Public vs Private Natal Care in Australia
Let’s face it, when your baby is inside you, it has gotten used to the luxury and pampering of the five star accommodations of your womb. Food whenever he wants it, temperature perfect, room to grow and very little annoying noise from the neighbours (except maybe if you have twins).
But one of the many, many decisions you will have to make as an impending mother is do you go through the public or private hospital system of care for your pregnancy and birth? What are the benefits of each? Can you afford what you want? Are all of the bells and whistles necessary? And depending on where you live; what options are available to you?
Money is always an object and never so much as now. In coming months you are going to need to decide between the ornate hand-carved crib of your dreams and the latest Ikea model. You are going to be very shocked by how many months’ rent a pram is going to set you back. Do you need private healthcare on top of all that too?
The public system is safe and excellent. In Australia we are a bit blessed to have such good public healthcare and so much of it covered by the Medicare system. There is no reason why you or your baby would be less safe or have lower quality medical care because you choose to go through the public system. Often, and probably even more confusingly, you can receive both types of care in the same hospital.
In the public system you will give birth in a public hospital and may stay around 1 to 3 days after giving birth, most likely in a shared room. Your GP may be able to care for you during the pregnancy and the obstetrician available at the time of birth at your closest hospital will attend the actual birth. Midwives will generally look after you throughout the labour until crunch time comes (I’m going to stop calling it that; let’s go with ‘the big moment’ instead).
You should have access to the full range of pain relief options, including having an epidural if needed, and can have either a planned or emergency caesarean section as required.If your birth is straightforward you may be sent home within six hours of giving birth.
You could also choose a birthing centre which is entirely staffed by midwives, or choose to give birth at home. Your only options for pain relief are natural ones, and if you run into complications while giving birth you will be transferred to a public hospital for medical intervention. Both of these systems are covered by Medicare, but I won’t be discussing these options in detail here.
Pros and Cons of Public Healthcare
· This is the best choice financially
· You should receive the full range of health and medical intervention that you and your baby need
· If you are generally laid back or not fussy, this can be an easy option
· If your pregnancy is low risk or you’ve been here before then this is a good choice
· Although you will give birth in a delivery suite (which is not shared), you will most likely stay in a shared room afterwards. Your partner is unlikely to be able to stay with you afterwards.
· You may get sent home very soon after giving birth
· You will not get to know your obstetrician prior to the birth, but you will meet your midwives and can be looked after by your GP in a shared care arrangement
· The delivery suites will be a bit more basic, and amenities like bathroom, food etc. will not be as luxurious.
How much out of pocket?
You shouldn’t be out of pocket at all through the public system; this should be completely covered by Medicare.
In the private system you will generally choose an obstetrician and then a hospital, or a hospital and then one of the obstetricians who services there. You will meet the obstetrician early and have all your pre-natal appointments getting to know this person. The hospital you give birth at is a private hospital, and can be just for giving birth which is sometimes nice. You can stay up to 4-5 days after giving birth in the private system.
You will need private health insurance with obstetric cover to utilise this system. Going private generally requires good prior planning, as many health insurance policies have a twelve month wait on obstetrics. It might be too late to sign up unless you can convince bubs to spend a few extra months on the inside.
Pros and Cons of Private Healthcare
· You will get to know your treating doctor and have many months to ask all the questions and concerns you have.
· If you are high risk you may feel more comfortable with a specialist.
· Your hospital may have more perks including birthing pools in the delivery suite, private bathrooms, better food, alcohol and ancillary services.
· You can stay generally as long after birth as you are comfortable, and often your partner can stay with you.
· You have to have health insurance already that covers this option.
· Even with the health insurance you can end up quite a bit out of pocket.
· Depending on where you live, this may not even be an option for you.
· You may not actually get a private ward room in the end even if you paid for one; it will still depend on what’s available at the time.
· If your birth ends up being pretty straight forward you will be attended to most of the time by midwives, and may only see your obstetrician in flashes, leaving you wondering what you paid all that money for.
How much out of pocket?
It is hard to say exactly as will vary between health insurance policies and the expertise of your obstetricians. You will pay monthly insurance premiums for the coverage, and also may be average between $2000 and $8000 out of pocket in addition to this.
Some questions it might help you to ask yourself
These hard hitting questions may shed some light onto what kind of birth you want to have:
How nervous or stressed am I likely to be through the pregnancy, birth and the labour?
If the answer is ‘very’ you may be more inclined to the private system, as you will get to know your obstetrician throughout the ninth months leading up. If you wake up in the middle of the night with burning questions you can call up and ask; this kind of personal attention is what you are paying for.
Is there any reason why my pregnancy or birth is higher risk?
If this is the case you will be looked after just fine through the public system, but may be more comfortable in the private system or specifically with an obstetrician who specialises in your kind of risk.
Am I a giant ‘fraidy cat’ when it comes to pain?
It’s nothing to be ashamed about, and probably better if you admit to this now. Both public and private hospitals will provide you with the full range of pain relief, although whether you can have it depends on how fast bubs wants to come out. You will only have natural pain relief in a birthing centre or at home, so these options are not so recommended for ‘fraidy cats’.
Am I happy to go home pretty much straight away?
If you feel that you might be a bit nervous about suddenly being left in charge of this tiny human and need a few days to get used to the idea, the private system will give you a little more time to prepare. You will also have access to services like lactation consultants and occupational therapists in a private hospital to get you on your way. Also if this is not your first birth and you are viewing this as a bit of a holiday from the chaos that’s waiting for you at home, then I recommend the private system for you.
What can I afford?
Having a baby is the beginning of a very long journey of flushing money down the toilet that will last the rest of your lifetime, I mean, is a wonderful lovely thing that can be a bit expensive. You will need to budget and work out what is important to you. In the public system, your costs are completely covered, in the private system some are covered by Medicare, some by your private health insurance (which you obviously have to be able to afford the monthly premiums of), and then there will be some costs left over for you. This may include $500-$1000 excess on your hospital stay and up to several thousand dollars out of pocket for your obstetrician and other specialists, depending on what they charge.
In the end you can control very little about your birth experience.
I chose the private system because I didn’t want to have what I thought would be a ‘sick person’ experience of a public hospital (and I was also a nervous nelly and a giant ‘fraidy cat). But to be honest I couldn’t tell you if I would have felt like a sick person in a public hospital. There were positive and negative aspects to each of my births and I believe that these would have been the case in either system really.
There is so much you can’t control when it comes to a baby coming out of you, so it might be wisest to choose the best option for you that you can, and then let the rest flow from that. You and your baby will be safe either way, the rest comes down to little luxuries and how much reassurance and peace of mind you think you’ll need.
Talk to the people who know you, and have either been through this themselves or are medically trained to know what they are talking about. They will be able to help you make the right choice for you.