Private obstetrician versus public

Pregnancy brings with it a lot of decisions. Before you’ve even had the baby, people will ask if you’re planning to breastfeed. They’ll want to know what names you’ve chosen, what you’ll be doing about going back to work, how you’ll manage childcare. But the most common question you’ll be asked is this: “Are you going private?”

A private obstetrician is just one of the birth care models available in Australia (see Cost of Pregnancy for others), though statistics suggest that around one third of women choose the care of a specialist obstetrician for their birth. Dr Andrew Foote, executive and spokesperson for the National Association of Specialist Obstetricians and Gynaecologists, suggests the reason so many women are willing to pay for their pregnancy and birth care is simply continuity of care.

“It’s the main issue,” he says. “Do you want to know the obstetrician who will be at the birth” Roughly a third of women will need no assistance whatsoever – they’ll come in and have their baby and it will be straightforward. But for two-thirds, there will be a need for intervention – the question is, who will do the intervention?

When you choose a private obstetrician, you know that the person who has monitored your pregnancy throughout will also be the doctor at the end of the bed if you require intervention during labour. “If you’re in that two-thirds, you know the doctor and you know that he or she is experienced,” says Foote. “If you go through the public system, you’re likely to have a training registrar who you haven’t met and who is less experienced.”

It all sounds very seductive when you’re facing the unknown quantity of labour, but it comes at a price. And it’s a price that’s recently increased. According to a report in The Daily Telegraph in September 2010, a cap, levied in January 2010, on Medicare safety net payments for IVF treatments and for women who use private obstetricians, meant that out-of-pocket costs to see an obstetrician have increased.

So what does it cost to see a private obstetrician?

“Out of pocket expenses vary enormously,” says Foote. “It can be anywhere from $1500-$8000. It’s very market driven – in Sydney and Melbourne the costs are higher.”
For this reason, he recommends asking about costs before you even make an appointment. “I recommend that you ring the office and ask about costs,” he says.
Don’t be embarrassed, you won’t be the first and – as Foote admits – it can be an issue. “Private obstetrics is not cheap,” he says. “The main reason for that is that we pay a lot of medico-legal insurance – around $70,000-$100,000 a year.”

Experienced doctors, who tend to be older, may be more expensive. “They put their prices up to make themselves less busy,” says Foote.

What other questions should I ask up front?

Ann Robertson, spokesperson for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, suggests the following:

• What services the obstetrician provides
• When he or she will be on holidays
• Who covers the births when the obstetrician is unavailable.

Foote agrees, adding that it’s also important to find out the doctor’s attitude toward “normal birth and intervention”.

“If you’re seeing someone who thinks that a ‘normal birth’ should be pursued in all circumstances, and you’re scared of labour and hope to have an elective caesarean section, you’re in the wrong place,” he says. “Ask up front.”

It’s also important that you ask your Private Health Insurance provider some questions to ensure you’re covered.

How do I find a good private obstetrician?

Robertson suggests that you first decide on the hospital at which you want to give birth. “Ask them for a list of obstetricians who have delivery rights at that hospital,” she says. “That will give you a starting point.” Check to make sure your private health insurance provider also covers that hospital before you begin.

Once you have a list, it’s up to you to do some research. “The best way is usually word of mouth recommendation,” says Foote. “Generally people ask their friends and family. It’s mostly based on personality – did they get on with their doctor, and feel at ease.”