Pre TTC - So many questions re healthcare system Pub vs Private! Help please

Well I am hoping that I should be TTC some time next year :pray:

Being new to all this stuff I am amazed at how ignorant I actually am on the subject. For someone who considered herself fairly well versed in most things.

Firstly I wanted to get my body ready, I eat pretty well and so while I carry a little extra padding I am well withing my BMI so that is not a problem. I have given up the cigarettes, so that is another rick in my box. Started taking folate and zic tablets as another start to get ready. Plan on begging a bit more exercise which should be helped with the onset of the warmer spring weather. I have also made an appointment with my GP for pre TTC bloods to check everything is normal and all good.

have a dialemma and here in is my first questions.
I stupidly never realised that there was such a long wait for maternity on PHI. I don't currently have PHI and should have thought of taking this out as an option earier (to give myself the best range of options) If I were to take it out now and fall preganant in say April next year with a EDD of January 2010, what portion of my pregancy would be covered, would I be able to give birth at a private hospital and would I be able to see a private Obs for any or all of my pregnancy? What if my EDD was only say 1 month past the 12 month wait? What is covered then?

If I were to go public, and had shared care with my GP and the midwives at the Maternity Hospital and my GP is not an Obs, would I get any Obs visits? Or not at all?
Do I get any scans with public and are they at the hospital or can they be organised with the GP at an external imaging clinic. If there are any issues with the scans am I then referred to a public Obs or does your standard GP handle it. If I want an amnio test can this be electively done on public health? If not covered on Public how much does this test cost?

I guess I am trying to determine wether I should put of TTC for another 12 months until I am past the 12 months wait, or if I should just bite the bullet and start TTC early next year and hope that there is not too much problem covering early pregancy on Public and then later on Private.

Eeeeek!

Anyone who can shed any light on any of these questions will be my new best friend! Thanks for taking the time to read!!

I can't answer most of your questions but I think if you can you should get yourself familiar with all birth choices available to you. Starting here; Birth Options Association Australia, would be a good start.

Each public hospital is different with regards to what care programs they offer. For instance mine offered midwifery care only, share care which is combined with your GP, a birth centre option, a young parents option.... I saw an obstetrician ONCE during my pregnancy and not one was in sight during my naturalm drug free, intervention free, brilliantr birth ;). The only reason I saw him was to discuss my drastically low iron levels.

My mum also gave birth to TWINS (in december), born vaginally, despite a separate hospitals attempts to force her into a ceasarian... all with midwifery care. There was an obstetrician on standby in case twin two turned during labour etc, but was not necessary - and who says twins, premature ones at that, are considered high risk?

If you want to see an obstertician because if you need a c-sec you want to know who is cutting you open, well that is your perogative. But if you are confident that you want a natural, intervention free, calm and empowered birth, I suggest midwifery care all the way.

Just because you have PHI doesn't mean you won't end up with out of pocket costs either. If you have an epidural or end up with a c-sec, there's thousands of dollars gone. How about if you're overdue... private obstetric care has a reputation for looking after themselves before thier patients (ie watching out for their bedtime ;)) and if you were say induced early just so your obstetrician was there; if baby isn't ready and your induction fails then follows by the cascade of intervention.

These choices can be hard, or they can be easy. I think deciding on where to have your baby is a matter of prioritising what you want from your birth first.

GOod Luck. BellyBelly is a great way to source your information but there is a rather postive skew on natural, midwifery led birth. :) Check out the birth and labour forums and Im sure you'll sourcve a lot of people questioning things like this earlier.

Thanks Cookie! I'll enjoy having a read.

Truth be known I will be happy to have as natural birth as possible, but I have a very worried husband. (Bless his heart) His best mates wife had one of those terrible experiences where everything that could go wrong did go wrong, haemorraging, blot clots afterwards travelling to her lungs, bad tearring etc, and he is frightened whitless that he may lose me, and given that I had to work hard to get him to agree to have a family in the first place I have to consider his fears as much as possible.

Bearing this in mind if I did go private I would want it to be in a public hospital where there was good access to emergency facilities if necessary!

I am a public hospital girl and love it.... even though we now have PHI I wouldnt be using it when we have our next baby....

I thought that you couldnt get PG for 12 mths after joining the PHI so in other word if you got PHI today you wouldnt be covered for a PG until this time next year....and if you did get UTD then the PG and birth wouldnt be covered but baby would be once its born... ( aslong as you get family health ) I could be wrong I am almost all the time LOL

Ring up a few heath funds and see what they say....

I can totally understand your husbands fear - my partner was similar.
His mother had a very 'negligent' doctor and she ended up tearing right through her rectum, they stopped counting at 150 stitches and now essenially has no function down there. She has a stoma (like a plastic poo bag) instead. Knowing this, he was very committed to "the knowledge of science" and would have much preferred me in private care.

But, his mum also used to work in medical records and advised things like this only happen in a very, very small percentage of births. And the way birth is handled these days is very, very different. The hardest thing for me was convincing DP to read and learn with me (so stubborn and hardheaded)! He would scoff at the power of breathing during birth (despite the fact it'sto do with supplying your uterus with more oxygen and therefor it working more effectively and lessening the pain). There is no harm in starting to look now for things that can help you during birth.

Learning about the best way to manage birth - the effects of induction, what an epidural does to slow down or hinder labour, ways to reduce the likeliehood of tearing, the causes etc. As they say knowledge is power. :)

ETA: What Tali said about the waiting for waiting period to be over before getting pregnant sounds right, as your birth would likely not be covered because your pre-exisiting condition; pregnancy was conceived before end waiting period.

I took out PHI soon after my wedding because we were planning for a baby, the way it works is you cannot make a claim with your insurer for pregnancy related expenses until you have passed the 12 month period. This doesnt mean you cannot get PG for 12 months, technically 3 months after you could get PG but would need to bear in mind that if you have early labour you may not be covered. My insurer told me that they cover the accommodation side of things, so the private hospital fee. Not sure about obstetricians, I think that is a medicare thing but you have to pay the gap amount. Tests are also a medicare thing as well I think. But dont quote me, im still learning myself!

Public, Private, Birth Centre or Home?
Who Cares? Choosing a Model of Maternity Care

If you have a paranoid DH I'd suggest you go public. Public hospitals can cater for all emergencies, some private hospitals can't but they wont tell you that.

Each hospital does things differently so it depends where you are intending on going. My public hospital did not provide any scans - just had to get those organised through my own GP or OB.

I had a private OB for all my appointments - cost $50 each visit for which I was out of pocket around $15 after the medicare rebate. My OB did not charge the pregnancy management fee which can be a couple of thousand. This was because I was going to a public hospital - if I'd been going private I would've been slugged with it.

It was pot luck which doctor I got when I went into labour but I got lucky and got a fantastic one who came to the rescue just when I needed him to. If I didn't have complications I would've just given birth with the assistance of the midwives. I hadn't met any of the midwives before (nor the doctor) but that didn't bother me at all.

I had an amnio and I had to have it done privately. It was done at another OB's office. I can't remember exactly how much we ended up paying as there were I think 4 different components to it but I think we were out of pocket about $80 for the scan and the procedure itself, $200 for the FISH results (results within 24 hours instead of having to wait up to 2 weeks) which are not medicare claimable and about $100 for the lab results so somewhere around $400. I've heard some people do get an amnio done publicly but I was never given that option.

I was very happy with my public hospital and bubs and I ended up staying 5 days (he was in special care) and we didn't incur any costs at all (apart from the TV).

I have to agree with Satya. My DP works in emergency medicine and I had this discussion with him when we fell pg with DS. He also told me that a lot of private hospitals can?t cope with a real emergencys and he knows of a lot of patients who have had to be transferred in the middle of labour or the baby rushed off to another hospital as soon as it?s born to hospitals where they can cope with the situation.

I did share care with DS which meant that I got a 12 week scan and the 20 week scan. I also had to have an additional scan and amnio at 14-15 weeks which was all covered under Medicare.

You can choose to have your baby in the public hospital and then transfer afterwards to a private hospital if you would prefer your own room. Check out your public hospital and private hospital before making the decision. Some public hospitals have single rooms anyway.

Good Luck

I just wanted to say thanks for posting this! We will be trying at around the same time, and it's been really good to read everyone's responses!

Good luck with your TTC!

We chose to go with Private Health Insurance about a year before TTC so that we would be covered. We are with NIB and pay about $169 per month for full cover for family and this will include bump when he arrives all we have to do is call NIB so they put him on the policy. This covers all the private hospital costs including theatre if needed which can apparently get into the thousands. We only need to pay the $500 excess and pay extra if the annethestic guy is needed cause they get billed seperatley. Make sure your insurance covers special care nursery if baby has to be taken to baby intensive care. Apparently not all health insurance cover that. I asked my local public hospital about having the baby in public as a private patient and they were not that happy to do this and could not guarantee a private room. In fact I was so upset that they were so rude about it that is why I decided to go Private. My Ob is only one block away from my private hospital also, thats great cause I know if something happens I am close to him and the hospital. I have had a tour already of the hospital and it was lovely and quite and clean! A lot of public hospitals are a bit grubby, so keep an eye out for that when you decide.

Just wanted to update this thread with a not so positive private hospital experience I heard about on the weekend. A relative of my mum's neighbour discharged herself from a Melbourne private hospital 24 hours after giving birth.

She may as well have given birth in a public hospital as her OB didn't turn up for the birth and she got the one on call (who just happened to be my OB who she loved). She only saw her OB twice during the pregnancy (all other visits she just saw the midwife).

She left the hospital early because she was basically just left in her room and was not checked on or provided with water. Apparently the facilities for using bottles were not good in the room and the midwives were not at all helpful so she went home early as it just seemed easier.

Not a good experience allround, but she sure paid for it.

If you ask around, you will hear mixed stories about public vs private. One piece of advice I would give you, is that your own preparation is probably more important than where you birth. If you are well informed, then you will be able to make better decisions and in most cases this will lead to a far better birth experience.

It is amazing how many people rely on What to Expect and Up the Duff as their only sources of information during pg. Reading really good books on labour and birth are far more helpful IMO. I would start with something like New Active Birth. This will help you understand the birth process better, and learn how you can help your labour by being active and getting into positions which assist, rather than hinder, labour.

With the right information (and a little bit of luck) you can have a great birth anywhere.

There is always going to be different opinions on public vs private. I would suggest that you consider both and then do what you feel is right for you - do tours of the hospitals, speak to staff and other mums etc but in the end go with your gut feelings. I went private and think it was worth every cent, had an OB who I was confident in and who listened to me and my concerns. In the end I got the birth I wanted and a great hospital experience. I will be doing the same in the future.

Good luck, its great that you are getting prepared now!

Thankyou so much for doing this thread, I to amd going to start TTC in dec or jan, but now i have read this i am so confused, we will be going public as we dont have insurance, But I had both my boys in New Zealand, and although I new aussie was different I dont think I new how much.
Do you have to pay for a C- Section??. (I have had 2 previous).
Do you have to pay for the scans?.
thanks all this is so helpfull :)

krissy2 - If you go public you will pay nothing for the birth regardless of what it involves. You may have to pay for scans though - hospitals vary on this one.

Krissy, Satya is right - you won't have to pay for a c-sec if you go public. And with the scans, it depends on what you're talking about... I believe both the 12-ish week Nuchal translucency scan (I didn't have this one, so not totally sure!) and your 18-20 week morphology scan - both ultrasounds - are claimable on medicare. We had the morph scan at an imaging centre, paid the fee and claimed afterwards. Got all except around $20 back, I think?
EternalHope, I so agree with MantaRay on this one. The public vs private debate is a bit silly, as we are all different, and hospitals are all different, and people's experiences of the same hospital can be different! Like what MR said, prepare yourself for the birth - as Cookie said, BB is a great resource for natural birth options and gives some great suggestions of further resources that will also assist you in preparing as best you can. Support people are something to think about too - if your DH is very nervy about the birth, you might want to think about having a doula to guide you through the pregnancy and support BOTH you and your DH through the birth.
Others know a lot more about PHI than me, but I'd suggest ringing a few different ones, or talking to a broker who might be able to find out more info for you.
With the shared care thing, you would get to see an OB if you needed to. E.g. I went through the midwife clinic at a public hospital, and had high BP toward the end. I saw a public OB a couple of times to consult about that.
Not sure about the amnio (would you really need one?) but the ultrasounds should be covered by medicare if not in full then close to it. But it definitely won't be like some private OBs who will give you an ultrasound at every visit - you'll likely only have two for the duration of your pg unless there're complications. Not sure what you mean by issues with the scans, but if you need specialist obstetric care then you will receive it from a public OB. You won't be able to choose the OB - who you get will be who you get IYKWIM.
HTH a little and good luck with your TTC!