Hospital

The vast majority of Australian women have their babies in one of Australia's public or private hospitals. The figures for 2011 which are our most up-to-date stats, show that 59% women who gave birth in a public hosptial had a 'normal' birth compared with 42% of women giving birth in private hospitals. The following information compares 'standard care' in a Public Maternity Hospital with care in a Private Maternity Hospital.

Care during pregnancy (Antenatal Care)

In the public system, your antenatal care is provided by a clinic midwife or GP obstetrician. In the private system antenatal care is by a private obstetrician. Antenatal Care is provided through a series of appointments either in the hospital or GP clinic, at your obstetrician’s private rooms. The purpose of these appointments is to monitor your health and wellbeing and that of your baby, and to provide you with information and emotional support. Appointments will often include asking you about your health, measuring your blood pressure, checking your urine for traces of protein and monitoring your baby’s growth and heartbeat. They are an opportunity for you to discuss your experience of the pregnancy and ask questions about your maternity care, as well as issues around preparation for parenthood.

Care during labour (Intrapartum Care)

If you have planned to give birth in a public hospital, your care will be provided by one of the midwives working in the Labour Ward or Birth Suite. Your care will be overseen by a registrar. Registrars are qualified doctors who are training to become obstetricians. A registrar will visit you every four hours or so to offer you progress assessments. The registrar will refer to the consultant obstetrician who is on call at the time.

If you are a private patient, your care will be provided by one of the midwives working in the Labour Ward or Birth Suite. Your care will be overseen by the private obstetrician you have hired. Your obstetrician will visit you every four hours or so. Some private obstetricians work in group practices and take rostered nights and weekends off. In this case you would be cared for by a different private obstetrician who is part of the group practice.

The medical team are there to provide you with physical and emotional support, help you to understand what is happening and provide you with information so that you can make the choices that feel right for you and your baby.

Care after your baby is born (Postnatal Care)

In most hospitals, you will be transferred to the maternity ward within a few hours of your baby’s birth. The maternity ward midwives will provide the majority of your postnatal care whilst in hospital, with a registrar or your obstetrician checking on your progress. Midwives will continue to monitor your blood pressure and temperature and check your blood loss and any wound repair. They will offer you support with breastfeeding and looking after your new baby. Some private hospitals have arrangements with local 4-5 star hotels for women who have had uncomplicated births to stay in private rooms

Postnatal care in your home (Domicilliary Care)

Some hospitals will offer you the opportunity to have a hospital midwife come to your home to provide postnatal care and support. Private patients should check with their maternity hospital and their health fund to find out what is covered and provided. Your hospital will let your local maternal and child health service know that you have had your baby and a nurse will visit you at home within the first two weeks after your baby’s birth. After this appointment you will be encouraged to meet with the nurse at their clinic for ongoing monitoring and information and support.

Advantages of standard care in a Public Hospital

• This model of care is free to any women who is registered with Medicare.
• Women in a Public Hospital are more likely to have a normal vaginal birth than those in a Private Hospital.
• Women giving birth in smaller hospitals are more likely to have a vaginal birth than those giving birth in larger hospitals.
• You will have access to epidural anaesthesia if required.
• If a complication arises you will not have to transfer to another setting.
• If something does go unexpectedly and seriously wrong during the labour, you and your baby will have immediate access to specialised care.
• You will have access to postnatal care and advice 24/7 whilst in hospital.

Disadvantages of standard care in a Public Hospital

• You will not know the midwife who provides most of your care during labour.
• Each midwife will have a slightly different set of values and preferences for providing care during labour and birth.
• Your midwife will leave when her shift ends and another midwife will take over your care.
• Hospitals are work environments and you may have limited control over the space in which you labour, including the degree of privacy, darkness, noise, warmth and access to warm water.

• There may be limited support for you to use a bath for pain relief or during the birth.
• Your partner will most likely be unable to stay the night with you after your baby is born.

Women who had standard hospital care in a public or private hospital, had a decreased likelihood of experiencing the following, when compared with Birth Centre or Midwifery-led Care:

• a spontaneous vaginal birth;
• breastfeeding at six to eight weeks;
• very positive views of care (Sandall et al. 2013 link).

Women who had standard hospital care in a public or private hospital, had an increased likelihood of experiencing the following, when compared with Birth Centre or Midwifery-led Care:

• a preterm birth;
• requiring an intravenous drip of artificial oxytocin to speed labour up;
• requiring an epidural or other drugs during labour;
• requiring vacuum or forceps assistance with the birth;
• receiving an episiotomy (Sandall et al. 2013 link).

Advantages of care in a Private Hospital

• If you have private health insurance, your health fund will cover the majority of the obstetric and hospital charges.
• You are able to choose your doctor based on how good a 'fit' her/his values and attitudes are with your own. Your level of trust in your doctor is relatively high because of this, and s/he will know your birth preferences in detail;
• You will have access to epidural anaesthesia if required;
• If a complication arises you will not have to transfer to another setting;
• If something does go unexpectedly and seriously wrong during the labour, you and your baby will have immediate access to specialised care;
• If you have a normal birth, you might be eligible to have your postnatal care provided in a 4-5 star hotel;
• You will have access to postnatal care and advice 24 / 7 whilst in hospital;
• Your partner is generally able to stay the night with you after your baby’s birth.

Disadvantages of care in a Private Hospital

• This model of care is only available to women who have maternity care covered by their health insurance fund or who are willing to pay the full fee;
• Most women experience a significant ‘gap’ between the charges made by their private obstetrician and the fees covered by their private health fund;
• Due to demand for private obstetric care by specific doctors, you may not be able to book in with the doctor of your choice;
• Most private obstetricians will require a significant financial investment by 24 weeks. This can make it difficult for women to feel able to change their caregiver if the partnership is not working out;
• Women giving birth in Private Hospitals are less likely to experience a normal vaginal birth and more likely to experience intervention than women in Public Hospitals, including a caesarean section (Hodnett et al. 2013 link; Sandall et al. 2013 link;);
• You will not know the midwife who provides most of your care during labour;
• Your midwife will leave when her shift ends and another midwife will take over your care;
• Each midwife will have a slightly different set of values and preferences for providing care during labour and birth;
• Hospitals are work environments and you may have limited control over the space in which you labour including the degree of privacy, darkness, noise, warmth and access to warm water;
• There may be limited support for you to use a bath for pain relief or during the birth.

Hodnett ED, Downe S, Walsh D. (2012). Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub4. (Link)

Sandall, J., Soltani, H., Gates, S. et al (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 8. (link)