Going public ? Can you choose ob ?

[Obogk]

Hi there

I am 7 weeks pregnant and had my first in the UK. This system is so so new to me. We have private health cover. The waiting period will be over in April 2011, baby is due AUgust 2011, so I am covered for the birth.
I am debating whether to go public or private, majority in the UK go public through the NHS, I was really looked after , no compaints.
I know with going private you still have out ofpocket expenses, may not have your ob deliver your baby and have read that there is more intervention through private system ??? Intervention why ? I know that the plus is you have your own room see same ob each visit.
My queries are re. public......how does it work. The doctor refers me to the hospital, then do I soley see my gp and a midwife and then pot luck ob on D day ? Do i still have to pay ? Can a private ob deliver in a public hospital? is that cheaper ? As you can see I have zillions of questions flying around and need to make my mind up pretty soon.
Any input would be appreciated
thanks

[sunnyflower]

If you go private you are usually out of pocket a couple of thousand.You go to the hospital that your ob works in.Book early as good ones get booked out quickly.Your ob will deliver on the day (or should do).

Going to a public hospital as a public pt means you do get whoever is there on the day.You will be charged nothing.It's usually called shared care which means you see the gp until about 32 weeks (just an estimate )and then you go to the hospital ante natal clinic, until you deliver..

Personally if you find a good public hospital i think thats the way to go.Why pay all that money when you don't have to?

Hope i have helped you out a bit!!

[Tam-I-Am]

Heh, there's a lot jumbled up there together, so I'll do my best.

Intervention why ?

Very political question, so I'll give you a political answer. Obstetricians are trained in high risk pregnancy, and therefore they tend to see risk where there isn't necessarily any. Midwives are trained in low-risk (normal) pregnancy, and tend not to intervene unless and until there is a problem. Obviously these are broad generalisations.

My queries are re. public......how does it work. The doctor refers me to the hospital, then do I soley see my gp and a midwife and then pot luck ob on D day ?

It depends on what model of care you choose within the public system. You can do shared care, in which you'd attend an antenatal clinic at your chosen hospital 3 times, and see your GP the rest of the time. You can attend a midwife-led clinic or birthing centre, in which case you'd be assigned one or two midwives who would oversee your care, and you'd touch base with an Ob once or twice. Or you can choose solely obstetric led public care, in which case you'd be more than likely to see a different midwife and different Ob every time you attended the hospital.

In the public system, it's pretty much always 'pot luck' on which Ob attends you on the day of the birth of your child, although they will probably only be there briefly to check on you throughout the labour, and to catch the baby.

Do i still have to pay ?

No, the public system is free. If you choose to do shared care, you'll pay for your GP's visits, but anything that occurs within the hospital (except ultrasounds) should be free - ie Ob and midwife visits, physiotherapy, etc.

Can a private ob deliver in a public hospital?

Yes, but why you'd want to do that, I don't know - you end up with the disadvantages of both systems. Higher intervention rates, worse standards of care in the hospital.

is that cheaper ?

You would be a private patient in a public hospital, so no. You can't split your care that way - you're either a private patient, or you're not. You can't be attended by a private specialist in a public hospital, and be a public patient, it just doesn't work like that. If you're with a private ob in a public hospital, you're still a private patient in a public hospital. So you would pay for your stay and the facilities the same way you would in a private hospital.

The other option open to you, of course, one that nobody will probably tell you about is independent midwifery. Hiring an independent midwife to attend you at a homebirth, or in the hospital. If you do this, and they attend you in the hospital, it's unlikely that they would have any practising rights within the hospital (even if they worked at that hospital, they wouldn't be there in their employed capacity at that time), so they would serve as another, very knowledgeable support person. Homebirth is a real option in this country, although not many people take it up, and has the lowest level of intervention rates of all the ante/intra partum models of care.

I hope that helps :)

[Tam-I-Am]

Oh, and I just saw that you're in Perth. There is an awesome (free) community midwifery program for homebirths there. http://www.cmwa.net.au/

[speckled]

If you have private health insurance, and are a private patient in a public hospital then most costs associated with the hospital are covered. Most public hospitals do take private patients but I'm not sure how it works.

Private Obs book out quickly, maybe make an appointment with one- you can always cancel. Your GP should be the best to explain and direct you.

[Buttermilk]

I've done both.
Advantages of private care: You get the same ob on every appointment and he/she will be there for the birth. You develop a trusting relationship and this can be comforting especially as a first timer. They are available oncall 24/7 (or at least mine was) and if I ever had a problem I called my ob first, example once I needed an emergency visit to the hospital late one night and my ob was there for me and I went to my private hospital, not to the public emergency where I saw whoever and waited for hours (as it happened with my second)
Another advantage is the room and aftercare, you have a longer hospital stay in your own room where your partner can stay overnight, there is nursery care for your baby, I found the midwifes to be more on the ball and available so not understaffed, better food, more things provided ie.nappies etc.
Disadvantages: It costs more because your paying for an OB.

Public Care: As mentioned you can do shared care, so you see a gp (which is what I did) and do hospital appointments for the main ones, by memory about 3 or 4. You see someone different at the hospital everytime and have whoever deliver you on the day. Your gp is really only there to do the basic stuff, so if something is wrong or you need advice or want to discuss your delivery, you don't have anyone to do that with, I pretty much turned up in labour and did my own thing (which was actually good but is too long to explain why). My gp was free (bulkbilled) as was my hospital appointments. I only payed for scans/blood tests usual stuff that everyone pays for. You don't stay in hospital as long and have to share a room (which wasn't too bad) but the food was no good and I couldn't wait to get home!! You can also do midwife care where you go to a clinic outside the hosital and see midwifes, I can't tell you too much about that because I didn't choose that option.

You can have a private ob in a public hospital, it just depends which hospital your going to. This can be an option if you want private led OB care, but don't have private health cover and have to go to a public hospital. Since you have private health care and you wanted this option, you may as well use it for a private hospital and get more luxury. You'd be paying for the ob and private health anyway and te hospital would be free regardless.

As for intervention since an Ob will deliver at either private or public, your chances of intervention are there regardless. I can't say if they are higher at public or private or why. I've done both types of care and also had a c/s and vb and I had intervention with both. I'm also not sure what you mean by high intervention or how it is different to where your from. But for me the more knowledge I had, the easier it was to refuse certain things and understand what they were doing and why. I had alot more intervention the first time because I didn't know much and let them do whatever ie. I was induced and if I knew better I would have said hell to the NO! (and I refused alot more the second time and thus had a more natural uncomplicated delivery.

The 2 other options are birthing centres where you can have midwife care and more natural birthing is encouraged ie. water birth etc. and they are usually associated with a hospital. I can't tell you too much about that though, hopefully someone else can, my local birthing centre at the time wasn't in operation.
And homebirth where you hire a midwife. That can cost alot here because it's not covered by medicare or private health funds but is an option if homebirth is more for you, again I can't tell you too much (but I think someone else did, I didn't read too much). These 2 methods are probaly your best chances at intervention free births with continuaty of care and without hospitals and dr's (unless something is wrong in which case you are transferred anyway).

So you have alot of options and lots to think about!! Good Luck

[katieinwa]

If you have private health insurance, and are a private patient in a public hospital then most costs associated with the hospital are covered. Most public hospitals do take private patients but I'm not sure how it works.



if you are a private patient in the public system, you get charged for everything. just like you would if you are using your private patient in the private system. it just depends on what the health fund covers on the bill which will determine how much its going to cost you at the end of the day.

the only difference, in going to a public hospital as a private or public patient, is you get to choose your specialist, you get preference if there is a single room available (but if they are all taken you will get put in whichever bed is free). you also are charged for all costs if you elect to go as a private patient in the public hospital, just as you are when you are at a private hospital.

i have read somewhere that something like 40% of women don't actually see the Ob that they booked during their labour. either they don't make it, they are on holiday/leave or they are with another patient. kinda sucks when you pay all that money for lousy continuity of care

[doglover]

i have read somewhere that something like 40% of women don't actually see the Ob that they booked during their labour. either they don't make it, they are on holiday/leave or they are with another patient. kinda sucks when you pay all that money for lousy continuity of care

I am one of those 40%. Mine occured because my son was nearly 4 weeks early and my OB was on leave - hardly his fault. They dont book in patients when they are on leave (and a couple of days either side). However - I got my OB's stand in and he was fantastic. I didnt get just whoever was on. I had met this guy before. It was hardly lousy care.

I went private with my first and am going private with my second. For me the having my own room and shower/toilet, having my husband stay and be fed at no cost, having my own ob, having an ob that worked late so I could see him after work and not have to have time off, never having to wait more than 10 mins for an appointment, being able to call my OB 24/7 with any concerns - all made the money I spent WELL worth it!

[danni3]

I went public for my first two (and this one, but different care model as we have moved house)

I got to pick my OB, I saw him all through my pregnancy at his consulting rooms (after hours visits so hubby could come along too!) and he was called in when I was in labour to deliver bubs. I was out of pocket maybe $300 as he had a very small booking fee for public patients. (got about $100 back from medicare too)

I stayed in my own double room for the duration of both stays and my hubby was allowed to stay with me and baby too.

I have had very good public hospy/care experiences :)

[ladybug73]

I've gone through the public system nine times and usually it's the midwifes who have deliered my babies. I had a doctor there with my first three as I had epidurals and needed forcepts or vacuum extration. What I'm trying to say is if you go public you're more likely to have midwives do the delivering if all is going well. I have total trust in the midwifes and have had the same one deliver two of my babies. I'm heading back in to the public hospital, here in Brisbane, to have my 10th child in mid January.

Have you seen your doctor yet to confirm pregnancy/order blood tests? Your best bet would be to ask the doctor all the questions you have as things might be a bit different for WA as they are in Qld.

Best of luck and congratulations on you pregnancy.

[danni3]

I've gone through the public system nine times and usually it's the midwifes who have deliered my babies. I had a doctor there with my first three as I had epidurals and needed forcepts or vacuum extration. What I'm trying to say is if you go public you're more likely to have midwives do the delivering if all is going well. I have total trust in the midwifes and have had the same one deliver two of my babies. I'm heading back in to the public hospital, here in Brisbane, to have my 10th child in mid January.

I actually prefer just dealing with the middies too :D hence why this time I have chosen to go through the program run through the middies instead of havin gan OB ;)

[MissyMoo76]

Don't forget in regional areas, private Dr's work in the hospitals.

Sometimes in regional private hospitals, at the first sign of trouble, you will be sent via ambulance to public as some private hospitals do not have the staff or facilities to deal with truely sick patients. The public facility is the only place.

Royal Brisbane Womans Hospital, for example is where if you are high risk pregnancy/birth, this is the states leading facility & where you will be sent.

Birth centers are usually attached to public labour wards, if you have trouble, they press a buzzer & every Tom, **** & Harry with a white coat will appear ready to work! I myself wil be public for a lot of the above reasons. But each to their own.