One of the biggest decision facing pregnant women in Australia is how to manage their pregnancy and birth. And for those women who can afford to have private care or choose to budget/save to have private care, the choice between going private or staying with the public provision is a hugely important decision, but also a hugely confusing one.
There are advantages and disadvantages to both of the systems and in many cases, the option chosen will depend on individual circumstances. To make the decision clearer, work through the different factors and your budget to decide what is most important to you. 
1. Cost
Changes in the rules surrounding Medicare have meant that pregnant women are expected to pay more of the costs associated with private ante-natal care and the birth than previously. For women with good health insurance cover, they will still be expected to pay between $3,000 and $4,000 if they opt to go down the private route. If a woman does not have medical insurance, the cost will be far higher. Women choosing to give birth in a public hospital do not pay anything.
2. Birth Management
After cost, this is perhaps the most critical factor in deciding where to give birth. Women giving birth in a private hospital will have their care managed by an obstetrician, whereas most women having their baby in a public hospital will be under the care of a midwife. Statistics show that intervention rates when care is managed by a doctor are higher.
This is thought to be because obstetricians are more used to dealing with the abnormalities of birth, and are quicker to intervene in labour. Caesarean section rates are higher for women giving birth in a private hospital. Under the care of a midwife in a public hospital, women are more likely to labour naturally and give birth with less intervention.
In a public hospital there are always obstetricians present should a labour develop complications, but they are far more “hands-off” than they are in a private setting. Public hospitals run operating theatres 24 hours a day, so if a woman in labour needs a caesarean section or an epidural administered by an anaesthetist, this can be arranged with the minimum of delay.
Private hospitals normally only have staff in to man operating theatres during office hours, and if a woman requests an epidural or needs a caesarean section in the middle of the night, staff may have to be called in, resulting in a time delay.
3. Continuity of Care
In a public hospital, a woman in labour may be attended by several different midwives and doctors until her baby is born. She may not have met any of these people before, and the midwife or doctor allocated will depend on who is on duty at that particular time.
If women opt for private care, they will be able to choose their own obstetrician, and that person will see them through their pregnancy, will be with them as they give birth and will also visit in the hospital once the baby has been born. Many women find this continuity of care highly beneficial and reassuring in that they can build a good relationship with their obstetrician.
4. Complications in pregnancy and birth
Women who have had a difficult pregnancy of who have had complications will have been seeing an obstetrician prior to birth, and their care during labour may be managed differently. Care during a planned caesarean section will be broadly the same whether giving birth in a public or private hospital. Many private hospitals do not have as good facilities to deal with premature or ill babies as public hospitals, so for women going into premature labour or for those whose babies have been identified as having a potential birth problem, public may be the best choice.
5. Accommodation and Food
There is no denying that giving birth in a private hospital may be a more pleasant experience. Most private hospitals will offer individual rooms with en suite bathroom facilities. Rooms are often more akin to being in a nice hotel than in a hospital, and the environment may be more comfortable for partners too. Public hospitals do not all offer private rooms and may appear more basic. Food in private hospitals is generally of a better standard and patients may be given more flexibility over what they eat.
Let us know what you chose and any positive or negative experience you had.
