Trying for a baby? The Public vs Private debate

In Australia we’re fortunate to have a high standard of healthcare, an excellent public hospital system and a wide range of options for expectant mums. No two mothers and no two births are the same, so research as thoroughly as you can. Talk to other mums, your health practitioner and look closely at what your local area has to offer, so you can choose exactly what’s right for you and your baby.

The care factor

For Sydney businesswoman Olivia Trethewey, choosing a private obstetrician provided the reassurance of consistent, one-on-one care. “I thought very carefully about both private and public and eventually the decider for me as a first time mum was the comfort of knowing one obstetrician would be there for me throughout the journey.

“I was able to have a scan at every appointment, which made me feel calmer. I’m a quadruplet, and although I knew I was having just one baby, I still wondered if I’d suddenly see another one or two babies appear in there!”

If you choose the public route, you’ll be cared for by staff attached to your nearest public maternity hospital, where you’ll give birth. You may still be able to build consistency into your care through various models, including Shared Care between the midwives and your own GP; Team Midwifery, which provides you with care from the same group of midwives throughout, and even a system where two midwives care for you during pregnancy and are on call for your birth. Public hospitals are also fully geared up for very low intervention births, and might offer a Family Birth Centre where, if you choose, you’ll be able to move at your own pace as much as possible with midwives on hand in case things go awry.

Melbourne accountant Maggie Knight says she was pleasantly surprised by the choice available at her nearest public maternity hospital. “In the end I chose Shared Care, because my GP was close to my work and that made appointments easier. But I could have attended a Community Clinic or had Team Care at the hospital from a group of doctors and midwives. The public system seemed flexible and open to my needs.”

The comfort factor

Olivia Trethewey says she was drawn to the longer stay in hospital offered by the private system. Most public hospitals offer about two nights’ stay after a natural birth and four after a caesarean. Most private hospitals offer four nights for natural births and five for caesareans. Trethewey’s hospital, Prince of Wales Private Hospital in Randwick, Sydney, goes one better with a post-natal care program allowing women with complication free births to swap their hospital bed for an oceanfront room at the Crowne Plaza Hotel in Coogee.

“It was just amazing,” she says. “It was the perfect ‘halfway house’ between hospital and home. I’ll never forget standing on the balcony, watching the sunrise over the ocean, with my husband and new daughter. It was almost a money-can’t-buy experience.

The finance factor

The truth is, though, that money talks when you’re choosing between public and private. If you don’t have private health insurance, the cost of private hospital pregnancy and birth can range from $9000 to $30,000, depending on you and your baby’s needs. Even with insurance, the out-of-pocket costs of a private obstetrician, private hospital birth and postnatal care can range from $2500–$12,000.

Olivia Trethewey says she set out to minimise the costs as soon as she and her husband started talking babies. “We didn’t know how soon we’d start trying but I upgraded my private cover to include pregnancy, just in case. When the time came, we were able to afford the remaining out-of-pocket costs, which came to about $3,500.”

When Trethewey reviewed her policy, she discovered something that prospective mums don’t always realise: having private health insurance doesn’t mean you are automatically covered for pregnancy and obstetrics. Cheaper basic and many mid-range private health insurance policies don’t cover pregnancy, obstetrics and IVF. With most insurers, only a top level policy will provide pregnancy cover.

Most private health insurance funds also require you to have had private cover that includes pregnancy for 12 months (from when you take it out or upgrade) before you can claim on hospital costs related to childbirth. This means you need to have pregnancy cover for at least three or four months before falling pregnant, so it’s important to take out cover or upgrade your policy as soon as you start thinking about having a baby.

In a 2015 Ipsos research study commissioned by health insurance experts iSelect, almost half of women (47 percent) surveyed were either not sure or unaware of the 12 month wait time.

Another Ipsos study for iSelect this year found that one in five Australians surveyed with private health insurance are not sure if their policy covers them for pregnancy.

Sydney-based editor Aletha Wilkinson had intended to have a private birth with her first baby, but discovered when she was already pregnant that her existing private health insurance policy didn’t cover pregnancy and birth.

“First time out of the gate – whoops!” she says. “The worst part is I had actually updated my cover about a year prior, but did it online and never bothered to read the policy statement they sent afterwards. I did consider attempting to self-fund private care, but it ended up being a high-risk pregnancy and I was in hospital for an entire week in the end, so just as well I didn’t.”

She adds: “Always read the fine print. Don’t assume everything will be OK, whether it’s your health insurance policy or your health.”

If you’re going public by choice or financial necessity, it’s encouraging to remember that large public hospitals are well equipped to cope with the unexpected. During the birth of her first baby, Sydney business consultant Lara Dawson needed an emergency caesarian and general anaesthetic late in labour. “At 2am, there was a team of surgeons at the ready – I didn’t have to wait for a team to be called in,” she says. “Also I received some excellent free services; a social worker came to see me after the birth because of my trauma.”

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Originally published by Fairfax Media. This content may not be altered. Licensed to iSelect.