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

[Epacris]

I’ve been around BellyBelly for a few years now and I never really “got” Kelly banging on about choosing who you birth with is choosing how you will birth. If you don’t want an episiotomy don’t have a private obstetrician, if you don’t want a managed third stage, don’t go to a private hospital, blah, blah, blah. I just didn't believe that it mattered that much. I really thought the private model of care was the best type of care, I thought it was flexible and I thought I could get the care I wanted within it. Well, it’s expensive, that’s for sure, but as for the rest of it.... well I guess it’s OK. But for the birth of my child, is OK good enough?

I’ll go easy on myself for going private with my first child because everything is so unknown, but why oh why did I go back for more of the same with my second? I am so thankful that I finally woke up, made some great decisions about who would care for me and that I did have a truly beautiful birth in the end.

The private model of care is just so pervasive, but it’s so expensive and it’s just not that “good” for low risk women like me. Of course there are women who really, desperately need the services of obstetricians during their pregnancies and for the birth of their children. So why waste those precious resources on people like me? Midwives are the specialists in normal, natural birth, which is really the most appropriate care for most of us. Why are they so constantly sidelined and why do women like me see the private obstetric model as the default option?

Anyway, I just want to share my letter of thanks to the NSW Minister for Heath for the midwife-led, woman-centred care that I was lucky enough to be able to access for the birth of my third child.

I finally get it now Kelly!

29th June 2011

Jillian Skinner, MP
Level 31 Governor Macquarie Tower
1 Farrer Place
SYDNEY NSW 2000

Ryde Midwifery Group Practice at Ryde Hospital

Dear Mrs Skinner,

I am writing to you to tell you about the amazing and beautiful experience I had birthing my third child at Ryde Hospital. I was cared for by a truly exceptional midwife, Martin Griffiths, as part of the group midwifery model of care. I want you to understand how valuable and important group midwifery at Ryde Hospital is for women, babies and our community.

I had my first two children at the SAN at Wahroonga with a private obstetrician. I chose this model of care because I have private health insurance so I thought, well that’s just what you do. My first two birthing experiences were good, but there are many aspects of my care under the private model that I now believe were much less than ideal and much more expensive to me personally and to the taxpayers of NSW and Australia.

By less than ideal I mean I that I had care providers, treatments/procedures and interventions that hampered my experience and recovery. Under the private model of care I built a relationship with my obstetrician throughout my pregnancy, but during labour and after birth it was the midwives at the hospital that provided almost all of my care, people I had never met before and had no opportunity to get-to-know during such a busy and somewhat stressful time. The treatments and interventions I received include: internal examinations, “stretch and sweep”, direction into a birthing position I did not want to be in, coached pushing, episiotomy, immediate cord clamping, managed third stage (syntocinon injection), stitches and poorly managed 4th stage pain relief. These are all minor interventions but in my opinion they were unnecessary and detrimental to my experience, recovery and birth and mothering journey.

By expensive I mean at every obstetrician visit (of which there were many) it was clear that every single Medicare fee/rebate that could be accessed was. I believe that much of this was unnecessary and a waste of taxpayers money, not to mention a waste of my money as there would always be an additional “gap” cost to me. After giving birth I stayed in hospital for four days at huge cost again, to me personally, my family (husband taking time off work) and to taxpayers (subsidising private health insurance). I could easily have gone home much earlier but there is no out-of-hospital care under the private model. Once you leave hospital you are virtually abandoned and left to fend for yourself. If I wasn’t being over-serviced, I was being under-serviced.

In contrast, the birth of my third child with Martin Griffiths under the group midwifery model of care at Ryde Hospital is incomparable, just so much better. Martin favoured a completely hands-off, wait-and-see approach and it has worked so well for me. Throughout my pregnancy and especially during my labour and birth his presence was perfect, he allowed my body to do what it was meant to do, but he was there with me, supporting me the whole time. I felt comfortable, in control and free. This excellent care and support didn’t end when I left hospital, the in-home visits by Martin in the days and weeks after birth were invaluable.

I know I have experienced the very best care. All of the careful, evidence based decisions we made together about my treatment options have meant that my recovery has been brilliant. I was able to go home the day I gave birth, breastfeeding has come easily and naturally and there has been no disruption at all to our family life, I went to the shops and did the kindy pick-up the next day! My older two children (2 years and 4 years) have happily welcomed their new little brother and my husband has been able to confidently and quickly return to work.

I regret that I chose the private model of care for my first two births. It’s not that my experience in the private system was bad, it was good, but for something as special and important as welcoming a child into the world, why would you settle for good when you can have awesome! I am so thankful that I educated myself and finally found the best birth care model for me, better late than never. It is such a shame that women like me see the private obstetric model as the default option. There are women who really need the services of obstetricians during their pregnancies and for the birth of their children. Our health resources are precious, why waste them giving sub-optimal experiences to people who don’t need them?

I passionately believe in birth rights and birth choices and that midwife-led, woman-centred care should be the gold standard for maternity care in Australia. I feel frustrated and angry that important decisions about access to birth services are seemingly not based on evidence and I am left wondering about the protection vested interests. I feel so lucky that I have been able to access the group midwifery service at Ryde Hospital and I hope so much that it will be able to offer such a valuable and important service to women and families long into the future.

Thank you for taking the time to read about my experience. Please do not hesitate to contact me if you would like further information.

Yours sincerely,



Rachel _______

cc: Martin Griffiths, Midwife, Ryde Hospital
Nicola Roxon MP, Minister for Health and Ageing
John Alexander MP, Federal – Bennelong
Victor Dominello MP, State – Ryde
Debra Thoms, Chief Nursing and Midwifery Officer, NSW Dept. of Health
Rosemary Bryant, Chief Nursing and Midwifery Officer, Dept. of Health and Ageing
Dr Michael Nicholl, Director Women's and Children's Health, Royal North Shore Hospital
Dr. Colin Gunter, GP, Carlingford – Epping Surgery
Dr Steve Hambleton, Australian Medical Association

[onthefly]

You know I totally agree with you

[Cassius2]

I hope that you also sent it to your midwife! Great letter and a great positive way to talk about the importance of birth choices!

[BellyBelly]

Thats awesome hun! I'm always here to share the wealth, but I know people have their own journey and the right time to hear something. That's why I will keep banging on... and one day others might spread the word too, if its true for them

[Floweryfields]

Great letter!

[Shanti]

Good on you!!

I have private health but would never give birth in a private hospital.... no thanks!! You'd have to pay ME to give birth in a private hospital. Even then, not sure I would do it!!

[jackrose]

So great to read your thoughts and your letter.

I especially like this:

So why waste those precious resources on people like me?

Totally agree!! So glad your birthing journeys led to a happy place

[Heaven]

What a great letter!!

[helle]

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

[onthefly]

While I believe every pregnant woman should have continuity of care with known midwives (in additon to obstetric care where required), it is surely an even greater imperative for those classified as high risk? How much gets overlooked or forgotten about as women get bounced from one carer to the next?

[~mamaspice~]

While I believe every pregnant woman should have continuity of care with known midwives (in additon to obstetric care where required), it is surely an even greater imperative for those classified as high risk? How much gets overlooked or forgotten about as women get bounced from one carer to the next?

So true MadB! There were countless times where I had to tell THEM where everything was at. I guess that is the big benefit of having a private Ob in a high risk situation, and part of the reason I went that way in the end.
It would be sooo nice for all high risk mums to have access to a continuity-of-care MW who collaborates with an Ob. It would be the ideal situation IMO.

[onthefly]

Sadly, the current attitudes of teh AMA et al make this very unlikely. Who loses? Mothers and babies. This is why we need to tell OBs, and hospitals and the government what we need and why.

[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.

[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.