Birthing my way is still important! !

So the first 3 of my births were with a private midwife outside of a hospital setting. Costing us up to $2000 each which we paid after with the baby bonus.
Now after finding out we have identical twins on board we have decided a hospital birth is the best way to go. My midwife gave me the name of an ob who is willing to work on a twin vaginal birth plan.
We don't have phi and the only way to be sure this ob is at my birth and not another scalpel happy doctor that doesn't know me or my body is to hire her privately. This means continuity of care as I had with my midwife. For me this is paramount.
My midwife is willing to be by my side and is waiving her fees.
But we just got the ob quote and it's $4000 due by 30 weeks.
Hubby has said no way. We can't do it.
We would get almost half back from Medicare after the birth. But I see how the up front cost seems daunting.
It mostly annoys me that he is refusing to discuss it or work it out he's just saying I'm sending us broke. Like it's all my selfish fault and I should just go public and take my chances!
I'm just annoyed right now. And scared. I just want the birth I know my body is capable of with care givers I trust.

I let me husband decided that a Hb wasn't needed for number 4..... One of the worse decisions I have ever made.

Hugs

Congratulations on your pregnancy. :D

Will the private ob deliver you in a public hospital? If not, you will also be looking at private hospital fees, which are very expensive without PHI. Then there is the consideration of whether either of your babies will require SCN, which will cost more again in a private hospital. Ambulance transfer from private to public hospital if either baby requires a NICU... a whole heap of possible additional costs.

If your ob of choice will attend to you in a public hospital, have you checked whether the hospital is agreeable to that? A public hospital usually uses whichever ob is on duty/call if required. I'm not sure whether most hospitals would be agreeable to making arrangements for you to be attended by your own ob? If the ob has delivery rights at the hospital, I imagine it is possible, but I would certainly investigate before paying any money to the ob.

Lastly, Medicare only rebates a small amount from the obstetricians fee. From memory, we got a total of less than $500 back from Medicare for my obs management fee. We were OOP about $6K... with top PHI.

Well, that was a bit of a downer... sorry! I would encourage you to investigate all options and possibilities before you commit to a plan for the birth of your babies. How lovely of your MW to waive her fee! I hope you have a beautiful birth.

The ob is the head of the public hospital obstetrics so she is very much able to deliver at the public hospital.
I'll be a public patient at the hospital.
And the Medicare rebates are in total. The rebate for the pregnancy management fee is capped as you mentioned but there is a birth rebate that we are eligible to also

It's all very hard for hubby to accept. I really feel this ob is my best shot at a vaginal birth.

congratulations, twins are such a joy!

Of course how you want to birth remains important, and when you are higher risk it can be even more important to trust your caregiver. My suggestion would be to make an appointment with your local public hospital to discuss care options for you, and find out if there is any way you can enter a caseload midwifery team so you have continuity of carer and the knowledge that a known caregiver will form part of your decision making team. You may find there are midwives with a specific interest in multiple births and who will be delighted to caseload you. If your private midwife is still willing to support you as a doula then you may find this is all the support you need.

For my own twin birth I made an appointment with my designated OB in an NHS hospital and we came up with a plan that involved midwife led care with an OB to step in if certain conditions were met (preterm birth, bleeding, etc). If everything remained normal they he was happy to stay away because he knew I had made informed choices and that I would be "reasonable" if there were complications. I expected a fight, I did not get one. It's worth asking the questions and if you get a yes answer from an OB at the public hospital then ask them to sign your birth plan and detail their name so that subsequent doctors will see your plan and know it has been discussed and okayed by a senior member of their staff.

Good luck and I hope you find the answer for your care that you are looking for.

Perhaps it would be worthwhile exploring the options available to you, as traveller suggests?

I guess perhaps your husband is thinking about this in terms of money, rather than your care and sense of security. If you talk more, perhaps you can help to reframe the discussion for him so he can see it from your perspective. Money-wise, is there any way you could make things a bit easier for him to take it (things to sell, budgeting?).

I hope you can find a way to feel safe and happy with your care :hug:

Bellany, double check that you won't have to pay a bed fee for the hospital even though it is public. That is what usually happens if you use your own OB. Also check anaesthetists costs are covered.

We are in a similar position. We are also struggling financially right now. It won't be forever, but for the next few months it certainly will be. DH and I have discussed it at length, and have decided to take out our first loan for this birth. Our other options are not viable; the hospital I am zoned to is not a good option for us and how we see pregnancy and birth, and we don't drive, so we can't even get to a hospital ourselves. Not sure if that's an option for you. We're still debating whether to borrow from our bank (who will give us the loan we need, but we're dubious as we've never needed a loan before) or borrow from MIL, which would work well but would probably have repercussions as she's a bit odd. Would that be an option for you guys? It's certainly not the best option out there, but for us it's the only functional one :hug:

Just wanted to add that you can also claim the out of pocket obs fees on your next tax return. As somebody else mentioned, the Medicare rebate is capped and reduced from what it used to be, however, you can get about 20% of the remaining out of pocket expenses back at tax time.

Also, if you have an 'elect' c/s (as in, not being given a choice), it's going to make caring for twins and older siblings that much harder in the first few weeks due to the longer recovery. Just beware too, that if you get DH on board to agreeing to the costs etc and you end up having an emergency c/s for whatever reason, that he doesn't get cranky at the end of the day for spending the money and not having a vaginal delivery. We just went private so that I could try VBA2C and ended up getting pre-eclampsia at 40 weeks and a repeat c/s. Luckily DH wasn't phased about any of it, but I can see the potential for $ being an issue if you ended up having an emerg c/s. So might be worthwhile really stressing the importance of your birth wishes and not feeling like you're being pushed into something that you may not need, regardless of the outcome in the end. It's the journey and your wishes that's important throughout. Wishing you all the best!

woops. Also forgot to mention that I know a few mums that have had successful vaginal deliveries of their twins. I'm not sure where you live but one mum had hers at Bendigo Base (public hospy).

Just thought I'd mention the Medicare tax offset of 20% only applies to out of pocket costs after the first $2060. I am not sure it would apply here (unless you have other high out of pocket medical expenses).

I have 10.5month old twins and am also a student mid. My twin birth was intervention free, no continuous monitoring, no drugs, no induction, physiological thrid stage, whole labour in shower, both babies born in shower and dh caught twin 1. I fought very hard and had to refuse a lot of things to get the birth i wanted,, had the head ob fromthe whole region sitting out at the desk (which i didnt know until months later) as i was so "non-compliant". You have to remember there are hospital policies clah blah blah but in a public hospital they have no right to refuse care, its negligence, almost all hospitals say they "don't do breech birth" but legally they HAVE to do breech vaginal birth if a woman refuses a c/s. I think if you have your mw who you trust and can advise you then you could go to a public hosp and have the birth you want. I can understand firs thand every one of your worries and am more than happy to chat with you if there is anything you want to talk about.

P.S There is nothing quite like birthing a baby, experiencing that major high and then knowing its not over and you get to experence it all again!! amazing, congrats!!