A patient returned to see me for pregnancy management. Because she had discontinued her health fund membership, she told me this time I will not be delivering her baby, and she will be confined as a public patient. She will continue to see me throughout the pregnancy for antenatal care.

It was reported in the media recently that now 74% of pregnancies are managed in the public sector. The increase in the number of public patients I suspect has to do with people discontinuing or not starting health fund memberships because of financial reasons. I am sure most people who opt for public care are not aware of the huge differences between private and public health care, especially for pregnancy care.

With an increasing number of people seeking public health care there is a dramatic increase in the burden on an already overstretched and understaffed public health care system. I am not aware the NSW Government is not putting any more resources in or employing any more staff to cope with the increased number of public pregnant patients.

An increased number of pregnant patients without a corresponding increase in facilities and qualified staff numbers will adversely affect quality of care, increased waiting times, and increase risk associated with pregnancy and childbirth for mother and baby.

Sometime ago I wrote an article on the differences between public and private care for pregnancy management. It can be found on my website at ‘Private vs Public Care for my Pregnancy’. Below I have a simple table contrasting the main care differences. Private care is not standard and varies from obstetrician to obstetrician. I have therefore only mentioned what happens when a patient sees me for private pregnancy care.

Topic Public Private
Gestation of initial antenatal visit Often initial hospital visit in latter part of first trimester as the antenatal clinic too busy for you to be seen sooner

Initial pregnancy care usually with GP

Ideally at about 8 weeks gestation, though sooner if high risk pregnancy or bleeding or any other concerns
Waiting time at antenatal visits Can be for hours Usually none or only a few minutes

If I am called away for confinement my secretary will reschedule your appointment rather than you having to wait for long time

Who sees you at antenatal visits? If low risk usually midwives, student midwives, resident and registrar hospital doctors, GPs*

Qualified obstetricians usually only see high risk pregnancies

I do
Baby assessment Abdominal palpation and tape measure of ‘fundal height’ of uterus

Occasional ultrasound when clinically indicated.

Abdominal palpation and 2D, 3D and 4D ultrasound scan at each visit at no cost
Concerns and queries between antenatal visits Contact Birth Unit, GP or A&E Contact me via phone, email, website or social media (usually Facebook messaging)

I am happy to see you between scheduled visits and scan check your baby at no cost

If urgent problem out of hours or when in labour contact Birth Unit

Who delivers your baby? Usually midwives, student midwives if normal delivery

Usually resident and registrar hospital doctors do operative vaginal deliveries and Caesarean sections*

I do –  all normal vaginal deliveries, operative vaginal deliveries and Caesarean section deliveries unless I am away (colleague will attend) or you are to quick for me to get there (midwife will deliver)
Birth plan I suggest is needed as the staff looking after you in labour are not usually the same staff who saw you antenatally Not needed

Any concerns or special requests can be discussed antenatally and noted

Request for induction or Caesarean section by choice Not usually agreed to I am pleased to agree after discussion with you
Postnatal stay Usually shared room with shared bathroom facilities Single room with personal ensuite bathroom
Postnatal stay duration Usually 1 to 2 nights Usually 5 nights
Primary care provider Usually midwives, midwifery students and junior doctor staff me

*  With management by more junior and less experienced staff looking after you there is a greater risk that pregnancy and childbirth complications will not be diagnosed or be mismanaged and there is a greater risk of significant trauma with childbirth (including operative vaginal deliveries and Caesarean section deliveries), which can have disastrous consequences for you and your baby. I have had many patients who chose public care first pregnancy thinking ‘all pregnancy care is the same’ but realised in retrospect this was not the case. I believe pregnancy and childbirth is too important a time for you and your baby to take unnecessary risk.

I strongly suggest you continue or start appropriate health fund cover so you can be managed as a private patient. Even if this means ceasing health fund cover when you family is complete for financial reasons the financial commitment while you are having your family is well worth it. Don’t get caught (as several patients have) by opted out of your health fund cover and subsequently having an unplanned pregnancy.

There are some circumstances where it is possible for you to reduce out of pocket expenses for private pregnancy and confinement care. I suggest you give my office a call to discuss this if the out of pocket expenses is a major concern for you.

Finally, I do have some patients who at not in health funds who see me for pregnancy care and are confined as public patients. I am concerned about this option as I value the wellbeing of my patients very much and have no say out what happens to them when they are in the public system for confinement.

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