When might you see an obstetrician?
Your midwife may suggest you see a specialist because of your health, something that happened in a previous pregnancy, or something new in this one. It's common, and it doesn't automatically mean the obstetrician takes over your care.
Don't wait for a referral if you have
- bleeding in pregnancy
- signs of labour, or waters breaking, before 37 weeks
- fewer or weaker baby movements
- severe tummy pain, a severe headache or changes in your vision
In New Zealand, call your midwife now, or 111 in an emergency. In the UK, call your maternity unit's triage line now, or 999 in an emergency. In Ireland, call your maternity hospital now, or 112 or 999 in an emergency.
Common reasons a midwife suggests a specialist
This list shows examples. It isn't complete, and it isn't a checklist to assess yourself. Your midwife looks at your whole situation and decides with you.
Your health before pregnancy
- Diabetes (type 1 or type 2)
- High blood pressure
- Other long-term conditions, such as thyroid, heart or kidney disease, or epilepsy
- Mental health conditions, now or in the past
- A higher body weight, where extra support around birth planning can help
A previous pregnancy or birth
- A previous caesarean birth or other surgery on the womb
- Previous preterm birth, stillbirth or severe pre-eclampsia
- Heavy bleeding after a previous birth
Something in this pregnancy
- Twins or more
- Gestational diabetes, especially if it needs medicine
- New high blood pressure or possible pre-eclampsia
- Blood group antibodies found in your blood tests
- A low-lying placenta
- Concerns about your baby's growth
- A screening or scan result that needs discussion
- Your baby lying bottom-first (breech) or sideways late in pregnancy
- Going past your due date, usually around 41 weeks
How a referral works
The process is much the same in New Zealand, the UK and Ireland. Your midwife checks at booking and throughout pregnancy whether you'd benefit from a specialist's input. There are three levels:
- Advice or consultation: you see an obstetrician for advice, and your midwife usually keeps caring for you. The obstetrician may see you again later in pregnancy.
- Shared or transferred care: an obstetrician and hospital team take the lead, or share your care with your midwife. Your midwife may still be involved.
- Emergency: urgent hospital care, whoever is leading your care.
In New Zealand, midwives follow national referral guidelines, sometimes called "Section 88" referrals. In England, Scotland, Wales and Northern Ireland, the decision follows national NICE guidance and local maternity policies, and you may hear the terms "midwife-led" and "consultant-led" care. In Ireland, public maternity care is described as supported care (led by midwives), assisted care (midwives and obstetricians together) and specialised care (led by an obstetrician, for higher-risk pregnancies). Either way, the decision is made with you, and you can ask for a second opinion.
- Why am I being referred?
- How soon should I be seen?
- Who do I contact in the meantime?
- Who is leading my care afterwards?