Yahoo Lifestyle Choosing between public and private maternity care
Every time I confirm a new (wanted) pregnancy, my first question is, “So, how do you want your pregnancy managed?”
Where I practise, in a major suburban centre in Sydney, there are many options available for antenatal care. But more broadly speaking, in most areas your choices look something like this: private or public.
Private obstetricians can deliver in a public or a private hospital, but most women tend to go for the private option. The main reason for this is that if you have private health insurance, you’ll hardly be out of pocket at all for the hospital. It’s the doctor’s fee that will involve the biggest ‘gap’ fee (out of pocket expense). The size of this gap is incredibly variable. Some doctors, especially the most popular ones, charge thousands of dollars in gap fees. Others might only have you a few hundred dollars worse for wear after Medicare and private health insurance have chipped in.
The public system, where you attend the public clinic at your local hospital, can have several levels of care. For the most straightforward cases, you’ll see a midwife for your check-ups, but will also see a doctor a number of times throughout your pregnancy. The level of doctor involvement will depend on risk factors such as your health, weight and age.
You can also combine the clinic option with GP shared care, where you split your visits between your GP and the clinic. In this case, your GP will have to be accredited in obstetric care and will have a special interest in this area.
Depending on where you live, you might be lucky to have a birthing centre close by, where birth happens in a more ‘natural’ and less ‘medical’ way. Some birthing centres have ‘continuity of care’, where you are assigned a midwife who will look after you in your pregnancy and then deliver your baby as well, but alas, that is not the universal system.
Finally, you may also choose to hire a private midwife for antenatal care. Later this year, midwives with agreements with your hospital or its doctors will also be able to act as your primary carer during and after the birth.
Question time
Every hospital system in every state in Australia is different, so do your homework! Not every area has a birthing centre, not every area has GPs doing shared care and private obstetricians may be thin on the ground.
Most women will do well in every system, but I’ll give you the approach I use to my help patients make the big decision.
If a patient comes to me armed with the name of her preferred private obstetrician and requesting a referral, the answer is obvious. I don’t even do the initial blood tests, as most private specialists like to arrange absolutely everything. But if she’s not sure which option she wants to go with, there are four factors I ask her to consider:
1. Most importantly, how good is each system in your area? Is your local public hospital so awful you would be best off going privately with a doctor if you can? Do you love your GP and prefer her being involved in your care? The best person to chat to is your GP. We tend to know the midwives, the obstetricians and all the options and also get great feedback from our patients!
2. Can you afford private care? A lot of first-time mums get really worried about the pregnancy and delivery and see private care as a more ‘comforting’ option. But if you have a difficult baby, you might really need money for help after bub arrives (think lactation consultants, household help and the like) – so if it’s an either/or decision, consider that it may be better to go public and save your money for a rainy day!
3. How is your health? If you are diabetic, have high blood pressure or have had previous issues with pregnancy and delivery, having a good doctor will be critical. But if you’re young, healthy and odds are you’ll have a normal pregnancy, I don’t think you need an obstetrician at all, although you may well want one, which is fine.
4. How do you feel about painkillers? I know, I know – I’m the first person to say you have no idea of what the delivery will be like until you’re there. But most birthing centres don’t have the facilities for epidurals, so once the show is on the road, you won’t have the option of asking for one.
So spend some time thinking and go with the option that best fits with your individual situation and wishes for your pregnancy journey, and have confidence that whichever path you take, you’ll do just fine!
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