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Elective caesarean in public hospital


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#1 Gracey1712

Posted 16 July 2019 - 06:48 PM

Hello everyone,

Can I have an elective caesarean in a NSW public hospital?

I’ve been looking on internet for days trying to find an answer to my question, I can’t find a clear answer.

I did sign up for private cover as they all said on their website out of pocket cost would be $500 for a caesarean. Only now once I’m early pregnant I find this is not the case if I go private. Total out of pocket cost likely to be at least $10,000 which I cannot afford.

I have always had bad anxiety and now my anxiety is through the roof worrying about having a vaginal birth. I know so many people who have had awful experiences and I mean long term bad effects from vaginal births two are now in continent! Some have a had forceps birth with major tears. I can not deal with that.

I’m already slightly in continent when I run or occasionally when I laugh so don’t want it permanently after a v birth.
I am certain I want a c section. I want to enjoy my pregnancy and not be dreading birth the whole time.
This is my first pregnancy.

Has anyone requested an elective c section in an Australian public hospital?

How did the doctor and midwife respond?

Please can I ask people not to try and talk me out of c section and respect my opinion.

I have read and researched safety of c sections including journal articles. I know people who have had them and had excellent experiences and recovery. I know there are risks. I am making an informed decision.

Many thanks in advance.

#2 Mumma bug

Posted 16 July 2019 - 07:00 PM

My sister had a planned c section in a public hospital. She wasn’t incontinent but had a history of urithary issues (surgeries to widen her urethra I think) and recurrent UTIs. The obstetrician she first saw in hospital recommend a c section to decrease her risk of becoming incontinent. I would explain your previous history at your first midwifery appointment.

Edited by Mumma bug, 16 July 2019 - 07:00 PM.


#3 JomoMum

Posted 16 July 2019 - 07:11 PM

I will be having one at the end of the year.

I’ve only met with the midwife so far, but she advised it would be no issue given my history. They’ve got my medical records etc.

I sustained a nasty, albeit small, prolapse after my son’s assisted vaginal birth 6 years ago. It required surgery 2 years later after conservative treatment was insufficient.

My Gyno was very clear that it would not withhold another vaginal birth, so c section it is.

#4 QuirkyMum

Posted 16 July 2019 - 07:23 PM

Prolapse/severe damage to pelvic floor muscles/incontinence can also happen if you have c-section because your pelvic floor muscles carry some 4-7 kilos for months... How heavy baby gets and how much amniotic fluid you have are contributing factors so eating healthy and not putting on weight helps.
If you are prone to it, there isn't much you can do. But you could invest into seeing pelvic floor physio ( starting now) and doing exercises throughout the pregnancy.

#5 Summer81

Posted 16 July 2019 - 07:25 PM

View PostQuirkyMum, on 16 July 2019 - 07:23 PM, said:

Prolapse/severe damage to pelvic floor muscles/incontinence can also happen if you have c-section because your pelvic floor muscles carry some 4-7 kilos for months... How heavy baby gets and how much amniotic fluid you have are contributing factors so eating healthy and not putting on weight helps.
If you are prone to it, there isn't much you can do. But you could invest into seeing pelvic floor physio ( starting now) and doing exercises throughout the pregnancy.

This. My obs and various midwives have all said the method of delivery doesn't really impact pelvic floor it's the pregnancy itself.

Edited by Summer81, 16 July 2019 - 07:26 PM.


#6 PocketIcikleflakes

Posted 16 July 2019 - 07:35 PM

As pp's say every pregnancy runs the risk of pelvic floor weakness which is usually best treated with physio however a rough or traumatic birth can cause damage as well.

I think a good Dr should be sympathetic to you though given how anxious you about this. There's both the physical and emotional sides to consider.

#7 skicat

Posted 16 July 2019 - 08:01 PM

Does your hospital have a Mother Baby Unit or outpatient mental health clinic to perhaps help you with the anxiety?
Anxiety around the birth experience is very understandable. An elective C/S might be an option.

#8 Lallalla

Posted 16 July 2019 - 08:27 PM

I was told it is the weight of the baby/s and the number of pregnancies that increase risk of incontinence - like when I had my twins their combined weight plus 2 placentas etc make me more susceptible.

Also I had an elective in a public hospital - but it was because the alternatives were emergency c-section or death as it turns out.

What I didn’t get from the OP was why you would be $500 out of pocket in a public hospital? Is that using a private obstetrician? In the public system you are fully covered by Medicare....

Edited by Lallalla, 16 July 2019 - 08:28 PM.


#9 JomoMum

Posted 16 July 2019 - 08:31 PM

View PostLallalla, on 16 July 2019 - 08:27 PM, said:

What I didn’t get from the OP was why you would be $500 out of pocket in a public hospital? Is that using a private obstetrician? In the public system you are fully covered by Medicare....

She was referring to private here.

#10 Hollycoddle

Posted 16 July 2019 - 08:33 PM

View PostLallalla, on 16 July 2019 - 08:27 PM, said:


What I didn’t get from the OP was why you would be $500 out of pocket in a public hospital? Is that using a private obstetrician? In the public system you are fully covered by Medicare....

I took it to mean she wanted to go fully private but the hospital costs were too much. More chances of being granted an elective if going private.

#11 rosie28

Posted 16 July 2019 - 08:35 PM

View PostLallalla, on 16 July 2019 - 08:27 PM, said:

I was told it is the weight of the baby/s and the number of pregnancies that increase risk of incontinence - like when I had my twins their combined weight plus 2 placentas etc make me more susceptible.

Also I had an elective in a public hospital - but it was because the alternatives were emergency c-section or death as it turns out.

What I didn’t get from the OP was why you would be $500 out of pocket in a public hospital? Is that using a private obstetrician? In the public system you are fully covered by Medicare....

You’d be $500 out of pocket in the private system for the excess perhaps? But that doesn’t take into account the OB’s management fee or any scans etc.

#12 Hollycoddle

Posted 16 July 2019 - 08:54 PM

View Postrosie28, on 16 July 2019 - 08:35 PM, said:



You’d be $500 out of pocket in the private system for the excess perhaps? But that doesn’t take into account the OB’s management fee or any scans etc.

The $500 might be what you're out of pocket for the surgery itself but the private hospital stay and, as you say, the other obs' costs is where the costs really stack up. Not to mention the anaesthesist fees which are separate again to the surgery itself.

#13 knottygirl

Posted 16 July 2019 - 09:47 PM

From what I have heard, it depends on the hospital and the doctor. Some pubic will let you others won’t. Prob depends how much money they have. I would be surprised if you could have an elective c section for first birth though with no history of any issues.  The push now is for natural births and minimising c sections. I knew people who had emergency c section for their first and their second they still weren’t granted an elective c section.

#14 cabbage88

Posted 16 July 2019 - 09:56 PM

This is why I didn't bother with private health. It's ridiculous how much you pay!
You might need to go to each hospital until you find one that will support you. But it will be hard- recent studies have shown c sections have a 5 fold increase in mortality than a vaginal. Doctors avoid it because they don't want to put any mothers life at risk for no reason, and in public there's a lot of pressure on elective cesarian lists. But some hospitals may choose to for maternal anxiety but it's a hard argument medically speaking.

#15 xxyzed

Posted 16 July 2019 - 10:49 PM

When you go for your first appointment with your public hospital let them know of your preference for an elective c-section for mental health reasons and ask to be referred to the psychology team for assistance with the anxiety. I suffered with severe pre-natal anxiety and depression and the public hospital asked if I would prefer an elective c-section instead of vaginal birth for mental health reasons.

#16 Lou-bags

Posted 16 July 2019 - 10:59 PM

Not touching on the c section itself here, haven’t had one and don’t know enough about the public system to know how you’d go getting one. But two things I’d do if I were you are
1. Seek out some support for your anxiety. I had some post partum anxiety after my first baby was born, and some pre natal anxiety during my second pregnancy. It’s easy to convince yourself that you’re fine and it’s to be expected. But it was such a relief to open up to my GP about how I was feeling.

2. Get thee to a women’s health specialist physiotherapist (I can make some recommendations if you’re in Perth). Like PPs have said, pregnancy itself regardless of mode of delivery can damage your pelvic floor. Getting advice now will help you to learn what you can do to minimize the risks and promote your recovery post birth.

Congratulations on your pregnancy, and good luck.

#17 Ellie bean

Posted 16 July 2019 - 11:17 PM

I don’t understand how the out of pockets can be $10K if you have maternity cover, can you ring your insurer and chat to them OP?
Best of luck and congratulations

#18 *Ker*

Posted 16 July 2019 - 11:57 PM

I had an elective c/s for both kids in a public hospital. They sent me to the psychology team and she recommended it.

#19 blackcat20

Posted 17 July 2019 - 02:04 AM

View PostEllie bean, on 16 July 2019 - 11:17 PM, said:

I don’t understand how the out of pockets can be $10K if you have maternity cover, can you ring your insurer and chat to them OP?
Best of luck and congratulations
Definitely shouldn't be, mine was only $500 and that was my excess.

#20 petit_manchot

Posted 17 July 2019 - 02:53 AM

View Postblackcat20, on 17 July 2019 - 02:04 AM, said:


Definitely shouldn't be, mine was only $500 and that was my excess.

Depends on whether the specialist gap covers, and if not, what their management fee is. Not unheard of in parts of Sydney for that to easily be 6-8k. Private cover is really covering the hospital fees, moreso than those of the OBGYN + scans etc.

#21 blackcat20

Posted 17 July 2019 - 04:46 AM

View Postpetit_manchot, on 17 July 2019 - 02:53 AM, said:



Depends on whether the specialist gap covers, and if not, what their management fee is. Not unheard of in parts of Sydney for that to easily be 6-8k. Private cover is really covering the hospital fees, moreso than those of the OBGYN + scans etc.

Very true, but a $10k out of pocket isn't a given. With mine I looked through the list of no gap OBs through my health insurance provider.

#22 born.a.girl

Posted 17 July 2019 - 05:49 AM

View Postpetit_manchot, on 17 July 2019 - 02:53 AM, said:

Depends on whether the specialist gap covers, and if not, what their management fee is. Not unheard of in parts of Sydney for that to easily be 6-8k. Private cover is really covering the hospital fees, moreso than those of the OBGYN + scans etc.


Yes, this is what's being mistaken by some I think. Due to our idiotic system, the OP mistakenly thought the private hospital excess of $500 (an extremely common excess) was all she'd have to pay, but that's only the hospital, there's the doctor, the anaesthetist, etc etc to pay for also,and if they don't have any agreement with the fund, then you can be hugely out of pocket.

#23 QuirkyMum

Posted 17 July 2019 - 07:02 AM

View PostEllie bean, on 16 July 2019 - 11:17 PM, said:

I don’t understand how the out of pockets can be $10K if you have maternity cover, can you ring your insurer and chat to them OP?
Best of luck and congratulations
OB fees 6-11K (Medicare will return 530 dollars) + 1-1.5K fees for OB appointments throughout pregnancy + (in worst case scenario) c-section on a weekend -second Surgeon fees + anesthesiologist - around 4 K + 400 for one visit from pediatrician (if baby ends up in NICU - probably more).
15 K for a c section on the weekend without problems/complications.
I'm in Sydney.

#24 taters

Posted 17 July 2019 - 07:18 AM

My expenses  for OB alone who was a no gap provider with my health fund were $4-5k. Plus a $500 excess for the hospital but no gap for anaethetist for epidural. Paed was $450 ish. And thats in a regional area.

#25 Thagomizer

Posted 17 July 2019 - 07:37 AM

View PostEllie bean, on 16 July 2019 - 11:17 PM, said:

I don’t understand how the out of pockets can be $10K if you have maternity cover, can you ring your insurer and chat to them OP?
Best of luck and congratulations

I have had two c-sections in a private hospital in Melbourne. We were out of pocket between $8-10K for each. The first was closer to $10K as it was an emergency and out of business hours.

Costs included: $6K management fee, anaesthetist (around $1K, maybe more? the emergency surgery had much higher fees), second surgeon fees (differed for each as one included fees for being out of business hours and an emergency surgery), paediatrician (more for the second as we had several consults with them), hospital excess ($500).

It very quickly adds up. You get some back from Medicare. The health fund only covers the hospital stay, although they covered it completely, and covered my partner's stay and meals too. Most of the other costs were the other specialists involved, which private health don't cover.

Edited by Thagomizer, 17 July 2019 - 07:37 AM.





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