Not everything in life goes to plan, and the birth of your baby is no exception. But you can have control over what type of care you receive during your pregnancy.
The decision about how and where you want to give birth is very personal and you may consider advice from family, friends and social media, your own experiences with previous births, the location of hospitals, and, of course, whether or not you have health insurance with pregnancy cover.
In 2013, about 300,000 women gave birth in Australia; the vast majority – 97% – in a hospital, 2% in birth centres, and a small number at home or on the way to hospital. Of the mothers who delivered in hospital, 70% were a public patient and 30% a private patient.
Public vs private care for pregnancy and birth
In Australia, doctors in private and public hospitals alike provide high quality care for pregnancy and birth. The main advantage of going private is that you can choose the obstetrician who cares for you during your pregnancy and attends the birth.
However, this may not be the best option for you if you prefer a natural birth. The statistics are pretty clear on this: there are more 'natural births' (non-instrumental vaginal births with or without analgesia) in public hospitals and more caesareans and other types of interventions such as delivery by vacuum suction in private hospitals.
Birth in public vs private hospital - the stats
Source: AIHW. Women who gave birth in 2013.
|| Public (%)
|| Private (%)
| Normal vaginal birth
| Vacuum suction
Choosing the right obstetrician for you
Contrary to popular opinion, obstetricians do not get paid more for a caesarean than a natural birth. While a very busy obstetrician may find it easier to make sure that they can attend the birth by scheduling a caesarean, interventions may also be the choice of the mother.
"I had my first three babies in a private hospital with my own obstetrician," says a CHOICE member. "I liked the fact that the doctor took factors that concerned me, including hubby having to go away with work, into consideration and induced me on two occasions."
It's important to choose the right obstetrician for the type of care you want: ask about their rate of interventions, particularly caesareans. "There can be a variation of between 20% to 70% of the rate of caesareans between the specialists in one private hospital," says Dr Andrew Pesce, Obstetrician at Westmead Hospital in Sydney.
Giving birth in a public hospital as a public patient
- Lower rate of interventions and higher rate of natural births.
- Only very small, if any, out-of-pocket costs.
- Usually better facilities if you have a high-risk pregnancy or a sick or premature baby.
- Some hospitals have birth centres or midwife programs, where you can get more personalised care with your own midwife. Book in early, these programs are very popular.
- You often don't know the doctor and midwives attending your birth and may see a different doctor/midwife each time.
- Food and facilities may not be as nice as in a private hospital.
- You often have to share a room with other mothers and their babies.
- You may be cared for by junior doctors, who will call in a specialist when needed.
Giving birth in a private hospital as a private patient
- Continuity of care with your own obstetrician and their midwives during your pregnancy.
- Food and facilities may be nicer than in a public hospital.
- Better chance of getting a private room and your partner may be able to stay with you.
- Higher rate of interventions and lower rates of natural births.
- High out-of-pocket-costs.
- Your obstetrician may be on leave or may not make it in time for the birth. You usually won't know the midwives who attend your birth and provide postnatal care.
- If your baby or you need intensive care you may need to be transferred to a public hospital.
- Doctors and anaesthetists are often not on site but have to be called in. While they'd usually get there within 30 minutes this can be a disadvantage in an emergency. Some public hospitals also have staff available on-call, after hours, rather than on site.
Tip: Some public hospitals may encourage you to use your private hospital cover as a public patient without any cost to you – while there is no difference in your medical care, you may have a better chance of getting a private room.
How much does it cost?
If you go to a public hospital as a public patient, you would normally be fully covered by Medicare. But out-of-pocket costs could arise for:
- shared care with a GP who doesn't bulk bill,
- scans or pathology outside of hospital,
- childbirth classes.
Even if you have private health insurance, large and sometimes unexpected out-of pocket costs can arise for private care. "We have top cover and were out of pocket about $4500," Lisa told us on Facebook.
Health funds are not allowed to cover out-of-hospital care. Therefore, each time you visit your obstetrician, you may have out-of-pocket costs. The amount depends on if and how much they charge above the Medicare Scheduled Fee. The largest cost may be the pregnancy management fee, usually between $3000 and $5000. There are also caps on fees covered by the safety net, so even if you have already met the safety net, you could still be out of pocket. See our report about avoiding out-of-pocket costs.
According to health insurer BUPA, out-of-pocket costs as a private patient for uncomplicated pregnancy and birth can range from $1725 to $7392 in a private hospital and only slightly less in a public hospital.
For more about private health insurance see our hospital insurance review.
Ways to cut down on the costs
- Check with your health fund for an obstetrician who uses the fund's gap scheme for the birth and would attend to you in a hospital that has an agreement with your health fund.
- Use shared care with a GP who bulk bills. How to find a GP.
- Ask your obstetrician to detail all costs beforehand.
- Consider being a private patient in a public hospital. It's less likely that you'll have unexpected out-of-pocket costs for blood test, x-rays and ultrasounds, anaesthetist and paediatrician.
Health insurers clamp down on new mums
Health insurance is one of the things you need to think about well ahead of time if you're planning to have a baby. After all, the last thing you want to worry about during a sleepless night is an expensive hospital bill. See our health insurance buying guide.
The Private Health Insurance Ombudsman has warned expectant mothers of situations that could affect their policy cover, including premature births and early hospital admission. The Ombudsman says that while insurers used to be flexible if a baby was born early, this rarely occurs now.
Parents should be aware:
- There will be a 12-month waiting period: If possible, take out a policy well ahead of getting pregnant.
- The waiting period applies to the date you're admitted to hospital for the birth.
- You won't be covered if you have a premature birth within the waiting period or even if you give birth only a few days before the end of the waiting period.
- Mothers have been given the wrong advice by health insurers and expected they would be covered as long as the waiting period was served by the expected date of the birth of their baby.
Different rules for baby
So that your baby is covered you need to upgrade your policy to a family policy. If you have a normal birth and your baby is healthy, they usually won't get admitted to hospital, so you may not need cover for them.
But if your baby is born early, has any health issues or you have twins, they may need to get admitted to the special care nursery or intensive care. This can cost thousands of dollars.
Tip: If you are a private patient in a public hospital and your baby needs to be admitted, you can usually choose if you want them to be a private or a public patient.
Parents should be aware:
- Most funds require that you update your policy to a family policy one to three months before the birth of your baby.
- Some funds may require you to upgrade your policy as early as 12 months prior to birth.
- Children are covered for free: family policies are not more expensive than couple policies. However, if you're a single parent you will pay more for a single parent policy than for a single policy.
- Look for a policy that does not charge an excess for your baby, many insurers offer policies that only charge the excess for adults.
- Look for a top cover private health insurance policy that does not apply the excess to children.
- Take out private health insurance well ahead of getting pregnant.
- Check with your health insurer how soon you need to upgrade to family cover so that your baby is covered.
- Once you're pregnant, check whether you have served the waiting period.
- If you give birth before the waiting period is up, consider going to a public hospital as a public patient. Don't worry, Australia has a world-class health system and public hospitals have excellent birthing facilities.
'Mothering' the mother – midwives and doulas
Let's face it, giving birth can be a pretty overwhelming experience and in a busy labour ward, your midwife may have to care for more than one mother at the same time. So an extra support person to look after you and your partner could come in very handy. Such care can be provided by a doula.
A private midwife can also provide pregnancy care sometimes under an agreement with an obstetrician and in some states may be able to attend births in hospital, birth centres and at home. Both models of care are associated with a lower rate of interventions.
- Care by a midwife could cost between $3000 and $6000. Depending on the whether the midwife is endorsed by the Nursing and Midwifery Board, under some circumstances Medicare and some private health funds may pay part of the cost. It's important to check with the midwife beforehand.
- A doula does not provide medical services but can provide extra support during your pregnancy and birth. A doula can help you and your partner to prepare for the birth process and offer relaxation techniques such as massage to help you during labour. They also usually visit you after the birth and can help with a debrief and referral to other services, for example if you have problems with breastfeeding. Depending on experience and level of service provided, costs usually range from $800 to $2000. Doulas do not qualify for a Medicare or health fund rebate. For more information contact australiandoulacollege.com.au.