Australia - private or public for birth?

[pancakes]

Australians - is it completely antimustachian to consider a private hospital birth?

It is our first and I have no idea. People I've asked give vague answers like:

"If you have a clear idea of how you want to give birth private is better because you can find a doctor that shares your preferences." Or "if money is tight, public hospitals in Australia are excellent".

As this is my first, I have no expectations or preferences about what happens. I don't know what to expect so don't know how I could have formed strong opinions about things I haven't experienced, like pain management.

It looks like I'd be roughly out of pocket $3-5k in the private system vs <$500 in the public.

I'm interested in hearing other people's opinions. Is there something I'm missing?

[bobechs]

Just, whatever you do, don't be tempted to wander into the bush and deliver in a scooped-out hole...

[urbanista]

Public. No matter how much you pay to your doctor, she will not be there with you. The midwife will be there. Same as public.

My father in law is a specialist doctor. He says giving birth with private hospital in Australia is a waste of money. Me and three other women in our family had babies at public hospitals. Only positive experience. Can highly recommend Austin hospital in Melbourne.

[urbanista]

Also, out of pocket public is exactly $0, unless you want some specialised tests done that Medicare wouldn't cover.

Private is at least $6000. My sister went private the first time, and public second time. Just wasn't worth the money.

[arebelspy]

Australia is a first world country.  Their public medical facilities are, IMO, more than adequate to deliver a baby, something people have been doing for millions of years, and something that happens all over the world, hundreds of thousands of times every day, safely.

I'd absolutely do the public route.

If you have major complications during the pregnancy, you may want to reconsider.  If everything is basically routine during the pregnancy, I don't see why you'd need or want to.

Disclaimer: I am not Australian.  Though my wife and I did put our money where our mouth is on the belief that most countries' public medical facilities are perfectly adequate when we had a baby in Istanbul this past January.

[pancakes]

My doctor has explained to me that if there are major complications in my pregnancy or birth the private hospital will hand me over to my local public hospital (as a private admission) as they have the best equipment and specialists for high risk births.

In my area few places bulk bill for scans, GP visits, etc so I'll end up a little out of pocket for those even in the public system.

One of my parents is a GP and even they haven't really been able to strongly recommend me one way or another, which makes me think public. I'm sure if they thought that the care would be in anyway superior in a private hospital they'd recommend that to me but instead they just say to do whatever I like.

I'm struggling to understand why so many people go private, there must be something?

[arebelspy]

My doctor has explained to me that if there are major complications in my pregnancy or birth the private hospital will hand me over to my local public hospital (as a private admission) as they have the best equipment and specialists for high risk births.

Well if you'd go there anyways if there's a problem, and I'm sure they can handle anything routine, I don't know why you WOULDN'T go public.

One of my parents is a GP and even they haven't really been able to strongly recommend me one way or another, which makes me think public. I'm sure if they thought that the care would be in anyway superior in a private hospital they'd recommend that to me but instead they just say to do whatever I like.

Yeah, that's probably a pretty big indicator, since they have the most information, and would be looking out for your (and the child's) well being.  If they don't see a difference, there probably isn't one.

I'm struggling to understand why so many people go private, there must be something?

Any number of reasons, but my guess is probably mostly fear (it costs more, so it must be better, and I don't want to risk anything when it comes to my child), status (ew, who goes public, how shameful), or ignorance (thinking private is safer or better).  Those three things drive a LOT in life.

[HappierAtHome]

Your partner will only be able to stay during visiting hours once you've delivered in a public hospital - if you've had a C section, that could mean a week in hospital with the baby with him only being there for four to six hours a day. This may or may not be an issue for you; my husband vetoed public on that basis alone as he would pay anything not to miss out on that early time with the baby*. Private delivery usually means a bed and meals for the father (at a price, of course!) for the duration of the mother's stay.

A friend of mine was deeply distressed that the public hospital would / could not provide nappies - she ran out, and her husband couldn't bring any in as visiting hours had finished, so she had to 'borrow' some from another woman on the ward. Seems minor, but it left her feeling awful.

Other things: consistency of care (seeing the same midwives and OB the whole way through) is better with private. If you have complications, better to see an OB who is a specialist in that area rather than whoever is on call that night.

The majority of women will have identical medical outcomes for their babies at public or private. I know heaps of women who gone public and it's been great. Some have had a bad experience (NOT a bad outcome) at public so switched to private for the second baby onwards.

Are you in Perth or am I imagining that? If you are, King Eddies is great, but if you're in the zone for one of the other public hospitals PM me and I'll ask my OB contacts for info on their outcomes and standard of care.

*My medical condition makes private a much better choice for me anyway, so probably a moot point, but he REALLY cared about that aspect of public versus private.

[pancakes]

Thanks Happierathome, it is good to get the perspective of someone who has used the private system.

Yes I'm in Perth and in the catchment for King Edward. Everyone says it is a great hospital. My partner and I are keen on him being able to stay at the hospital (we have no family in WA so will feel isolated already) but not sure if we are willing to pay for that alone as the cost is huge.

I'm very relaxed about everything else, at least at the moment.

[HappierAtHome]

My SIL delivered twice there and had a great "experience" as well as good outcomes, pancakes! She went home the same day both times, so the partner staying overnight issue was irrelevant.

[urbanista]

I have never heard about limitations on visiting hours as being a problem. My husband stayed as much as we liked him to stay. Same for my sister and sister-in-law. But yeah, there is nowhere to sleep at public hospitals so I guess, husbands have to go home at night. Whereas at public you have the whole suit to yourself that include a sofa. Also, private include two extra nights in the hospital. Also in public you have to share the room with someone which can be a problem for some people. Whether that's worth $6000 is a personal choice. I would say, save the money and spend it where you really would need it. For me, a night nanny or sleep training in a good private hospital would have been invaluable as my son didn't sleep through the night for 3 years :(

[Kit Kat]

The big advantage with private is the longer hospital stay. This means you are given plenty of one on one time with the midwives to establish breastfeeding and establish a rough routine with your newborn. For me this was very reassuring as by the time I left hospital I felt ready and comfortable with the situation. Like others have said having your partner stay overnight is a big plus- it may not seem like a big deal now but if you end up with a traumatic birth, c section etc you want them there, believe me! As a preference I like to see a obstetrician as opposed to a midwife during pregnancy and birth and this is a big reason why I chose private but others will have different views.

[Ozstache]

We had our first child private and the second public. No difference in quality of care and the private experience actually had out of pocket costs that we would not have had to pay if we were public.

If I were doing it again, public for sure.

[Metric Mouse]

Your partner will only be able to stay during visiting hours once you've delivered in a public hospital - if you've had a C section, that could mean a week in hospital with the baby with him only being there for four to six hours a day. This may or may not be an issue for you; my husband vetoed public on that basis alone as he would pay anything not to miss out on that early time with the baby*. Private delivery usually means a bed and meals for the father (at a price, of course!) for the duration of the mother's stay.

A friend of mine was deeply distressed that the public hospital would / could not provide nappies - she ran out, and her husband couldn't bring any in as visiting hours had finished, so she had to 'borrow' some from another woman on the ward. Seems minor, but it left her feeling awful.

.......

The majority of women will have identical medical outcomes for their babies at public or private. I know heaps of women who gone public and it's been great. Some have had a bad experience (NOT a bad outcome) at public so switched to private for the second baby onwards.

This seems so strange. Why would the partner not be allowed to stay? Do they literally not have room for a chair beside the bed? And not providing diapers for their patients? Do they also not provide bandages to patients after hours? Are people required to bring in their own food as well?  I'm just at a loss at this level of medical care provided to the public. First world problems, I guess.

[pancakes]

Public hospitals have pretty strict visiting times. KEMH is 3pm-8pm for general visitors and one person I can nominate one person who can visit 8am-8pm.

This does bother me a bit, especially if for some reason we end up with an extended stay, but does it bother me $5k?

I'd say they don't provide nappies because it is a public hospital and nappies are not covered by Medicare or considered a medical expense.

[Primm]

Your partner will only be able to stay during visiting hours once you've delivered in a public hospital - if you've had a C section, that could mean a week in hospital with the baby with him only being there for four to six hours a day. This may or may not be an issue for you; my husband vetoed public on that basis alone as he would pay anything not to miss out on that early time with the baby*. Private delivery usually means a bed and meals for the father (at a price, of course!) for the duration of the mother's stay.

A friend of mine was deeply distressed that the public hospital would / could not provide nappies - she ran out, and her husband couldn't bring any in as visiting hours had finished, so she had to 'borrow' some from another woman on the ward. Seems minor, but it left her feeling awful.

.......

The majority of women will have identical medical outcomes for their babies at public or private. I know heaps of women who gone public and it's been great. Some have had a bad experience (NOT a bad outcome) at public so switched to private for the second baby onwards.

This seems so strange. Why would the partner not be allowed to stay? Do they literally not have room for a chair beside the bed? And not providing diapers for their patients? Do they also not provide bandages to patients after hours? Are people required to bring in their own food as well?  I'm just at a loss at this level of medical care provided to the public. First world problems, I guess.

I have no idea. And I have worked in the maternity hospital system for the past 10 years. In Australia. I've never heard of any of these problems. The husband is always allowed to stay (public or private) 24/7 in the hospital in which I work, and the nappies etc. are all supplied.

Don't base your opinion of our public health system on one single hospital. Some hospitals are their own special world, I don't know if it's the distance from everyone else, but they have some last-century views of acceptable. Not around medical care, but certainly the other family centred stuff.

Now, my humble opinion.

Public every time. ARS said up-thread that if you are high risk or there are problems with the pregnancy then maybe think about private, but in my experience issues around bub or mums health are far better treated in the public system. Referrals happen quicker and the experts all work in the public system in high-risk obstetric units and maternal fetal medicine.

If you're concerned about the little things - a glass of wine, a free newspaper, that sort of thing, then go private. But an extra $7 to $10k in "pregnancy management fees", plus your insurance excess, plus anaesthetist gaps (they do the epidurals as well so it's not just if you need a C/S) is a hell of a lot to pay for an extra couple of days in hospital. And you can buy your own bottle of Grange if you like for a lot less than the difference between public and private fees.

If you have a clear idea of how you want to give birth, my experience is that you're more likely to achieve this if you're in a public hospital. Midwifery-led care plus the O/B only getting called in if there's a problem mean you'll be more in control of your own delivery. FFS though, please don't come in with a 76 page "birthing plan". The longer and more detailed the birth plan, the higher the likelihood of the shit hitting the fan.

[HappierAtHome]

The anecdotes I'm telling aren't from King Eddies - I've actually only heard of good experiences there. The smaller metropolitan hospitals are the ones that seem to be much harder on mums.

[stripey]

I'm nulliparous (and intend to stay that way) but know several people who have given birth at King Eddie's, and also know a lot of staff that work there (via my work). All positive.

[arebelspy]

I'm nulliparous

What a cool word! Thanks for introducing me to it!  :)

[AliEli]

Hi Pancakes,

I'm a nurse, and I'm also pregnant with my first baby (due Jan :D) so have been thinking about the same things.  Having worked in both public and private hospitals of different major healthcare groups, I am going public.  I have worked in acute wards in private hospitals (not maternity), but I have seen enough hair-raising events that were avoidable in private that I am only considering public hospitals.  If you do decide to go private, it would be worth investigating whether the hospital has a resident doctor on-site (not on-call) 24/7, as it makes a big difference to how quickly things are dealt with if there are any issues.

[Anatidae V]

I think it depends on circumstances and preferences. I plan on being a private patient in a public or private for my first, and then doing subsequent births based on how that goes. We are only starting to try to conceive now, so it's a while away for us, but I already have a gynaecologist recommendation for my particular problems and some names for getting a doula. We'll be going Fiona Stanley or SJOG Murdoch, although I heard about people in labour being sent away from FS!

It is interesting to hear from the nurses that private might be worse. As well as an on -site doctor, what other questions are good to ask (both private and public)?

[stripey]

I'm nulliparous

What a cool word! Thanks for introducing me to it!  :)

And your partner  would be considered primiparous ;)

[arebelspy]

I'm nulliparous

What a cool word! Thanks for introducing me to it!  :)

And your partner  would be considered primiparous ;)

Cool!  Gonna start using primiparous (and multiparous some day?). 

[Eucalyptus]

My sister is a midwife with several years experience now, South Australia. Aunty also a highly experienced midwife and pediatric nurse who has worked everywhere (she gets good money doing temp work). I know lots of midwives! When they all do their training they get sent around the state to most of the public hospitals, and also do a lot of work in most of the privates. Midwives tend to know a lot of midwives and hear what everything is like everywhere.

They all unanimously agree, all the time, that Public is the way to go. Pretty much the only reason to pick Private is if you want your own hotel room. That's about it. Damn expensive hotel room.

-Public is much better regulated. Midwives and doctors all conform to the latest cutting edge standards of care informed by the best science available. My sister literally is made to read Nature and Lancet papers, and then the new piece of policy that comes out from it (well not really made, she loves it!). In private its all up to the individual doctors and hospitals what they do. They can be years behind in some things in best practice.
-Yes, you won't have the same midwife for the entirety of the stay, but why would you want to? You could land a crap one!
-If anything goes wrong, its always off to the big public hospitals which have all the specialists on tap.
-Modern best practice is to get parents and babies home earlier rather than later, assuming everything is fine. It is better for healthy mothers and babies to be at home. Public system will keep you in if there is an issue. Most of the time in Private you are paying for a room for a few days that you don't really need. Go home and sleep in your own bed and be in your own environment :-)
-If something is really wrong as I said they keep you in Public anyway. If you really need the help past visiting hours there are midwives there overnight, and sometimes they let fathers stay anyway, depends on the hospital.
-Public they send out a midwife for at least one visit after you go home-so if you need more advice you can get it. Also, you can call them up for phone advice too. For most people this is plenty.
-Shared rooms are little issue in a Public maternity ward. Usually its only two mothers to a room. You might be lucky and have no one. Its more likely a midwife is nearby.  Trust me, after going through childbirth, your sense of privacy with strangers will all be shot out of the water! Sharing a room with another mother and baby is pretty tame compared to many many people coming in and starting at you for hours during birth. Heck, you'll probably make friends! My daughter's best friend is the girl that she shared her first room with, in hospital...

[Anatidae V]

On visiting hours; if I'm in labour, and it's outside visitors hours, is there any chance my partner will be sent home?

With a diagnoses of anxiety and vaginismus, I'm likely to have more emotional ramifications from childbirth, and I'm more concerned about not being listened to regardless of public or private. What's the best way of achieving that?

[Eucalyptus]

On visiting hours; if I'm in labour, and it's outside visitors hours, is there any chance my partner will be sent home?

With a diagnoses of anxiety and vaginismus, I'm likely to have more emotional ramifications from childbirth, and I'm more concerned about not being listened to regardless of public or private. What's the best way of achieving that?

They won't send your partner home while you are in Labor, never! The whole point is that they are there.

I've had depression before, and anxiety. Its great that you are aware of it now :-) There are lots of support mechanisms in place in the Public system (I assume the same in Private, just you'd probably have to pay for it) for women that have a high chance of having postnatal depression and other issues, both pre and post natal. Ask your GP and/or midwives/hospital (depends on the system and if you are in shared care or group practise, who you have to ask), they'll point you in the right direction. Modern Australian midwives and doctors are super aware of these issues, and ready and willing to help you :-) Don't be afraid to let them know you need help, speak up at any stage :-) Best of Luck!

[Metric Mouse]

Your partner will only be able to stay during visiting hours once you've delivered in a public hospital - if you've had a C section, that could mean a week in hospital with the baby with him only being there for four to six hours a day. This may or may not be an issue for you; my husband vetoed public on that basis alone as he would pay anything not to miss out on that early time with the baby*. Private delivery usually means a bed and meals for the father (at a price, of course!) for the duration of the mother's stay.

A friend of mine was deeply distressed that the public hospital would / could not provide nappies - she ran out, and her husband couldn't bring any in as visiting hours had finished, so she had to 'borrow' some from another woman on the ward. Seems minor, but it left her feeling awful.

.......

The majority of women will have identical medical outcomes for their babies at public or private. I know heaps of women who gone public and it's been great. Some have had a bad experience (NOT a bad outcome) at public so switched to private for the second baby onwards.

This seems so strange. Why would the partner not be allowed to stay? Do they literally not have room for a chair beside the bed? And not providing diapers for their patients? Do they also not provide bandages to patients after hours? Are people required to bring in their own food as well?  I'm just at a loss at this level of medical care provided to the public. First world problems, I guess.

I have no idea. And I have worked in the maternity hospital system for the past 10 years. In Australia. I've never heard of any of these problems. The husband is always allowed to stay (public or private) 24/7 in the hospital in which I work, and the nappies etc. are all supplied.

Don't base your opinion of our public health system on one single hospital. KEMH are their own special world, I don't know if it's the distance from everyone else, but they have some last-century views of acceptable. Not around medical care, but certainly the other family centred stuff.

Thanks for replying, Primm. This makes more sense.

[AliEli]

"It is interesting to hear from the nurses that private might be worse. As well as an on -site doctor, what other questions are good to ask (both private and public)?"

Is there an ICU on-site?
Is there a theatre on-site?
At what point would you be trasferred out of the hospital if something went awry?
What proportion of women have C-sections at the hospital?
What proportion of women have episiotomies?
How does that compare with the state average?
If the private ob can't make it to the birth, who is their back-up?  Can you meet them before the event? 

[pancakes]

Thank you everyone for the great input and experiences.

I think based on the quality of my local hospital and feedback here we will go public.

Instead of out of pocket OB costs we can put some of that money towards extra time off work for us to spend time with the baby. That stuff I feel will matter more in the end than my choice of dr (especially given I have no preferences for the birth at this stage).

Thanks also Eucalyptus for your thoughts on early discharge. I have an old family and the talk is always around the "good old days" when you could stay a week in hospital after a successful non-complicated vaginal birth and how now hospitals push women out the door. This has always been referred to as a negative around me so it has been good for me to question that.

[Eucalyptus]

Thank you everyone for the great input and experiences.

I think based on the quality of my local hospital and feedback here we will go public.

Instead of out of pocket OB costs we can put some of that money towards extra time off work for us to spend time with the baby. That stuff I feel will matter more in the end than my choice of dr (especially given I have no preferences for the birth at this stage).

Thanks also Eucalyptus for your thoughts on early discharge. I have an old family and the talk is always around the "good old days" when you could stay a week in hospital after a successful non-complicated vaginal birth and how now hospitals push women out the door. This has always been referred to as a negative around me so it has been good for me to question that.

Yeah don't be afraid to go home! Home is awesome!

Best of luck :-)

[Trouble]

I'd like to add a couple of things to this thread:

1. Is there a community midwifery program or birth Centre where you live? Best practice is actually to be cared for by one or a small team of known midwives.
2. Have you considered home birth as a option? Might seem scary at first but have a look into it if there are independent midwives in your area.
3. Thought about getting a doula? In my opinion they are INVALUABLE for helping you navigate the overload of things you want to know. They can help you with your birth plan, they're there for the entire labour and they can help you when (in my example) the medical professionals are trying to push you in a direction that isn't backed up with latest best practice.
4. Public had much lower c-section and intervention rates than private. And with public they can't kick you out if you say "no, I won't let you induce me for this silly reason" or disagree with them.

I had #1 public and was incredibly fortunate to end up without a c-section (bit I wouldn't call my birth natural, just vaginal), and had PND as a result of my bullying OB.I had #2 in the public system with doula support and had to fight the whole way through as I had some risky things come up (Vasa previa which disappeared thankfully, then I went to 43 weeks which is not nearly as dangerous as medical professionals try to  tell you). It ended up being an amazing birth. With #3 recently conceived I'll be going to a birth Centre (would home birth but I don't like the rental I live in, and the birth Centre is just gorgeous!) because I know that I will be loved and supported and treated like someone who has their baby's best interest at heart, rather than someone who is pushing against policy.

[Metric Mouse]

Thank you everyone for the great input and experiences.

I think based on the quality of my local hospital and feedback here we will go public.

Instead of out of pocket OB costs we can put some of that money towards extra time off work for us to spend time with the baby. That stuff I feel will matter more in the end than my choice of dr (especially given I have no preferences for the birth at this stage).

Thanks also Eucalyptus for your thoughts on early discharge. I have an old family and the talk is always around the "good old days" when you could stay a week in hospital after a successful non-complicated vaginal birth and how now hospitals push women out the door. This has always been referred to as a negative around me so it has been good for me to question that.

Yeah don't be afraid to go home! Home is awesome!

Best of luck :-)

Here in the states we just about had to fight to get released 24 hours after delivery. I was quite surprised by the amount of push back staff gave when we decided we were ready to return home.

[arebelspy]

(Statistics stolen from abortion thread.)

This was the most recent result I found with a quick google search
http://www.indexmundi.com/g/r.aspx?v=2223
Canada is good but not great, we need to do better as well.

Maternal mortality rate (deaths/100,000 live births)         Rank worst to best out of 184
Brunei              24                                                         133   
Grenada            24                                                         134   
Saudi Arabia      24                                                         135   
USA                 21                                                        136
Hungary            21                                                        137   
Iran                  21                                                        138   
Luxembourg      20                                                        139   
Puerto Rico        20                                                        140   
Kuwait              14                                                        146   
Serbia              12                                                        147   
Canada           12                                                        148   
Denmark          12                                                       149   
United Kingdom 12                                                        150   
France               8                                                         162   
Switzerland        8                                                         163   
Germany            7                                                         164   
Australia            7                                                         165   
Norway              7                                                         166   
Estonia              2                                                         184   

(PS lining these up was horrible, tired of it, they are readable)

Looks like Australia is one of the best in the world for maternal mortality rate--well above the US, Canada, most of Europe, etc.  So in terms of safety, public is likely fine.  :)

(Just saw that data, and figured I'd cross reference it over to this thread.)

[Anatidae V]

Thanks ARS. I know for me that kind of thing reassures my anxiety, but on the other hand the quality of experience is important for my ability to decide to have the second child after I've avoided the first. That seems to be more where the public vs private comes in, stuff like how long does it take me physically and mentally to recover after the birth. Interesting that the graph is per birth- since many of the better countries have lower birth rates per woman, I wonder how that would change if it was per woman who'd been pregnant instead of each birth.

[Astatine]

I don't have kids and will not be having kids. However, the vast majority of my friends have small kids. IIRC, nearly all of them gave birth in a birthing centre at a public hospital. The birthing centre is a lot less "hospital" than a standard hospital ward and is intended for low risk births. But, all of the facilities are close by if something does go wrong. If it's a straighforward birth with no complications, generally my friends got sent home after 24 hours.

[KirstyB]

Had my first at private hospital in USA, second at SjOG subiaco. My experience at SJOG was awful - definitely wouldn't recommend paying for that when plenty of friends at the time had a great experience at the public hospital.

[Anatidae V]

Now pregnant with #1, I've decided to go private. Will let you know how that goes...

[pancakes]

I'm booked into KEMH now.

I had an interesting conversation with the hospital admin about my name as they didn't have any records of me and kept insisting that I must have changed my name at some point. I've never been admitted to a hospital before which is apparently unusual.

[arebelspy]

Now pregnant with #1

Congrats!!

I'm booked into KEMH now.

Good luck! :)

[Metric Mouse]

I'm booked into KEMH now.

I had an interesting conversation with the hospital admin about my name as they didn't have any records of me and kept insisting that I must have changed my name at some point. I've never been admitted to a hospital before which is apparently unusual.

Wow. Quite the impressive admitance procedures at that place. I'm sure they do fine in other departments...