My dilemma - Public or private care during pregnancy - doing my head in

OK, I've been going round and round in circles on this and it's doing my head in. I just can't make up my mind on which way to move forward with my pregnancy care. I have private health insurance so I can go either way. Excuse my stream of consciousness below, but I just need to get this all out.

My pros for Public
- I get to deliver at the Royal Women's Hospital - it's very new and very beautiful. It's also the best maternity hospital in Victoria and if anything (god forbid) goes wrong then I am in the best place to sort it out.
- Midwife led care - I understand the research that midwife led care for uncomplicated pregnancies is the best way to go. I am hoping (as I'm sure everyone does) that my pregnancy is very straight forward with no problems.
- The Royal Women's provides a midwife community clinic 2 mins walk from my house and also very close to work. This means that apart from my first appointment at the Royal Women's, all of my appointments during my pregnancy will be at the Community Clinic. I am also hoping that because it is a small clinic, I will see mostly the same staff.
- It is all free, leaving me more money to spend on our new addition to the family.
- Low intervention rates - I am very aware of their different philosophy to pregnancy and very much want a natural birth.

My againsts for Public
- Being rushed. This is my first pregnancy and I don't really have any close friends that have been pregnant. Hence, I have little clue what I'm doing. I want continuity of care and someone who is there 'for me'. I'm not sure that the Public system won't provide this, but I know how very busy and stretched they are.

My pros for Private / Obstetrician led care
- OB's provide more of a specialist care in case something goes wrong. Also, they are more on the look out for things that might go wrong.
- I get to see the same OB for my appointments
- Frances Perry House (where I would go) is very beautiful and comes highly recommended
- I know it's probably a bit shallow, but I love the idea of going to a swish hotel after birth
- We can afford it, making it an option

My against's for Private / OB led care
- High intervention rate - I don't want drugs / a cesarean unless it is absolutely necessary. This is a big one for me.
- The OB isn't really there for the whole birth to explain it to me anyway.
- It costs a lot of money, which could be better spent

Husband sees both sides, but thinks that is we can afford it surely we should have the best care, which in his view is 'private'. But I'm not so sure it is the best care, for me anyway. However, he'll back whatever call I make.

Other options
- Independent midwife - This interests me, but for the life of me I can't find any based in Melbourne's West. Any suggestions would be super!
- Doula - See above.

Some questions...
Can I start down the public path, but if my pregnancy is complicated move to an OB to help me through? I know it can be very hard to get one after 8 weeks of pregnancy so don't want to miss out on the good ones !

And here's me making a decision...!
I think I'd like to stick with The Women's for now, but meet with a doula and talk to them about the whole thing.

I think that I'm thinking too much about this! However I hate indecision and like to be very organised and know what I'm doing.

Sorry for the long post.

Cheers,
Fiona

Can you be a private patient in a public hospital?? I have a feeling you can and then you can extend your stay if you do not want to be rushed and kind of get the best of both worlds. Have a look into it. I am not sure of all the pros and cons of this but will ask some people who have done this.

Oh and in a public hospital you will always see a OB if your pregnancy becomes high risk. If you are low risk you will normally just see a midwife.

if i were you, i would make a decision and stick with it. i wouldn't be changing haf way through as i think this will only stress you out even more.
do you know anyone who has used any of the obs you would consider using that you could have a chat to?

From my experience I would go public with a doula (what I'll be doing next time). I went public with a midwife who was allocated to me, but I didn't find she gave me enough support during the actual labour, and I ended up with a c-section - not to say this wouldn't have happened anyway, but I might have had less regrets about it. I'm almost 100% sure that the labour wouldn't have been any different with a private ob (I had the same choice as you with private health) and stories from my friends made me wonder why you pay all this money to an ob who tells you to hold on until he gets there for the birth- it's not like you need him unless there are difficulties, and you'll get an ob in a public hospital if that happens anyway. By that time you're probably so over it you don't care who your ob is!

Food for thought, have you taken into account the different nursing care you will recieve in public hospital versus private. In a public hospital there is a set nurse to patient ratio which the hospital should obey. Not all private hospitals have the same ratios so i would be asking this before i booked into a private hospital as you do not want to be sharing your nurse with anymore patients than you have to. Especially important during labour and post natal care, if you need help breast feeding etc you don't want to have to wait forever for your nurse to be available.

I think this is a very personal choice and one only you and hubby can make yourselves. It's great to get lots of feedback from others who have used both options but ultimately you need to decide this yourself and based on what you want. From the sounds of it though you seem to be swinging towards the public option. Don't let the idea of going "private" sway you especially if you have a fantastic public hospital at your disposal.

Having said that I went private and don't regret it one little bit. My OB was AWESOME and went above and beyond what I expected. He came to see me several times during my labour (only 10 hour labour so not too long). The midwife who was with me for the labour was fantastic and I knew her from our antenatal classes, she even stayed past her shift to help deliver me. I had some difficulties during my PG (CVS and GD) and found that being with my OB gave me a better sense of calm and explanation as I could go to him for answers and a caring voice to answer me. I could ring him at any time with any concerns and get an answer. My hospital was wonderful, cannot fault it. The rooms were gorgeous and very private, own bathroom and it was like staying in a hotel. Food was fabulous and I even got a double bed in my room.

Regarding intervention, it would be a matter of finding an OB who is happy with your birth plan and to follow it. One nurse who saw me early wanted to try sintocin to speed things up (mind you I was dialating at at a good rate) but my OB said no and was happy to let me go as is, so it really is a matter of having your OB be there for you!! My OB didn't rush me and was happy to let me go naturally even though I had gestational diabetes which generally means induction and c/section is baby is big. I had neither occur and bubba was small and luckily went into labour naturally 11 days early. I will go private with any further pregnancies..

So this really is a decision you need to make yourself, obviosuly with some well meaning information behind your decision. I would recommend making the decision and sticking with it as switching half way through may be more stress than you need. Also if you were wanting to switch to an OB half way through you may find it difficult to find someone as you generally have to book in early with an OB. I know someone tried to book with my OB 1 week after I did and couldn't get in. Most OB's book patients based on their due date, so they may take X number of ladies due each month and then that is it. Good luck and happy and safe pregnancy..

I am feeling this dilemma too.

THis will be my 3rd baby.

Private:
THe first was private with appointments with Dr Bella in Eleanor St Footscray (you mentioned the western suburbs so thought I'd pop that in). Then a delivery at The Mercy (East Melb now in Heidelberg) where I ended up needing an emergency c-section. I don't beleive my health insurance status had anything to do with it, the baby was posterior and it was a 13 hour labour. He just wasn't coming out.
My prenatal care was very good, in hind sight I would say this ob was much more thorough and gave me every test imaginable just so she was ready and could rule out everything. For instance the test where they check you for Strep B. Later in my 2nd pregnancy I would find out that the public system doesn't always request a check for strep B. I came up positive for for it so was very happy they found out before baby was exposed.
Financially I was up for a capped $800 in dr.s appointments, plus all my scans and blood tests, plus co-payments on my hospital stay, plus the anasteasiologists (i haven't even tried to spell it right sorry) fees. Probably close to $2000.

Public:
The second was public system with appointments at The Mercy and a natural birth at The Mercy. This was a wonderful experience and I was lucky to have been given a double bed in a private room just because they had iy spare. The pre natal care was all by the book. I fortunately had a very 'boring' pregnancy. I felt like an old hand by then and was just attending appointments as a matter of obligation. The scans were the most exciting part for me. Financially I just paid for my ultra sounds and blood tests. Depending on where I went for the u/s this pregnancy would probably have cost us about $700 tops.

This 3rd one -my due date is about 18 June - confirming with and u/s in a week or so.
Dr Bella's assistant wasn't sure if she could take me on since my due date is still under question and the dr is away for May 2008. Rather than risk her office saying no, I have booked in with an Ob who delivers at St Francis Perry House.

Co-care? :
However I am in two minds about it. A friend mention co-care or something like that where you attend appointments as a public patient. I was very happy with my pre-natal care the second time around, publicly. I didn't see the same person at each visit but they were all well versed on my history and they don't really do all that much but answer your questions, measure you, weight you, check your urine/blood send you off for standard u/s etc. It's all very scripted and standard. But then because you're privately covered you can still book in for a private delivery. I am really not sure how on earth this works and plan to attend my first appointment privately and broach the topic with the ob.

Hope this helps and doesn't confuse you even more.

I understand this is your first pregnancy. With my first I was very nervous and wanted only the very best - (lol I even bought a bugaboo which a couple of years later I regretted but they were the BEST at the time...) This time around it's about making the pregnancy as easy and stress free, and as easy on the bank balance as possible. But still ultimately, I'm undecided.

Thank you everyone for your views. I appreciate all the thinking that goes into our various decisions.

I have decided to go with the Royal Women's Hospital, and go through their Shared Care program. I have a great relationship with my GP and would like to continue to see her. The clinic is across the road from my house and also close to work.

I also got my letter from The Women's and they have a trial program at the moment, which is one on one midwife care. So everytime I come in, you will get the same midwife. That sounds PERFECT for me, so am going to sign up tomorrow.

I am also going to work with a doula through my pregnancy. I think that will be good for me AND husband. Especially husband!

OK, good to have made a decision. Woo!

Thanks everyone for your views. Muchly appreciated.

Hi Fiona, I'm having the same dilema as you. But I've already had one bub at a private hospital. I had a cs (which I didn't want) and although I got to stay in a lovely suite for 6 days the midwives were not very nice. They were always rushed and understaffed. A midwife brushed me off when I knew I had a bladder infection and they also failed to pick up that DD wasn't attaching correctly and as a consequence 5 days post birh my milk had not even come in properly.

If I knew our local public hospital was having a trial with the one on one midwife care there would be no doubt that I would go there.

This is more for Spice than for Fiona as she's already made her decision.

You can always see an OB throughout the pregnancy yet deliver at a public hospital with whoever is on duty at the time. That's what I did. It cost around $50 per OB visit (a little more for the initial one). I did this because I wanted to have the same person caring for me during the pregnancy but was happy to have whatever midwives were on duty at the time at the hospital.

My labour was long so I didn't just have the one midwife, but it was one on one care while they were on shift. It made no difference to me that I had never met them. I must admit I didn't like the first on duty doctor but the one that was there for the birth was fantastic.

We had a 5 day stay in hossy (3 days in the 2 bed ward, 2 days in a single bonding room) and all the midwives were fantastic. I got so much individual attention to help with breast feeding. Bubs was in SCU due to infection and jaundice and the midwives helped me every single feed time, sometimes staying for the whole time if I needed it. I never got the feeling the staff were in a rush, they always had time for me.

I would choose the same type of care again in a heartbeat.

I am going public and I see the same OB evey 2 weeks and I have seen the Midewifes 2ce now - I love my Ob she is perfect! And I love the support that the midwifes that I have seen have given - I have done the tour of the birthsuits and wards and they have all been updated. I have no regrets about going public - and it is all free!

Fiona - I know of a doula who works in the Northern & Western suburbs if you are interested?

I went Public and had no problems...was extremely happy with the care they provided! Had a quick labour so I had the same midwife but my sister gave birth 2 months prior and had a long labour and a couple of diff midwives but they all treated her so well and the original one stayed with her past her knockoff time until bubs was born!!! That was great of her!!!
My friend is a Doula in Geelong...let me know if you would like her website address!! Doula's seem to be a good idea these days!!!