Private or Public Health? Important Pregnancy Decisions
Before we get to the role of each individual clinician in the delivery suite. Lets talk more broadly about the larger healthcare system in Australia and the different choices you have.
The biggest question to ask yourself is – private health? Or public health? There are many pro’s and con’s and question’s you need to ask yourself when deciding between both options.
In this video Donna (our midwife) and Dr Anneliese (Obs/Gynae) summarise the main differences for you.
(This is specifically talking about the Australian healthcare system)
Donna: Public hospital versus private hospital, which is always a spirited conversation. And a lot of the time at this stage you’ve already made your choice. And maybe you’re thinking I have to spend a long time waiting in a public hospital. Or I chose the public hospital because I really wanted a water birth. But maybe I’m thinking of what my other options are, but just very broadly if you’re not quite aware of the differences. How would you best explain, say, a private hospital booking admission?
Anneleise: Sure. Look, I think probably the biggest thing that with private that everybody knows about is picking your own obstetrician. So we’re the ones that are there with you for every antenatal visit and therefore the birth.
But there are a lot of other differences with public and private hospitals. So in a private hospital, you’ll have a midwife who’s with you throughout the whole labour. Your obstetrician is kept up to date throughout the labour and will come in as necessary. Obviously obstetrician will be there at the birth.
But you will also have access to fully qualified anesthetists and pediatricians who have completed all of their training, who have been working for many years, and who are able to come and help with things like epidurals and looking after your baby.
And I think probably one of the biggest differences that I see between public and private is the aftercare. So in private, it’s pretty routine that we would encourage women to stay for around four nights after a normal delivery, five nights if they have a cesarean section and that time is actually very. Useful to spend time with the midwives who are looking after you to actually learn how to look after your baby, learn how to breastfeed, learn how to give them a bath, and feel confident by the time you go home. Whereas in public, obviously the demands are a little higher and there’s more pressure for women to go home early and not necessarily with all of that same support afterward.
For some people, it might also make a difference that in a private hospital, mostly it’s set up so that your partner can stay with you during the duration of your stay as well. Whereas in a public hospital, you might be sharing a room with someone else and it’s much harder for partners to stay. So, you know, having that extra support around you afterward is probably one of the main benefits of private practice, but there are so many other parts to private practice as well.
Donna: And look, from my perspective as a midwife. I’ve worked in both models, so I’ve worked in a busy public hospital. Where you do see a lot of people training, so when Annalise was saying fully qualified, a lot of training programs are undertaken in public hospitals, so it doesn’t mean that you’re going to get substandard care, but it’s a strong education focus and there are all of these clinicians that are learning whether they’re students or registrars and in a training program, they’re very well supported. But it is the model of training, whereas in a private hospital generally people are fully qualified.
Anneleise: Exactly. We’re all finished our training to be able to work independently.
Donna: Independently, and that’s where the term consultant comes from, is that they’ve finished their training, their final exams, which is how many years?
Anneleise: Many. A lot. A looong time.
Donna: So you should be very well reassured that anyone that looks after you in a private hospital has completed all of the training. But there are a lot of levels in a public hospital of supervision, so there’s no one being crazy or rogue, but that is a part of the training.
Anneleise: Of course, yeah.
Donna: Absolutely. And so you might have a doctor that’s learning or you might have a lot more student focus, which is great for all of our people coming out.
In the public system, you’re also discharged very quickly, and at that moment there’s a lot of change happening in how quickly people go home. In some cases, they’re really encouraging you out between 4 and 24 hours. Which when you’re in a private hospital, four to five days is quite different.
And so that doesn’t mean that you kicked out the door and good luck with that. There is the support that comes to you at home, but obviously, that support comes once a day. Or once every second day. So there’s a lot of times in between where you might have to call up and get advice or you have to kind of pad through things yourself, which for some parents, especially if they’re feeling really overwhelmed and anxious, is too much for them.
And that’s why, again, yes, being a private patient does cost more. You’re paying out-of-pocket costs, but you’re kind of paying for that reassurance and support.
That’s not obviously if you were unwell or the baby was unwell. They’re not going to send you home from the hospital in the public sector. But if everything looks good, even if you’re feeling anxious and you want to stay, they’re still going to say ‘bye bye’ and send that support out to you at home. In a private hospital, our focus is to support parents. So the dad and the mum together learn what to do with their baby together.
That’s why we encourage dads to stay in. That’s why we do a lot of education with the mom and the dad together so that they’re both getting that knowledge and that on-the-job training in that first few days in the hospital. And as a midwife in a private hospital, we do encourage that education. So if you have a big Italian family, we’re going be like, it’s time for everyone to go home because we need to to do a feed or we need to help you to learn something because that is the reason why you’re staying in for those extra few days.
What is your role?
Let’s start with the most important one…You!
You are the patient, it’s your care and your baby. All the clinicians during labour want to provide you with the most personalised care to help you have the best birthing experience possible. So your biggest role is helping the clinicians understand your unique circumstances and requirements so they can help you with your pregnancy decisions.
Only once they know this can they advocate for your needs and provide you with the best care possible. So in your appointments don’t be afraid to speak up, you’re not weird, afraid or putting them out. Believe me, they have heard and seen it all before and they want to give you the best birthing experience.
Donna: Right. So getting to the gritty end. They’re coming out. And you know, a lot of women at 32 weeks have done some sort of education or they’re really looking for like, how do these babies come out? And what can I expect and what can I plan for? And so, you know, when to come in? What’s an induction? What can I read? Starts to become the first thing that everyone asks you. You’re at a BBQ. Ohh. So what are you planning with this baby? And you’re like, ohh, I don’t know, healthy baby.
Anneleise: That’s the important thing.
Donna: Yes. Or you hear some people say I’m having an induction, or I’m having a cesarean and they’re all individual choices and they shouldn’t be judged because, you know, it’s your individual need.
Anneleise: Absolutely. I think birth is a very, very individual thing. And most women have been along to antenatal classes or started to do some research and will get a feel for what things are important to them. And I think that it’s really important to discuss those things with your care provider in the last few weeks of pregnancy so that we can all be on the same page and help you to hopefully achieve the sort of birth you want. And some people might have particular concerns that mean that we do things in a certain way or they might be worried about certain things and we can address those issues as well. I really enjoy the last couple of weeks of pregnancy where we’re talking through, OK, what do you want? What can I do that will help this experience be good for you?
What about midwives and doctors?
Depending on your situation, you may spend most of your pregnancy with your midwife, GP, gynaecologist or obstetrician. And they are your mentor, advocate and guide.
But when you are in the birthing suite in labour, what are the different roles there often we see midwives and obs/gynae. What are their roles? Why do we need both?
Donna: So say your waters have broken at 2:00 o’clock in the morning, beautiful light pink. You’ve come in, I’ve assessed you and said we’re all good, you’re 4 centimetres and so Annelesie is your doctor and so are you going to come in?
Annelesie: Ohh, look, if everything is fine at 4:00 AM in the middle of the night, not usually. Often hospitals will have the ability to remotely monitor a baby. So at the hospital, I work at we have that option and I can just log in and have a quick look and check that I’m happy with the baby as well. But otherwise, we have our fabulous midwives who are able to interpret what they’re seeing with a CTG trace and let us know if things are completely normal, we would expect it to take some time and we wait and let things happen.
If there are any concerns with the baby, the baby is not coping, or if the midwife is not sure about something, then we would absolutely come in and assess the situation. But if it’s all normal, we wait and let things happen.
Donna: And I guess it’s realizing everybody’s role. So, you know, a midwife’s role normally is with ‘normal’. We’re very good at normal. We understand normal. We can assess abnormal, but we’re not the managers of ‘abnormal’. That’s why we work as a team. So if everything’s going very well, even if you’re a private patient, we’re going to say to the doctor this is what’s happening. She’s going to say, that’s great. Let me know if anything changes.
But you may not see that doctor for a few hours because they can check. We might communicate with them, but they’ll generally come at the end and steal the glory. Coming in and safely transitioning that baby into the world. And we’d say, ‘oh look, it’s time to come in now’.
Annelesie: So the midwife is very much there for supporting you through the labour. They’ll be able to make suggestions on things that you can try, different positions, different things that you can do to try and help move the baby into a better position. They’re great, all those things and they’ll stay with you the whole time and give you lots of support and advice throughout the labour. And then obviously we come in and we deliver the baby because we’ve looked after them for nine months and want to be there.
Donna: And that’s a part of your relationship, you’ve got to know the doctor throughout. And so it’s lovely to see it at the end. But if you’re in a public hospital, in a public setting, a midwife is educated and trained to do the whole shebang if everything’s nice and normal. So if all is very good, you might actually not see a doctor at all. You might have a midwife that does everything.
And so that doesn’t mean that you’re not being monitored or if anything changes that you wouldn’t get that support, but it’s knowing that. That a midwife is trained to do all of that to deliver babies and in a lot of cases to do suturing, put Jelcos in, and do newborn checks.
So if everything is all very normal you might have me the whole time and think when’s the doctor coming? Now the doctor in a public setting is there for the abnormal and it’s generally a doctor that you have never met anyway. And so if I was worried I would say, ‘hey Brenda in room 3 I’m a little bit concerned about’. And then they would come in and offer some opinion and some treatment for that because things have moved from normal to abnormal.
And so as the patient, you don’t need to manage that. Your job is just to do what you’re doing. And that’s why you have health professionals that sit around you to help, to know how things are going.
You get the bill from them, but what does the anaesthetist do for you during birth?
Sometimes you may also need an anaesthetist. Say, what? Another doctor? Anaesthetist area of specialty is on pain and medication management.
If you want to hear more about caesarean births, induced labour or epidurals, just click on the links.
But don’t be put off, be rest assured, it is still all your decision about how all these things happen. Watch Donna and Nathan speak about consent and how you are very much in control of your own destiny.
Dr Nathan also speaks about some great strategies to over come anxiety or hesitation about medication during childbirth. It is your body and your care, make sure they care caring for your health – whether that is emotional, physical or mental health. You aren’t putting them out, that is their job.
There’s a bit more to anaesthesiology than I thought, even the sneaky photographer role:)
Donna: So you always need, in say something like a caesarean, you always need an anesthetist and obviously surgeons. As well as all of the other support groups. And so the anesthetist’s role in something like that is to offer pain relief?
Nathan: So during a cesarean, our role is to make the procedure comfortable and tolerable for you. And there are only really three ways we can do that. The other thing that we do is sort out your pain relief afterwards. So for the first two hours, days, weeks. We’ll chart all that.
Donna: So you’re in charge of that as well?
Nathan: We’re in charge of starting the ball rolling, talking to you about it, and having a plan. And often if there are problems later on with pain relief, you guys might give us a call at home and sort something out for you.
Donna: OK. And you obviously make sure that the bloods are OK as well? So the doctor might have done the bloods, but it’s your role to interpret that in terms of the medications.
Nathan: Yes, yes. So whoever requested it should be following up as well, but we’ll be having a look at those. And making sure that it was safe to go ahead with your procedure and safe to have whatever pain relief afterward you need.
Donna: And I guess also for mums to know that before they have any procedure, they always have to sign a consent. So sometimes the mum’s a bit nervous about a spinal anesthetic, for example, for a cesarean, then maybe they see the anesthetist beforehand. So they get all that information. And there is this part that they sign, that they understand what you said.
Nathan: Yeah, that’s right. So we’ll certainly talk about the pros and the cons and make a suggestion about what anesthetics are best for you and then ultimately the choice is yours. And as a patient, you can choose to accept or choose an alternative. And then we’ll normally get you to sign to say that we’ve talked about it and are happy to go ahead.
Donna: So it’s always completely your choice and a great discussion to have with your care provider, whether it’s the midwife or the doctor. There are some people, I find that are very anxious about anesthetics and maybe they don’t like needles or they’ve had a bad experience before. And having a chat with you on a nice bright sunny day and not stressed and anxious, they can get lots of good information so that it doesn’t seem as scary.
Nathan: I think so. I think importantly as well, if you have a chat early on, you can put in place some other plans if you are needle phobic, hypnotherapy might just be magic for you. So go and see a hypnotherapist early on and spend some time with them. You’re not going to lose anything and it may well make a massive difference to the rest of your life, not just your labour and delivery. We can also do things like numbing cream if we plan ahead long enough to get you more comfortable with needles. And just to inform you about what’s going on so you can be relaxed.
Donna: Nathen had got lots of chit-chat to get you through a cesarean no problem, so you can talk about anything.
Nathan: I love taking photos of your baby as well once it’s done.
Donna: Yeah, he gets quite particularly with the angles, actually.
what about when you are home alone?
You have so many clinicians during labour, but then after that – suddenly, you are on your own!
We are glad you asked, because this is exactly what we do. Goldilocks is a next generation baby monitor that tracks your baby’s feeding, sleep, breathing, skin and core temperature.
But we don’t just track, we also provide insights and advice from clinicians (just like those you have seen above) right when you need them. It’s almost like having a virtual midwife with you the whole time.
You can find out more about Goldilocks by clicking the link.
Disclaimer: This article is for general information only and not intended as a substitute for medical advice. All information provided on this website is not intended to diagnose or prescribe. In all health-related matters we recommend consulting with your local healthcare professional