Saturday, November 22, 2008

Obstetrics and Gynecology in New Zealand

Well I suppose I should talk about work. Obstetrics in New Zealand is completely different than in the US. New Zealand has a Nurse Midwife based system. A pregnant patient is followed through out her pregnancy by the Nurse Midwife. This includes all prenatal care,even home visits. She can labor and deliver at home, or in the hospital. She will be followed throughtout her labor by the midwife. The patient "goes natural" most of the time. Analgesia is occasionally used which includes pethidine(somewhat like stadol) or nitrous oxide (laughing gas) and on occasion fentenyl(don't use those in the US for labor!). The nurse must consult the Consultant Doctor for fentenyl or an epidural. They have a very low rate of epidurals.
Continous electronic fetal monitoring is not used unless there are complication. Just intermittent auscultation. I do not think they have intrauterine pressure catheters(I have yet to see one). They do have internal fetal monitoring but only when there is a problem. Patients do not always get IVs and IV fluids. But any complications get a hep lock. They continue to eat, drink, and ambulate especially in early labor.
Induction of labor happens at 42 weeks or when medically indicated complications occur. In these cases the Consultant OB becomes involved.
We have OB Registars (Residents) who cover L&D. There are six registars at the present at Palmerston North. Throughout New Zealand there is only one O&G Residency Program. The residents rotate through the main teritary and secondary care hospitals throughout New Zealand (Auchland, Wellington, Hastings, Hamilton, Palmerston North, Nelson, Dunedin, Christchurch...) for their experience. No real academic structure like in the US. But the residency program is actually six years instead of the four year programs in the US. The residents have to set exams both written and oral to be able to complete the program. The program is governed by the New Zealand Medical Council and the New Zealand/Australian College of Obstetrics and Gynecology of which they will become Fellows.

1 comment:

Andi Anderson said...

I truly like to reading your post. Thank you so much for taking the time to share such a nice information.
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