state that you would like your midwife LMC to continue to be involved in your care.
The relationship that you establish with a midwife during your pregnancy is a significant one, and is not only helpful during the birth of your twins, but can improve continuity of care. Your midwife should also ensure you have an adequate antenatal education (nutrition, rest, breastfeeding, after-birth care and preparations at home)—since you probably won’t have the time or energy to educate yourself once the babies arrive! Just like with a singleton pregnancy, your midwife will provide postnatal care.
It is important for a woman pregnant with multiples to be able to continue to receive shared care from a midwife, if that is her wish—for a number of reasons:
- To ensure you have one health professional who provides care from the antenatal period, right through to the postnatal period
- To coordinate antenatal education and discussion about healthy lifestyle choices, in preparation for the birth and parenting of twins
- To help you navigate the complicated and confusing medical world, and ‘translate’ the terms you don’t understand
- To provide a relationship that can help you feel more secure during the birth
- To act as an advocate to support your wishes, if needed