Don’t go private *just* because you have private health insurance

[Jennifer13]

Epacris, you might be interested to know that our expensive private ob and his wife chose the same hospital where you went for DS3 for their first birth. let's just say DP decided taking the chance we might need public if our homebirth does not go to plan was acceptable after that.

We also weren't impressed that when we asked the private hospital about their attitude to care the standard of menu and pay TV connection are the first things mentioned. Ummmm... So I was talking about patient medical care, but anyway. The word 'hotel' was put in there, which wasn't exactly top of our minds when considering birth. We would like a hotel stay before the baby gets here, not while! Plus, the completely risk-based, not care-based, attitude of the hospital.

Thank you for sharing your experiences - they were helpful in the discussions DP and I had about our choice!

[Epacris]

Epacris, you might be interested to know that our expensive private ob and his wife chose the same hospital where you went for DS3 for their first birth.

Seriously.... wow, that just speaks volumes doesn’t it. That says way more than my little old letter.

[Jennifer13]

Maybe I should add that his wife is a m/w too.

Your letter speaks just as much!

[onthefly]

This is my letter that I'm sending to our health minister and community midwifery program - like Epacris it sums up my attitude on this issue

My daughter was born late last year with the help of the midwives from the Community Midwifery Program, WA, and I would like to commend the excellent services offered by the program to parents and babies here in Perth. We are very fortunate to be able to access such a high-quality, state-funded program offering continuity of care in a midwifery-led, parent-centric model.

I’d like to take this opportunity to tell you a little more about our story and how we came to seek the services of the Community Midwifery Program, WA.
Having experienced two low-risk pregnancies via two contrasting models of care – our first child was born in a private hospital in Perth – I have come to appreciate what a difference the care and support women receive can make, not only during the birth, but also the entirety of the pregnancy and post-natal period.

When pregnant with my son, our first child, my husband and I decided to consult a private obstetrician, one who was recommended as being ‘pro-natural’ in his attitude to labour and birth. We thought that we were paying for continuity of care, as well as the peace of mind of having a surgeon available. We had regular checkups with our obstetrician, though we did not truly have the opportunity to get to know each other. As my due date came and passed, we were propelled into a medical induction of a perfectly healthy pregnancy.

At the outset of labour we found ourselves in argument with the obstetrician as he was very reluctant to consider our wishes – we wanted simply to delay the use of drugs in the induction. We then realised the folly of our previous thinking in regard to continuity of care as our doctor left and we were cared for by a number of different midwives whom we had never met before. The only support these midwives offered for me, even when I myself was in distress, was drugs.

The induction led to a cascade of intervention, with my son ultimately removed from me with forceps. Given that there was nothing apparently wrong with either myself or my baby prior to the induction, I feel this was an unnecessarily traumatic birth for my child. The guilt and disappointment I felt following my son’s birth remains with me still. In time I came to realise that at the heart of my disappointment was the lack of respect with which I was treated. I was only ‘allowed’ to make decisions for my pregnancy and baby grudgingly – as though the final responsibility for birthing was not mine. The midwives – constrained no doubt by being as unfamiliar to me as I was to them – watched their machines rather than me, and offered me nothing more than medical pain relief.

Following this experience, my husband and I agreed we wanted to do things differently next time, leading us to the Community Midwifery Program, WA. Having our own midwife made a world of difference. Appointments were relaxed, and most were in the comfort of my own home. I was never hurried, in fact our meetings were rarely shorter than 30 minutes. This gave us plenty of time to get to know each other – building rapport and trust – and discuss all our preferences and wishes for the upcoming birth.

An important difference was the attitude of our midwives towards the birth – principally their recognition that it was my responsibility as mother to birth my baby. This framed our relationship, so that while our midwives offered medical advice based on their training and experience, they also provided all the relevant information on the options available with the final decision left up to me.

Whereas our previous experience left us anxious about our medical caregivers and unsure whether we could trust their advice, the calm, considered care and support offered by our midwives meant we could trust them implicitly. During my labour, our midwives were able to offer the support we needed – which for us was a quiet presence in the other room, with as few interruptions as possible to check on myself and my baby.

The labour was long and very painful – we later discovered malpresentation was the reason for this. Late in the labour our midwives advised a hospital transfer due to foetal distress. We accepted this judgment and still feel no unease with the decision. In the end we did require obstetric assistance, and this was available to us through our nearby backup hospital where I birthed my daughter.

Even though I did not experience the ‘normal’ birth I longed for, the care I received throughout the pregnancy and birth meant that my daughter had the best birth experience possible. I feel quite certain that (based on our experience first time round) had I returned to the same obstetric model of care I would have certainly needed medical pain relief to cope, and I think it very likely I would have ended up with a caesarean, either due to failure to progress or foetal distress.
And yet I birthed her. And as hard as it was, I’m really glad I did.

We are very thankful to the midwives of the Community Midwifery Program, WA for the tailored care they gave us throughout the pregnancy, labour and post-natal period. I would never want to birth again without my own midwives and truly this level of continuity of care should be the gold standard in maternity care in Australia. Every woman should have access to care via a known midwife, even if they are classed as higher risk and also require obstetric care. Knowing each other and building trust means mothers and babies are safer and their needs are more likely to be met while avoiding unnecessary interventions that actually increase the risk to mother and child.

I hope that the State Government will continue to support the Community Midwifery Program, WA and its work. Sometimes in the debate about birth choices there seems to be an emphasis on survival rates, as though just being alive at the end of it is all that matters. I would think, as a first-world nation with a high standard of living, we would view low maternal and foetal mortality rates as our starting point – we should aim higher, to help mothers and babies achieve the best possible experience. I believe that supporting the sort of care model exemplified by the CMPWA is one important way we can do that.

[Epacris]

Ahh mate, you already know how much I love your letter, but for the benefit of everyone else...

This bit makes me cry.

And yet I birthed her. And as hard as it was, I’m really glad I did.

I’ve read it before but now I’m crying again.

And you last two paragraphs rock!

[jackrose]

I understand Epacris, that is an amazing story and an amazing letter.

Well done MadB, that is exactly what needs to be out there when it comes to birthing stories. What a journey you have been on and what a difference a bit of respect and empowerment can make to a birth for a mother, a baby and all of those around them.

Thanks for sharing that, you have made my night!

[RhiChiChi]

Ok, so this thread has got me thinking. We want another baby and I went private first time and had no issue with how things went etc... however, it has me thinking about options. Now, I googled 'midwifery led care' and two choices come up around here - Monash & William Angliss. What I want to know is, how do you know for sure you are going to get that continuity of care from the midwives at these two places? I assume that there are shifts/rosters like all other medical facilities, so if I am in for say two days, how do I know I am going to get the same midwife? Is that what people mean by continuity of care or am I confused?
I got the same midwife that was there when DD was delivered. When she was rostered on, she was allocated to me & obviously other patients. I think I saw her three or four times shifts when I was in hospital.

[onthefly]

Yes, continuity of care means having the same carers (2-3 probably) throughout your pregnancy, birth adn the post-natal period. Ideally you should have a primary carer, plus 1 or 2 backups.
Many midwifery practices try to provide continuity of care. They assign women to teams and attempt to get you to see the same people and ensure one of your known midwives will be at the birth with you. Some are more successful at this than others. Ultimately, it's hard to guarantee when midwives work shifts/rosters.
The CMP caseloads midwives and assisgns backups, so you have your primary midwife throught, with a backup filling in when necessary for appointments and also atttendign the birth. There's still the possiblity that due to unforseen circumstances your primary midwife may be unavailable for the birth, but you'd still have your backup, who you will have met at least once before. In the homebirth program we had long appointments so I had a 1 hour chat with our backup before the birth, so although we'd only met once I felt quite comfortable with her. She also attended one of my post-birth follow up appointments.
Anyway, that's about as close as you can get to guaranteed continuity of care I believe. IT sounds like the hospital you were at last time also tried to provide continuity of care, that's great to hear.

You can give them a call and see how they organise things. Ask how they try to ensure continuity of care and whether this continues post-birth.

[Jennifer13]

I have a private m/w booked for our HB and she will be bringing her backup m/w to most appts. They are in a practice with another three, and if something unforeseen happens closer to the birth I would have one of them. I have spoken to each of the other three on the phone already and would be completely happy with any TBH. I think I will be meeting some of them as they have regular get togethers for their Mums every couple of months (including those who are pg and who've given birth already).

If I need to go to a hospital my m/ws come with me.

You could also consider a doula to provide continuity of support at least.

[RhiChiChi]

Thanks MadB & Jennifer - you have clarified the continuity of care part alot - I was sort of confused as to how it would work, but it seems like the teams of mws are smaller than at a hospital & obviously you see them for appts, rather than an OBS.

At the hospital I had DD at, it is a small local hospital that caters for a maximum of 16 maternity patients but did say that if they were over that number then they use the general ward. I think I was lucky (it was 4 years ago) to been assigned my mw so many times but I was in hosptial for 8 days (me choice). I would need to visit each of the centres to see what I thought and actually chatted to the staff. I know there have been changes at the hospital where I had my DD due to population growth, so they offer mws to come and visit you at home if you discharge 'early' but I don't know how many mws they have and who gets assigned etc....

[Gabby 1973]

Thanks for this thread. I went private (Frances Perry House) for our first baby (born on 09.09.2009 ) We were out of pocket quite a lot and it turned out to be a more expensive exercise than I would have thought - call it the naivity of a first pregnancy! We are TTC for bub number 2 and I am thinking of a shared care arrangement with my lovely GP who is alligned with the Women's which is very good from what I have heard. I am guessing with a shared care situation this might be better if you are classed as high risk which I wasn't with our first baby?
Any thoughts on shared care with your GP and the royal women's (in Melb)?
Many thanks

[Lolpigs]

On a positive note. I went private and my dr and midwives were 100% natural all the way. Even when I had an urge to push and my middie wanted to check I was fully dilate before I did actually push (I had progress alot faster than expected) I asked for gas (to help me hold the push) she encouraged me to wait and that I could do it without it and showed me how to pant.
My dr even stood back while my midwives delivered our baby

So glad to read this. I'm going to the SAN and have made a point to go to classes and spend time with the widwives and the hospitals practises to ensure I feel comfortable. The midwives made a point of saying unless you want something we won't be asking you, which was reassuring for me who wants to avoid Epidural etc and wants at most Gas. They even gave me ideas of sitting in with the jets in the bath for contractions, moving around whatever. Which is really great.

I too am concerned about Induction etc, and how one intervention leads to another and in the Prenatal classes the SAN lead they seemed keen to point this out, to be sure you want something done and are keen to point out that I am in control. There was also comments made about older OB's who are more set in their ways Vs younger OB's who are more inclined to be less invasive.

With all aspects of medical things, while I'm happy to have them providing there is actually a need. My greatest concern is having things done just because its "standard" as I've always believed this is rubbish.

I agree that attitudes within hospitals needs to change about birth, when I think of the horrific experience my mother went through 30 years ago, I shudder to think that this would be my only option.

I think so long as women go into this with eyes open, I think this is half the battle. So many women I know don't know they have any options at all which is still very surprising.

I agree with the continuity of care, this seems like a big issue.

[Epacris]

Hey Lolpigs, it was actually the SAN where I birthed my first two babies and it was *that* model of care (private obstetrician/private hospital) that I was comparing to my most recent birth experience. For my private births my ob only turned up right at the end, in fact, he missed the birth of my DD (she was very quick). As I said in my letter, I had built a relationship with my ob throughout my pregnancy (and I liked him, he was great) but almost all of my care during labour and in the days afterwards was provided by the hospital midwives. I had never met any of them before and I would never see any of them again. Some of them were absolutely lovely, some of them were not so great. But the most important point for me, comparing my first two births to my most recent birth experience, is just that I didn’t *know* them, I laboured and birthed with strangers.

When I was in labour I found myself doing things that I didn’t really want to do, being directed into an uncomfortable position, being directed to push, managed third stage, things like that. I just did what the midwives said. My experiences weren’t bad or traumatic but I know I just did what they said because I didn’t feel comfortable talking to them and telling them what *I* wanted because I didn’t know them. I only know this now and I only know this because I have experienced a labour and birth where I did know my midwife, I trusted him completely and he knew exactly what I wanted and what was best for me during my labour.

I’m really sorry if this is not what you wanted to hear right now. I have thought very deeply and really hesitated in posting this. I just really didn’t want to say “Yeah it was great”, when the whole purpose of this thread for me was to say, “Well actually, there is a whole lot of room for improvement”.

As for offering drugs, with my first baby, as soon as I walked in the door (I had a contraction on the floor in the foyer) the very first thing they said to me was “Do you want an epidural?” and I said “umm, errr, why, do you think I need one?” and they said “Well you seem to be in a lot of pain” I still **** myself laughing about that. “I’m pushing a baby out of my vagina, I’ve heard it can be mildly unpleasant, I thought YOU being a midwife would have seen this sort of thing before.” I didn’t actually say that, I just thought it, and I never did have an epidural with either of my births there, just gas (and managed third stage).

Lolgpis I really do wish you all the very, very, best for a beautiful birth.

[*Danni*]

I just wanted to pop my head in and say that I gave birth in a private hospital (norwest private) and I would definitely recommend creating a birth plan, make sure they put it in your file beforehand and bring a copy with you and be prepared to explain it (I had DH on that duty) and make sure every midwife in change of shift reads and understands it.

I found this to be an invaluable tool in assisting me to have the natural birth I ended up having in a private hospital. Some of the midwives attitude was just outright terrible, but they knew what I wanted and it had to be made very clear to them from the start. I had no gas, no intervention, no pain relief and was given time for the cord to stop pulsating and bub to do the breast crawl ALL because of my birth plan.

Put it in writing. your wants, your values and your expectations - in black and white. they are MUCH more likely to listen to you then.

The only reason I went private is because (besides having private health) as it was my first pregnancy I wasn't 100% sure of the outcome and I wanted to have peace of mind that IF necessary, i would receive the best medical care from an OB I somewhat trusted and that was very Important to me. I did a calm birth class and was very pro natural birth though. However next time (if and when) I am considering a home birth!

I would say to anyone that if you can get whoever is with you to be your voice and advocate that will help immensely.



Sent from my iPhone more than likely while I should be doing something else

[Jennifer13]

Unfortunately, Lolpigs, the SAN's c/s rates are unacceptably high, not to mention their rates of intervention use. Very nice rooms and like Epacris says, some lovely m/ws, but some not so good.

I had a c/s at the SAN, which was scheduled due to the risk of a low lying placenta. The options presented to me for a VBAC this time around included every possible thing that would make a VBAC as difficult as possible (constant monitoring, cannula on arrival, etc). We walked away from that discussion feeling like the whole system was geared around risk and not getting sued, rather than me as a mother and my wishes.

The antenatal class was basically a menu of drug options by stage (timing emphasised). The bfing class was very good and baby care one good as well. I did get to know a couple of the m/ws who made sure they took shifts while I was in hospital. But I still got a m/w who thought it was okay to painfully squeeze and express my colostrum without even asking me, when I had a baby that was feeding beautifully already.

My baby was taken to the nursery and my DP not allowed to stay a couple of hours after the c/s, even though I was able to get around. Overall, I didn't hate my experience at the hospital, but now I have educated myself so much more, I am doing things differently.

Maybe look into a doula and a good clear birth plan. GL!

[Lolpigs]

Hmm I just did the prenatal class and they barely talked about pain meds. Perhaps it was the person leading the class?

The interventions discussed dont really bother me so long as they are valid medically. I guess I just have a different view on hospitals.

[Julie Doula]

I think a lot of women don't actually get told the full menu of their birth choices. There's a saying, "If I don't know what my choices are, I don't have any." And people have a way of not informing women honestly about ALL their options - especially if they have a vested financial interest.

In NZ, you get pregnant, your first stop is the local Midwifery clinic.

In Australia, the local GP is often the first stop for many newly pregnant women.

And many GPs steer women, like herding cattle, towards the medical model. Not all GPs are fair and even-handed about informing women of midwifery or natural birth options AS WELL.

So many women I've spoken with got told "your choices are Private or Public." That's it.

So women get told that your only options are Medical Model A and Medical Model B.

Some women don't even get to hear of the existence of Midwifery Model of care, and many don't even realise there is a huge difference in the practice and philosophy of the two very different models.

Marsden Wagner explains it here

One of my clients found out there was such a thing as Birth Centres (these are 'kind of' midwifery model - but are still controlled by a medical hierarchy). Her public hopsital obstetrician strongly discouraged her and told her, "do you know how many births those places botch up?" (This after she'd had an extremely unnecessarily traumatic botched birth in a hospital that this obstetrician approved of.) She terminated care with that ob, went to the birth centre, arrived 10cm dilated and gave birth in the exam room as she didn't have time to get to the birthing room. Dad caught and the midwife and I looked on smiling.

So the full menu of options:
Medical model, private hospital
Medical model, elective caesarean, public or private
Medical model, private obstetrician ($$$)
Medical model, public hospital
Medical model, birth centre (a little bit of Midwifery model)
Medical model, Know Your Midwife continuity of care scheme ( a little bit of Midwifery model)
Midwifery model, private midwife for pre and post natal care and for in-hospital support (within Medical model) ($$)
Midwifery model, private midwife for planned homebirth, with or without doula support ($$)
Unassisted homebirth, with or without doula support

When you see a full menu of options like that, and you carefully research the pros and cons of each options, then it is much easier and clearer to match yourself up with the option that suits you, your style, your needs and your personal philosophy and values the best.

There's a big difference between consciously choosing the medical model after ruling out the others as not appropriate for this particular pregnancy and birth you're having - and being herded into the medical model because they never told you about any other options, and 'it's what everyone does'.

[Ambersky]

I'm so glad this thread got bumped... so pertinent for me right now.