Should I go private to have my baby? The care is better in the private system, isn't it?

Visit my website to learn more about my services. Well, maybe not. The study below compared postnatal care in the public and private system. Read on to find out more.


Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care …

A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care.

This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers.

… Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review.

Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and accommodate partners over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care.

… Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike.

And there we have it: care is not necessarily better in the private system.

What this study showed is that both the public and private health systems struggle to provide postnatal care. In both settings, staffing presents a major challenge: too many patients, not enough midwives, yet care needs to be provided. Hospital administrators in private hospitals make up this short fall by providing nurses instead of midwives in postnatal wards. The Australian College of Midwives is opposed to this because nurses are not qualified or educated to care for postnatal mothers and babies.

The private hospital staff reported “increased acuity of postnatal care” meaning that the women they are caring for have increased care needs. This may be a direct result of the high caesarean rates in private hospitals: up to 45%+. Caesareans often result in babies who do not feed as well, delayed milk production (and associated problems such as jaundice and weight loss in babies), greater need for pain relief, diminished mobility, far more observations are taken (blood pressure, temperature etc) and these women have a longer length of stay in hospital.

Added to this, the increased use of single rooms, while certainly loved by women, means that midwives have much further to travel to get to their patients. Those corridors can be pretty long in private hospitals! The staff desk and treatment room are often quite a distance from the patient’s room and numerous trips back and forth eat into the time that is available for the midwife to provide care.

Private hospitals often have a well-baby nursery where babies sleep overnight. In some hospitals, rooming-in is not encouraged (“get a good night’s sleep. We’ll look after your baby for you”) This separation of mother and baby impacts breast milk production, bonding and affects breastfeeding the following day. More breastfeeding problems = increased time required to care for each patient, but there is simply not enough midwives to provide this care. Nurses step in and formula may be suggested, compounding the problem … and so it goes on.

Yes, a private hospital looks nice, and granted the food is much better. Certain service aspects are better too: you get newspapers delivered, messages are delivered to your room and so on. But at the end of the day, people go to hospitals with the expectation of a safe birth and the provision of safe care. When care is provided by nurses, when caesarean rates are high and hospitals fail to meet the WHO Guidelines on breastfeeding, care may be compromised.

Melissa Maimann, Essential Birth Consulting 0400 418 448