In Australia today there are a few different options of birth place for women. You can birth in a private hospital, a public hospital, a birth centre, or at home. Not all options are available to women everywhere in Australia and home birth is not funded by the government in Australia at the moment. (But that is another blog post all together.)
Yet most couples find that their main decision is whether to go public or private. This post is about the differences between choosing public or private hospitals.
In our society today it seems that anything private is perceived as better quality and better care. Not many women will actually look at the statistics and understand what it involves to go private rather than public. I can only speak about how I have experienced how the hospitals work here on the Sunshine Coast in my practice as a birth doula.
Private hospitals often look impressive. They often have nice rooms and birth rooms with en-suites and generally good facilities. I know lots of women who choose private just to have their own room post-natally, where their partner can stay with them overnight after the birth, which is a totally understandable wish. In Public Hospitals, we are moving towards that kind of standard, but here on the Coast we have a few years yet until women get their own room after birth.
The main difference in the care though, between public and private, is that to give birth in a private hospital you have to go through an obstetrician, who works at the particular hospital you have in mind. This means that to go to a private hospital, your main carer is going to be a doctor rather than a midwife. In our public hospital you see the obstetrician once, if everything is going to plan, and apart from that your care is through the midwifery lead antenatal clinic or shared with your personal GP. The main difference between obstetric and midwifery lead care is that an Obstetrician is taught to manage risk, and specialises in complicated and difficult births whereas a midwife knows about natural birth. They know what it looks like and they know how to recognise a birth that is moving away from it’s “normal”, “natural” path. Manyobstetricians don’t see very many normal, natural births.
Because our society has got an inbuilt fear of childbirth these days, for many couples it seems the safest option to have a private obstetrician, who can save them “when” things go wrong. But if we look at the statistics, many more things seem to go wrong when an obstetrician is involved as the main carer.
Having obstetricians as the main carer means that private hospitals are running up a much higher Caesarean rate and intervention rate all together. In 2009, the caesarean rate in Queensland private hospitals was 48.6%. In the public hospitals the rate was 27.6% compared to a national rate of 30.9% and a Queensland rate of 33.9% . I wonder how many women investigates this before choosing to go private. Particularly if you wish is to have a natural birth. And these are average figures. So if you are wishing for a natural birth, it is very important to look into those figures before choosing a hospital and a particular obstetrician. (http://www.couriermail.com.au/lifestyle/parenting/caesarean-deliveries-on-the-rise-in-queensland-private-hospitals/story-e6frer7o-1225893654551)
In a public hospital there is always an obstetrician available, but you will only see him/her if there is a problem and you will see the one rostered on at the time you are there. It is still the obstetricians who are running the birth suite, but you are cared for by midwives unless there is a problem. Unfortunately we don’t have any midwifery models here on the coast, which would give you an opportunity to know your midwife before you go into labour. Neither do we have a Birth Centre, but recently “Friends of a birth centre on the Sunshine Coast” was formed and is now lobbying for a Birth Centre connected to the new University Hospital proposed to start building in 2012. ( find them on Facebook here)
At the moment it is very difficult to find accurate information on caesarean rates in Queensland private hospitals, but the common knowledge around the trap says that Nambour is around 30% like the National average. Selangor is a around the 50% mark after the introduction of CTG on admittance (this means that when you enter the hospital you will have the belt on for 20min) Buderim Private is said to be around the 80% mark.
So before you choose your preferred birth place, please ask lots of questions to make sure that the hospital of your choice reflects what you wish for your birth, shop around to get a good feeling of the different hospitals and visit at least three obstetricians.
This is also a great way to actually think about what sort of birth and which kind of care you would like.
Some things that are great to inquire about when you are shopping around for the best birth place for you is:
What is the overall philosophy of the facility? i.e.do they promote active birth and support women’s choices?
What are the hospital’s caesarean section and epidural rates? This will give you a good indication about whether the facility really does support active birth and women’s choices
Are your doctors/midwives supportive of water birth? At the moment Queensland health will not allow water births in our public Hospitals, but Selangor provides this service happily. Even if you don’t think you will be having a water birth, it is good to know in case you change your mind in labour.
What sort of props are available in the birth suites? For instance bean bags, birth stools, blow up plastic pillows for the bath, plastic chairs for straddling in the shower, decent size mats for the floor, dimmer switches, CD players.
How many post natal beds are there? Can my partner stay overnight?
What is the staff-to-patient ratio in the birth suite? Often the staff-to-patient ratio will be better in the public hospitals as private hospitals are run as big businesses and the bottom line counts. The ratio should preferably be no less than one midwife to 2 to 3 labouring women.
What is the staff-to-patient ratio in the post-natal ward? A reasonable ratio would be one midwife to 4 – 5 women.
Is the hospital baby friendly accredited? This is a fairly new thing, where skin to skin and breastfeeding is promoted as a general philosophy.
(questions are inspired by Susan Ross’s Birth Right Book)
Now as the situation is here on the coast, we don’t have the option of choosing our own midwife, either in public or in private,unless you are choosing a home birth, so here are some important questions to ask, if you are choosing an obstetrician:
Your first initial instinct about your care giver is important, no matter whether you are choosing a midwife, a doula or an obstetrician.
- Ask how long they have been in business, if they have children/grandchildren and get a feeling for their personal attitude to pregnancy and birth.
- Ask how many births they do per month. Some Obstetricians take far too many clients per month. About 15 – 20 is a good amount, to have a reasonably chance to actually have him/her at your birth.
- If you have chosen a female doctor specifically, make sure you find out how many male obstetricians are in her practice too. Ob’s work in groups and back each other up and give each other a chance to have weekends here and there rostered off. This means that you might end up with another OB than the one you have chosen. The same goes if you have chosen an OB because he is water birth friendly. If everyone else he works with isn’t, your chances of a water birth is much smaller.
- Pam England from Birthing From Within suggests this: Ask open ended questions when you are working out how your OB works rather than questions that suggest the answer you are looking for. Rather than enquiring “I don’t want an episiotomy. Do you cut episiotomy routinely?”, ask ” How many of your patients require episiotomy?” or “How do you help Moms avoid tearing or episiotomy?”
If you OB answers a question about a particular procedure with “I only do that when it is necessary”, consider that an inadequate response. Your next question should be, “How often do you find it necessary?”
This will reply to any procedure, whether it is epidural, VBAC, Vacuum, cesareans, lying on your back to give birth, induction etc.
So remember this is a very important decision for you and your family. It is important to find a hospital or birth place, and care giver, who will support your wishes and philosophies about birth. Just as you would shop around buying stereos, cars etc., don’t be shy to look at different hospitals, talk to different doctors and midwives. Be critical and curious and get your questions answered before you choose your birth place and your caregiver.