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Public vs private hospital debate
Just some interesting stats on public vs private


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#76 PrincessPeach

Posted 09 July 2013 - 12:33 PM

QUOTE (soontobegran @ 09/07/2013, 12:27 PM) <{POST_SNAPBACK}>
I think it needs to be said that private obstetricians don't all give away interventions on request.


This is very true actually.

When I went to visit my GP after my BFP she asked me straight up if I wanted a c-section or not, because that would determine which Ob she would recommend to refer me to.

#77 Prancer is coming

Posted 09 July 2013 - 12:40 PM

Personally, I would choose private.  I have birthed 2 privately and 1 public, but only went public as there was no other option where we were living at the time.  Whilst it was fine, I liked my private experience better.  I loved my ob, who was also very skilled and willing to do a breech birth when that was a potential issue.  Whereas the public hospital (who had an ob visit ONCE a month) would have shipped me off 2500kms away if I wanted to attempt it.

All 3 of my births were drug (including gas) free and intervention free.  I did have an episitomy at the private hospital, but also had a shoulder dystocia emergency so I figured this was warranted.  I even managed a natural third stage with no injection to help the placenta come quicker in the private.  And funny enough, the ob had to talk the midwife through it as she had never done one before.

I discovered later that it was really uncommon for people to have non drug and intervention births in my hospital.  Personally, I never had anyone pushing drugs or interventions.  So I figure there was a genuine need or preference for people that had these things.

I also had a friend swap to private as the public hospital would not let her have a Caesar.  So agree with people making choices based in their preferences.  But in my sample size of one, I could not have been happier with my private care and it certainly assisted me to have natural births.

#78 angelinaballerina

Posted 09 July 2013 - 12:45 PM

I have had 2 public births and will not hesitate to have another if the need arises.

Both times I had a private room - the hospital I go to only has 1 room with 4 beds, every other room on the floor was private with own bathroom.

I was encouraged to stay as long as I liked after both my c-sections. 1st birth I was in 5 nights, 2nd birth was 3 nights. But both times asked if I wanted to stay another - I was happy to go home.

The visiting midwife came 3 times after each birth to check both baby and myself (she was really lovely).



In saying all this, if I was not able to attend the public hospital of my choosing I would go private. However - not a lot of people realise that they get a choice with public. I found it very interesting to know that you can 'demand' to be transferred to which ever public hospital you like as long as there is a reason. So I made sure my GP referred me to the one I wanted rather than the closest to my residential address. I also requested to have all my OB appts on the same day each fortnight/month and I had the same OB each visit. She didn't perform my delivery, but I had a lovely surgeon who visited me the next day to ensure I was doing ok.

#79 Mumsyto2

Posted 09 July 2013 - 01:20 PM

QUOTE (soontobegran @ 09/07/2013, 11:16 AM) <{POST_SNAPBACK}>
Private hospitals do not have medical staff on site 24/7.

Some do to a degree.
The private hospital I used pretty much does  In addition to the many working there regular hours or as patients need them, an anaesthetist (experienced in epidurals) is physically located in the hospital 24/7 and also a general surgeon is physically located within the hospital 24/7. They also provide the committment that you will have an ob and paed not only on site but in the OT within 20mins should it be required & your chosen ones cannot get there quickly enough.

I have tested this and they were true to their word. Both times I requested an epi I had someone there within 5mins even though completely out of hours. Another time I had a sick child in the kids ward at that hospital and the on call anaesthetist had to attend to replace a line, there within 5mins. Whilst they were there a woman wanted an epi and as they were having issues with my child they said to call x in. I said they should go do the epi and come back as we probably all needed a break anyway but they said it's okay, x was on call and would be there in 15 tops. Another anaesthetist also has to be on call to attend within 20 mins in case the on site one is in theatre (for instance if an appendix comes via ED in the middle of the night and they are in theatre with the on-site general surgeon). Apparently they have some policy regarding real estate around the hospital of which the hospital owns a substantial amount - they sell to relevant Dr's only and have a buy back option to keep the cycle going so distance/traffic are never an issue with people on call.

I also had an ob at my bedside out of hours within 10mins when something went amiss and they went to theatre to scrub (thinking I would need an immediate CS) whilst my own ob was making their way in. Same deal with paeds and to be honest at times you would get a response within the same timeframe and no quicker from on site people within the public system dependant upon workload and how many crises there are at any one time. This hospital did not have a L1 SCN though, L2 only.  It's all of these things you toss around when making decisions on what is best for your personal situation and the decisions will differ between individuals according to priority of 'wants'.

To me the main benefit of going private, apart from continuity of care with my ob, was the guarrentee of a private room, ability for DH to room in if we wanted, ongoing availability of LC if required, and length of stay as extended length of stay in the public system is often dependant upon bed avalability not whether the mum feels up to it, has established positive breastfeeding etc. Some people may actually prefer going home the same day and in this case many of these reasons would be redundant for them. I have known people who have been forcibly discharged after 48hrs in public hospitals due to bed availability and a few of those have returned via ED with complications which i find quite frightening.

Edited by Mumsyto2, 09 July 2013 - 01:30 PM.


#80 vanessa71

Posted 09 July 2013 - 01:20 PM

I went private both times as I wanted to have elective Caesars and didn't like my chances of having this done in the public system. Besides, I hadn't been paying PHI for years not to use it.

I think it was well worth the $80 I was out of pocket for my 5 day (x2) hospital stay.



#81 jules77

Posted 09 July 2013 - 01:21 PM

QUOTE (soontobegran @ 09/07/2013, 12:27 PM) <{POST_SNAPBACK}>
I think it needs to be said that private obstetricians don't all give away interventions on request.


Exactly! I started to get anxious at about week 37 of my second pregnancy and asked my Ob if a c-sec would be a better idea.

He answered "you would never 'want' a c-sec Jules, especially when you have given birth vaginally before".

My Ob was so pro-natural birth that I remember begging him to break my waters during DS2's labour just so I could get things over with.

I don't even know why this question gets debated.

You choose the care that suits you and your family best.

There's never, ever going to be one mode of care that is superior for all women.

Edited by jules77, 09 July 2013 - 01:23 PM.


#82 Bethlehem Babe

Posted 09 July 2013 - 01:28 PM

I doubt any private hospital could match my experience with my local country public hospital.  Both births I was the only patient on the ward.  Three weeks ago, I had the NUM, a midwife and two student midwives looking after me... Better than one on one care!
I can't comment on the birth outcomes but loved they supported my vbac attempt, and debriefed me afterwards.

#83 seayork2002

Posted 09 July 2013 - 01:33 PM

I had my son in the UK so cannot comment on hospital here but from my experience and what I know they have a very similar set up. I never considered going private as I assumed if women could successfully give birth at home then there what was the point in going private, I did not care who delivered my baby (as in I did not feel I needed to have met the person before) and as women have been giving birth (mostly successfully) for thousands of years I could not see what on earth a private hospital could give me over public, I did not want a home birth myself but I was happy to go to my local hospital and just have my baby.

It turned out I was induced and from the time I was induced to the time I left with my baby was about 18 hours altogether anyway so I was happy with this.


#84 Soontobegran

Posted 09 July 2013 - 01:50 PM

QUOTE (Mumsyto2 @ 09/07/2013, 01:20 PM) <{POST_SNAPBACK}>
Some do to a degree.
The private hospital I used pretty much does  In addition to the many working there regular hours or as patients need them, an anaesthetist (experienced in epidurals) is physically located in the hospital 24/7 and also a general surgeon is physically located within the hospital 24/7. They also provide the committment that you will have an ob and paed not only on site but in the OT within 20mins should it be required & your chosen ones cannot get there quickly enough.


There are a couple of private hospitals around here which have an ER. These will have a doctor on site 24/7 but these are a rotation of local doctors, none of them are obstetricians in practice. There is a intensive care doctor working on rotation as there are ICU/CCU's but these hospitals are unique.
They have a 30 bed maternity unit also which is only serviced by private obstetricians whom are often there on and off  from early morning to late at night in clinics and theatre but once the lists are finished, patients are visited they are off home to wait for the calls to come back in.

There is no anaesthetist or obstetric caregiver and whilst there is always one on call and within 20 minutes away, the only person responsible for the patient is their own doctor unless they have pre arranged someone to cover for them.

I think most decent private hospitals do try to provide the correct medical support within moments from the hospital but suffice to say it doesn't always work that someone can get in there. sad.gif
I had one DD who waited 2 hours for an epidural and I waited for over an hour.
Having said that this happens in public too when resources are stretched way beyond available anaesthetists, theatres, obstetric staff too.

#85 seepi

Posted 09 July 2013 - 01:54 PM

After birth care is important for more than just comfort and reassurancve and breastfeeding.

My public birth was awful and then my DD was ill afterwards. But I virtually never saw a midwife and when I buzzed for one after baby was throwing up red and green and hadn't fed since birth she just brushed me off and left again.

DD was critically ill and we were ignored. I am another that has never really got over my experience in public hospital.

#86 Lou-bags

Posted 09 July 2013 - 01:57 PM

QUOTE (soontobegran @ 09/07/2013, 10:27 AM) <{POST_SNAPBACK}>
shrug.gif I am not so sure about this.
I do not think that the decision to be a private patient is made because a woman wants intervention.

She invariably wants choice of doctor, choice of private room and choice of staying longer than 24 hours.

I think it needs to be said that private obstetricians don't all give away interventions on request.


I agree with this.

I am going private for my first baby. My reasons are exactly those- that I wanted continuity of care (having someone I can trust is REALLY important to me, and I can't trust someone I don't know), private room and choice to stay longer.

That and because I want to AVOID interventions. I figured if I could find a private OB who is supportive of my birthing choices, who knows me and how I feel about the different interventions, that I would be less likely to be pressured into any decisions.




#87 Awesome101

Posted 09 July 2013 - 02:00 PM

You cant just compare Public to private, this area to that area. Its down to individual experience verses individual experience.

I have birthed both as a private patient in a public hospital and in a private hospital. The birth and midwife care in the private hospital was SHOCKING but everyone else I know who went to this hospital had a great experience. My public hospital birth was fantastic, great birth, clean private room, excellent midwives. I'm going again for this baby but its been 7 years - the midwives may be different. I'll just have to take it as it comes.

#88 PooksLikeChristmas

Posted 09 July 2013 - 02:07 PM

Wow people could stay longer than 2 nights in public? People stayed on longer for BFing support? I've never heard of that happening. We were told from the outset it was 2 nights max unless you had a c-sec.

FWIW no one ever checked my stitches either, I read here on EB about people having 6 week checks and so asked my GP to check them for me. Was that something the visiting nurses did for others?

By home visits, what do you all mean? I had a Dom nurse come after our first night home for about 1/2hr to weigh baby and when I was asking about feeding issues she said to bottle feed till the LC saw us in a few days. She drew up a chart of how much milk he should be having and that was about it. But it was actually the most time any midwife had spent with me til that point.

The MCHN came a couple of days later, had a look at the bassinet and my house, weighed baby, and congratulated me on having a "natural birth". No bfing support, no mention of my healing, she just wanted to make sure the baby was alive and well and I didn't have a drug lab in the bathroom, presumably.

There is obviously some big diversity of experience here.

#89 Wigglemama

Posted 09 July 2013 - 03:03 PM

Pooks, it's got to be said. Your hospital experience and postnatal care sounds absolutely shocking. I can actually understand your anger because my core belief as a midwife is that I look after women the way I would to be treated and the way I would like my daughters to be treated. Definitely not the way you were treated and if I found out a woman was demoralised by the care I gave, I would be shattered. Absolutely heartbroken.

As you can see, many women have had varying experiences in both private and public systems. Neither system should be tarred with the same brush. The benefits of both are very clear though. You can get some choice with both or get locked into a fight with hospital policy, staff shortages and inappropriate care with both.

It is unfortunate that many women don't trust the public system but my belief is that public maternity units are trying to evolve into care that is woman centred and focuses on patient rights above everything. However, funding will always be a hurdle and the biggest flaw in the public system. If the money is not there to spend, then the public system will need to prioritise where the money goes. I agree it sucks.

Edited by Wigglemama, 09 July 2013 - 03:05 PM.


#90 seepi

Posted 09 July 2013 - 03:06 PM

some people rave about our public hospital, others despise it. (as did I). I've decided it comes down to how busy they are.

In peak times the 4 bed rooms are always full and they are hustling people out asap. also midwives are practically never sighted except in an emergency - noone check my stitches and i was there a week. (baby in special care).

But a friend was there over xmas when it was quite empty and had amazing care - a special private room, midwives took the baby overnight when he cried etc.

I thinks our is actually ok, except when busy (relatively often), when they are abysmal.

#91 Soontobegran

Posted 09 July 2013 - 03:11 PM

QUOTE (Pooks*potters @ 09/07/2013, 02:07 PM) <{POST_SNAPBACK}>
Wow people could stay longer than 2 nights in public? People stayed on longer for BFing support? I've never heard of that happening. We were told from the outset it was 2 nights max unless you had a c-sec.

FWIW no one ever checked my stitches either, I read here on EB about people having 6 week checks and so asked my GP to check them for me. Was that something the visiting nurses did for others?

By home visits, what do you all mean? I had a Dom nurse come after our first night home for about 1/2hr to weigh baby and when I was asking about feeding issues she said to bottle feed till the LC saw us in a few days. She drew up a chart of how much milk he should be having and that was about it. But it was actually the most time any midwife had spent with me til that point.

The MCHN came a couple of days later, had a look at the bassinet and my house, weighed baby, and congratulated me on having a "natural birth". No bfing support, no mention of my healing, she just wanted to make sure the baby was alive and well and I didn't have a drug lab in the bathroom, presumably.

There is obviously some big diversity of experience here.





Yep, evidence of a huge variation in levels of care. It isn't right and I have no idea what it would take to fix it.
There are some public hospitals where people want to work, the bend over backwards to get a job there and that will very often impact the type of care the patients get.
Unhappy hospital, rubbish management, funding issues equal terrible patient satisfaction and poorer outcomes.
Pooks, there are public patients who do not get discharged if they are not well or not managing well at some places. Sometimes an effort to get an extra day but most definitely not everyone goes home after 2 nights.

#92 Soontobegran

Posted 09 July 2013 - 03:12 PM

QUOTE (Pooks*potters @ 09/07/2013, 02:07 PM) <{POST_SNAPBACK}>
Wow people could stay longer than 2 nights in public? People stayed on longer for BFing support? I've never heard of that happening. We were told from the outset it was 2 nights max unless you had a c-sec.

FWIW no one ever checked my stitches either, I read here on EB about people having 6 week checks and so asked my GP to check them for me. Was that something the visiting nurses did for others?

By home visits, what do you all mean? I had a Dom nurse come after our first night home for about 1/2hr to weigh baby and when I was asking about feeding issues she said to bottle feed till the LC saw us in a few days. She drew up a chart of how much milk he should be having and that was about it. But it was actually the most time any midwife had spent with me til that point.

The MCHN came a couple of days later, had a look at the bassinet and my house, weighed baby, and congratulated me on having a "natural birth". No bfing support, no mention of my healing, she just wanted to make sure the baby was alive and well and I didn't have a drug lab in the bathroom, presumably.

There is obviously some big diversity of experience here.





Yep, evidence of a huge variation in levels of care. It isn't right and I have no idea what it would take to fix it.
There are some public hospitals where people want to work, the bend over backwards to get a job there and that will very often impact the type of care the patients get.
Unhappy hospital, rubbish management, funding issues equal terrible patient satisfaction and poorer outcomes.
Pooks, there are public patients who do not get discharged if they are not well or not managing well at some places. Sometimes an effort to get an extra day but most definitely not everyone goes home after 2 nights.

#93 Soontobegran

Posted 09 July 2013 - 03:12 PM

dp

Edited by soontobegran, 09 July 2013 - 03:15 PM.


#94 Brownbear

Posted 09 July 2013 - 03:18 PM

.

Edited by Brownbear, 09 July 2013 - 07:30 PM.


#95 merleauponty

Posted 09 July 2013 - 03:54 PM

I'd loved to have gone public. Who wants to spend that much money on OB fees?

However, I really wanted continuity of care. And this is simply not offered at my local, large, inner-city hospital.  

That was the only factor in my decision. I didn't anticipate how much I relied on a 5-night hospital stay to establish BF (no supply issues but traumatised nipples). My local public hospital has a maximum 2-night stay; although
as I had a CS for breech I suppose that even there I'd get to stay longer(?).  

My friends are mostly lefty yoga-loving feminists - as am I - and I feel quite uncomfortable IRL owning up to a private-hospital birth! Having said that, a number of them are reneging on their principles for birth no.2 due to birthing in a system that was experienced as overloaded.

#96 Datrys

Posted 09 July 2013 - 04:40 PM

I think there's a perception - and certainly all of my interactions have backed it up - that the public system has an agenda.  Low intervention, low pain relief, fully breastfeeding, all of that = success.  Never mind the wishes of the mother or how she copes with it.  Whereas the perception is that the private system is not as quick to push that agenda, and more willing to work with the mother where she's at.  (She who pays the piper...?)

I'm very conflicted about the term "woman centred."  It sounds nice in theory, but that pesky agenda seems to keep interfering with it becoming reality.  Unless of course you ditch the hospital system completely, which is a whole other set of problems.


#97 Jobrielle

Posted 09 July 2013 - 06:48 PM

Can't fault my care with both girls. One born in a regional nsw town, public hospital, normal vaginal delivery, had my own room and was kept in for 7 nights ( until I refused to stay any longer) trying to establish breastfeeding. She was delivered by my gp, who is also an obstetrician as I was doing shared care. Bub had jaundice and was seen by the pediatrician every day, and a few times after discharge. All free and excellent care. Dd 2 was born in Sydney, major tertiary public hospital, normal vaginal delivery after gestational diabetes and pre eclampsia. Was allowed to go into labour myself despite this, shared a room with one other person after birth. Kept in 4 nights. All free again. My experience with public was second to none.

#98 lucky 2

Posted 09 July 2013 - 06:50 PM

QUOTE (Pooks*potters @ 09/07/2013, 02:07 PM) <{POST_SNAPBACK}>
Wow people could stay longer than 2 nights in public? People stayed on longer for BFing support? I've never heard of that happening. We were told from the outset it was 2 nights max unless you had a c-sec.

FWIW no one ever checked my stitches either, I read here on EB about people having 6 week checks and so asked my GP to check them for me. Was that something the visiting nurses did for others?

By home visits, what do you all mean? I had a Dom nurse come after our first night home for about 1/2hr to weigh baby and when I was asking about feeding issues she said to bottle feed till the LC saw us in a few days. She drew up a chart of how much milk he should be having and that was about it. But it was actually the most time any midwife had spent with me til that point.

The MCHN came a couple of days later, had a look at the bassinet and my house, weighed baby, and congratulated me on having a "natural birth". No bfing support, no mention of my healing, she just wanted to make sure the baby was alive and well and I didn't have a drug lab in the bathroom, presumably.

There is obviously some big diversity of experience here.

This sounds familiar pooks, very Melbourne IME.
Except the bit about not having proper post natal observations.
In answer to your questions, the MCHN doesn't assess perineums/healing, you get that done at the GP 6 week check up.
Other than that it should (at least be offered or questions asked re comfort, discharge, colour) be the MW in the hosp and the Dom MW who does this.
You can also be advised on how to monitor healing and identify if there is a problem, there is often an emphasis on patient involvement with care, and you are out of the hospital so quick that I can see why this is important.
One dom visit, unfortunately too common for Melb, insufficient in some cases, perfect or even "too much" for some women.
MCHN should have enquired about feeding and offered assistance, that assistance may have been to discuss LC resources in your local area or hospital or practical assistance with bfing. I would depend on her workload, your needs and the MCHN's skills. Many MCHN's have gained the IBCLC qualification to improve their ability to provide bfing support. Also many local councils now run a Breastfeeding Clinic.
I've heard that the Hosp you went to has a good Bfing clinic, I hope that was true for you.

#99 Tigerdog

Posted 09 July 2013 - 06:53 PM

I agree OP, so resentful of the push to get people to take out private health insurance when it's no guarantee of getting any better treatment anyway.  If there's no private room available when you happen to go into hospital for any reason then too bad, you don't get it so you're paying for nothing, really.  The only time PHI is useful is if you've got a chronic health condition requiring frequent hospitalisation, this is the case with my sister, she has an attendant specialist providing ongoing care who always gets her into a private hospital when required.

Edited by Tigerdog, 09 July 2013 - 06:55 PM.


#100 Tigerdog

Posted 09 July 2013 - 06:58 PM

QUOTE (Saecularis Angelus @ 09/07/2013, 04:40 PM) <{POST_SNAPBACK}>
I think there's a perception - and certainly all of my interactions have backed it up - that the public system has an agenda.  Low intervention, low pain relief, fully breastfeeding, all of that = success.  Never mind the wishes of the mother or how she copes with it.  Whereas the perception is that the private system is not as quick to push that agenda, and more willing to work with the mother where she's at.  (She who pays the piper...?)

I'm very conflicted about the term "woman centred."  It sounds nice in theory, but that pesky agenda seems to keep interfering with it becoming reality.  Unless of course you ditch the hospital system completely, which is a whole other set of problems.


Opposite IME, I was whisked in for c-sections with both my kids in the public system with no real reason I could see - whip 'em in and out according to the schedule of the hospital rather than allow more time for nature to take its course.  I would say they actually err on the side of more intervention, ie. after having my first they wouldn't let me go past my due date with my second due to risks so booked me in for a c-section a few days before my due date.




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