How do you decide on public or private maternity care?
 

Like the thread title says, how do you decide whether to go with public or private care when you are pregnant?

Its my first time, so i dont know what to expect and its more difficult because I dont know anyone here who has had a baby.

I am 6weeks so far, and my GP said I would need to make an appointment with an obstetrician as soon as I could. So I have an appointment with his recomended one who is at Mater in Noth Sydney. We did this so that we would not miss out if we chose to go down this route, the 1st appointment is in a month.

He seems to have a very good reputation from what I have managed to google about him.

But I am still unsure whether we should go to Mater to the Royal North Shore Public Hospital. We have insurance through work, but I dont know how much we would still be out of pocket going private.

Re: How do you decide on public or private maternity care?
 

Its a tough decision.

My wife is a public midwife - so I'll declare my bias upfront - but having said that we had both our children via a private obstetrician.

Roughly speaking the pros and cons are as follows (this is a very brief summary - so excuse the crudity of the analysis):

PRIVATE
=======
1) Costly - despite whatever cover you may have, you are likely to be thousands of $$$ out of pocket by the time you've added up pre-natal appointments, gap fees, anaesthetists and incidental extras that arent covered.
2) You are almost guaranteed to have an obstetric led birth not a midwife driven one. This means your chances of a c-section are massively increased and therefore your chances of complications are increased. Dr's tend to be quicker to intervene than midwives and reach for tools like inductions more freely - this results in a much higher rate of 'unsatisfactory birth experiences'. If you're in any doubt about this conside that the USA has the highest c-section rate in the world and has the amongst highest maternal DEATH rate of all OECD countries. For a well constructed debate on Dr vs Mdwife issues see the movie documentary "The Business of Being Born".


PUBLIC
=======
1) You will have to wait..... Every pre-natal appointment will cost you at least half a days waiting. You'll go mad.
2) You wont have guaranteed continuity of care. Different selection of health professionals at each visit.

There is no right answer - but dont be fooled into believing that private doctors will give you an unquestionably superior experience. Some people value the more natural modwife driven approach - others just cant afford half a day off work for each of the half dozen pre-natal appointments! Some like the reassurance of knowing the doctor, others hate the idea of being treated like they have something wrong with them for what is essentialy a normal process your body would do with or without anyones help!

-- If you do want to use a private obstetrician - you'll need to book in soon, the good ones book up VERY early!

(Hint: good ones are usually older guys - with cheaper fees 'cos their insurance rewards them for years of trouble free service - new 'younger' obstatericians have larger insurance bills to pay and pass that on in fees! Female obstetricians tend to be popular BECAUSE they're female and their fees end up rising simple because of supply & demand! <---- Not my opinion - but the opinion of my wife and many of her colleagues).


ETA: I had a feeling I was repeating myself! http://britishexpats.com/forum/showt...57#post7786757

Re: How do you decide on public or private maternity care?
 

Hi I just had a baby at the Royal North Shore Public 2 months ago. At first I was going to an OB and had booked in to the Mater and then I realized how expensive it would be. It was my second time around and I knew I was unlikely to have any complications so I cancelled the Mater Hospital and OB. You can book in with the midwives clinic at RNSH public side and it is all covered by Medicare. I had regular appointments with the midwives for a basic check and they would book me to see an OB there if they felt it was required. As for the birth I had a great experience...the midwives were great and they offer water births there too. The maternity ward is fairly new and all was good. After the birth I did have to wait in a temporary room for a few hours but then I was moved to the maternity ward and I got a private room but there's no guarantee on that one.
I was totally glad that I didn't go private and spend the money, I got everything I needed. But if you have reason to believe you may need extra care it might not be as good. Good luck!

Re: How do you decide on public or private maternity care?
 

Thanks, that helps a lot! I would def prefer a more natural birth, for quite a few reasons. But then I am sure lots of people think that to start with.

We have booked with an obstatrician already, but we did that with the knowledge that we might still cancel depending on our decision. My husband wants to go with him for no other reason I think than he doesnt know what to expect.

I think I would prefer a mid-wife and try to avoid my doc persuading us to have a c-section just because he doesnt want to miss his game of golf.

Thanks that sounds really really good. We are kind of thinking the costs seem very high, and its not like we have planned this and been saving for it. We could afford it, but not knowing what will happen after the birth, I do think we might want to save as much money as possible.

Re: How do you decide on public or private maternity care?
 

How soon did you have t obook in to RNSH? We dont want to miss out by waiting too long, or do you not have to worry about this with them?

Re: How do you decide on public or private maternity care?
 

A friend of mine had a private OB and wished she had gone public because he didn't even make it to the hospital for the birth!
The other reason I decided it wasn't worth it is that if a baby has complications, the baby will be transfered from the Mater to RNSH because they have a special care nursery there. Other than long waits and not seeing the same midwife each time I think they have everything you need.
I would just call them now and they'll guide you on timing. I think you start at 12 weeks or so.

Re: How do you decide on public or private maternity care?
 

I thought I might give them a call and find out about timings with them.

I am also worried that if something does go wrong I will be moved to the public hospital anyway.

Re: How do you decide on public or private maternity care?
 

Public. Women have been given birth for centuries and midwives are patient. Doctors, fine examples of humanity that they are, see delays as medical complications that they can fix.

Why pay thousands so that a bloke can carry out a C-section and **** off to the Golf Course.

If you can, find a small midwife led hospital. We had 3 children this way and we had no dramas at all - infact my wife was asked to be a guest at information sessions.as a model punter.

Re: How do you decide on public or private maternity care?
 

Thanks, thats how i feel too. Its not as though I am ill. I have heard that Royal North Shore has good mid-wife care. Its what I am leaning towards.

Re: How do you decide on public or private maternity care?
 

I had our daughter privately and had a c-section because she got stuck! I have to confess that I did not really think about the options- just went with the flow (on a recommendation)


A mate of mine went public, she had complications galore (very premmie twins) and received the most fabulous service. Could not fault it in any way.

I guess it depends how you feel, but public health care seems far better here than in UK. (Disclaimer: only hearsay as I have not had a child in UK)

Re: How do you decide on public or private maternity care?
 

One thing I think you should work out is whether you will go natural or caesarean. If you go for c-section you'll be there for a minimum of 4 days, so you'll want to be comfortable and it helps if you have your own room. You have no chance of getting either of those in the public sector. We've been private all three times and hasn't left us out of pocket more than a grand each time, but it was worth it just for the ability to have that extra comfort. Plus our local hospital didn't have the best of reputations at the time (my wife works there too).

Re: How do you decide on public or private maternity care?
 

My wife got her own room for 3 days (public) and it was very comfortable... But that was the exception rather than the rule. You can get your own room when you go public, but the chances are low. Most other women in the RBH shared a room with one other person.

Re: How do you decide on public or private maternity care?
 

My preference would be natural, I dont like the idea of a caesarean unless its an emergency. Obviously its too early to know if I would need one or not, but if possible I would prefer not to have. I dont really like the idea of a major operation for something that should be a normal part of life. But being my first time I really have no idea what its going to be like.

Its a good point about the private room though. I think that RNSH has quite a good reputation. If I was private it would be at Mater which would need to transfer me to RNSH in an emergency, if this did happen wouldnt it be better to be at the correct hospital already, not 10mins away in an ambulance?

Re: How do you decide on public or private maternity care?
 

Most midwifes I know say they would go private in a public hospital That way they get the best of both worlds esp if something goes wrong. Many private hosp don't have the same level of cover as public hosps

Re: How do you decide on public or private maternity care?
 

While I agree with your point I'm surprised about your statistics. I gave birth in Rome in 2008 and here the c-section rate is hovering around 50-60%. Some of the private hospitals have an 80+% c-section rate! In the US, I thought it was more like a mere 30-35%. The Italian newspapers claim that Italy has one of the highest c-section rates in the world with Brazil a close secon. The US was held up as a 'model' country with the relatively low c-section rates of 30% or so...Italy can only aspire to that!

I don't think my advice would apply to Australia where the c-section rate is so much lower. I was petrified of an unnecessary c-section (you should hear some of the horror stories!) so I went public at a hospital with midwife led birth which had a relatively low 41% c-section rate. I'm jealous that you get to give birth in Australia- my girlfriends back home tell me that they have all these amazing luxuries in the hospitals there like birthing tubs, epidurals, gas and air, private or 2 person rooms, private bathrooms and nurses who help you with breastfeeding.

Good luck!