The real cost of having a baby

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

HAVING a baby is an extraordinary gift, but from the minute you see that double line spring to life on the home pregnancy test, the questions start ...

... can we afford it?

It's not until it reaches this point that a couple must choose whether to have the baby in the public or private hospital systems, and often cost is the deciding factor. So how much can you expect to pay to give birth to that precious bundle of joy?

I have a big issue with any discussion of birth choices that leaves out two important options: private midwifery care and homebirth. It's not as simple a "public or private". Unfortunately the vast majority of Australian women are not given all of their options. I'm hopeful that this will change after November this year when private midwives will for the first time be given Medicare Provider numbers and access to the PBS for hospital birth.

Public vs private

... The reputations of maternity wards in public hospitals are getting better and better, and often, if there is an emergency, a private patient will be rushed to the nearest public hospital for treatment.

But there is also a niggling perception that you are "just another patient" in the overcrowded public system. Do you want to take the risk of your case falling through the cracks or becoming a public hospital horror-story statistic?

What an emotionally-laden and inaccurate report to state! There is far more accountability in the public health system and that is why cases that "fall through the cracks" are exposed. They are exposed, often a root cause analysis is undertaken, memos are written to staff, staff are disciplined if indicated and general improvements are made.

Often it is the same doctors doing the rounds in both public and private hospitals, but the difference is that in the public system, who you see comes down to luck of the draw, and a complete stranger will be delivering your child.

In many hospitals, caseload midwifery and team midwifery models are being established to increase the woman's chance of birthing with a midwife she has met before. Of course, if women choose to birth with a private midwife, she will absolutely have a midwife she has met before.

When you go private you can get to know your doctor, devise a solid birth plan and take comfort in knowing they'll be there for you no matter what.

I don't know too many obstetricians who are wholy supportive of birth plans, unless the birth plan allows for epidurals, induction, episitomy and so on. Many obstetricians in Sydney at least will work in a team of 2, 3 or 4 obstetricians and they share the on-call on weekends and public holidays. So for approximately 114 days of the year, a woman has a 25% chance of having her doctor attend her.

If there's an emergency and your doctor is sick or on holidays, their office will give you an alternative contact who knows your case.

How is this any better than having whichever obstetrician is on call in a public hospital?

In the public system, a team of midwives will see you for appointments and the on-call doctor will perform your delivery when you go into labour.

Ahem. Midwives "deliver" the majority of babies in this country, not doctors. We can a doctor in if we need to, but midwives re qualified to attend normal births.

Another factor to take into account is hospital rooms. If you go private, you get your own room (providing there is one available), but in a public ward you may have to share with three other women.

Many of the public hospital maternity wards are being or have been re-built. And most have single and doulbe rooms. No more sharing the room with 3 other mothers and babies. The newer rooms also have lovely ensuites. And the food has improved over the years!

Privacy comes at a cost, though, and a private hospital stay can cost in excess of $7000, or more if your baby requires emergency care or you need extra medical help. The good news is that the bill gets sent straight to your health fund, which covers the full cost (you may have an excess of a few hundred dollars to pay, depending on your policy).

Or a thousand or so dollars, depending on the co-payment or excess. Plus parking, phone, meals for partner, snacks at the cafe, anaesthetist, paediatrician ...

If you're nervous about the prospect of the birth and want a familiar face attending you, and a private room to recover in, private is for you.

I disagree. If you want a familiar face in labour, you're best to use team midwifery, caseload or have a private midwife. In the private hospitals, women will not have met the labour ward midwives before arriving in labour, and they will not have met all the postnatal ward midwives.

... Obstetricians

If you decide to go private, a new challenge arises: picking an obstetrician. Choose someone you get along with, who calms you down and who is always available to answer your questions.

Hmm. So bedside manner is more important than outcomes? Bedside manner is more important than intervention rates?

Pick a hospital that’s close to home and go through their doctor lists. Look at internet pregnancy forums and ask other mums about their experiences with certain doctors ...

An initial consultation costs an average of $200. You will get $68.75 back from Medicare.

An obstetrician’s full fee ranges from $2000 to $10,000. The higher bills include all appointments, which total up to about 15 by the time you are 40 weeks pregnant.

If you are billed separately for each appointment, they cost a national average of $80 to $100, of which you get back $34.40 from Medicare.

An average bill for a Sydney obstetrician is $4000 to $5000. This is much higher than the national average of $1700, according to the Australian Medical Association. As of January 1 this year, Medicare will give you a rebate of $463. Prior to January, patients got 80 per cent of the obstetrician’s bill back. So going private now costs families thousands of dollars more than it did before.

Unless women opt for a private midwife. This option will be funded from November onwards making private midwifery a more affordable option for hospital (and home) birth.

Ultrasounds

If you’re going public, ultrasounds are free, but you only get two: one at 12 weeks and another at 19.

If you’re going private, your obstetrician will send you off to ultrasound clinics for the big scans, which cost between $200 and $300 a pop. Of that, you get back roughly $50 from Medicare and none from your private health fund.

... Baby bonus

Once the baby arrives, you may be entitled to the baby bonus and ongoing government help to recoup some of the money you’ve spent and allow some financial reprieve while mum isn’t working.

The sum of $5185 is now paid in 13 equal fortnightly instalments, and is payable for each child in a multiple birth. To be eligible, a family must earn less than $75,000 in the six months after the birth ...

Melissa Maimann, Essential Birth Consulting 0400 418 448