Congratulations you are pregnant! You may have lots of questions to ask yourself: how, where, when? One of the decisions a pregnant Australian woman has to make is choosing the type of obstetric care she receives during her pregnancy and birth: private or public.
This decision may depend on the following factors:
- Current private health insurance with a pregnancy cover for over 12 months.
- The type of birthing experience desired.
- Presence of obstetric risk factors.
If you are planning a family and have a preference for a private obstetrician care, you need to get insurance well in advance. Health funds have a 12-month waiting period before you can claim for birth-related services. This will cover your hospital stay and any medical interventions that you may need. On top, however, there is an out of pocket fee for your private obstetrician which varies between clinicians (usually between $3000 and $5000).
On the other hand, public system attracts very little out of pocket expenses but it has its downsides. Obstetric care is mainly provided by midwives, with some input from an obstetrician when required. Whilst public hospitals provide high quality care for birth-related services, the disadvantages include no choice of an obstetrician and no choice of the hospital.
Continuity of care is one of the advantages of the private care, where the same obstetrician who monitors you throughout pregnancy will also be present for the birth. This is in contrast to the public system, where the midwives and doctors attending your birth will be different to whom you have been seeing though out your pregnancy. (1)
Personalised care by your private obstetrician can also ensure your desires for pain relief are met. For example, women who are terrified of pain may be organised an epidural in place before contractions start, which may be more difficult to organise in a public system.
A woman, with a private obstetrician, may have a choice of an elective caesarean section if she wishes, without a medical indication. Whilst there is a controversy whether this is an advantage, there are women who prefer to plan their delivery day, and their life around it. Some are simply terrified of birth and its associated complications and prefer to opt for a C-section. In the public sector this birth option is only available to high-risk obstetric patients.
As you go into labour, your private obstetrician will arrive as soon as you present to the labour ward. This is in contrast to public system where midwives will be managing your labour and only call the doctor in the difficult circumstances. You also may be cared for by junior doctors, who will consult in an experienced obstetrician when needed. Therefore, the most important benefit of a private obstetrician, is close and regular monitoring provided by your clinician of choice during labour, which reduces the incidence of complex emergency C-sections. (3)
Lastly, there are differences in your experience in a private vs a public hospital stay. As a private patient, the woman is guaranteed a private room, where your partner may be able to stay too. In the public system a woman often has to share a room with other mothers and babies. Furthermore, a private system provides you a longer stay in the hospital, which allows longer time for recovery and breastfeeding support. For example, post-vaginal delivery public hospital stay is 1-2 days and post C-section delivery is 3 days, compared with 5 days for both types of deliveries in a private hospital. (2)
Midwives also play an important role in a private obstetrician care. Your private hospital midwives will be supporting you throughout your labour, post-birth care and breastfeeding.
If you feel a private obstetrician may be the best option for you and your baby, speak to your GP about making a referral to your clinician of choice. (4)
- Fawsitt CG, Bourke J, Lutomski JE, Meaney S, McElroy B, Murphy R, et al. What women want: Exploring pregnant womens preferences for alternative models of maternity care. Health Policy. 2017;121(1):66-74.
- Dahlen HG, Homer CSE. Web?based News Reports on Midwives Compared with Obstetricians: A Prospective Analysis. Birth. 2012;39(1):48-56.
- Adams N, Tudehope D, Gibbons KS, Flenady V. Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis. BJOG. 2018;125(2):149-58.
- Stevens G, Thompson R, Kruske S, Watson B, Miller YD. What are pregnant women told about models of maternity care in Australia? A retrospective study of womens reports. Patient Education and Counseling. 2014;97(1):114-21.