Gynaecology Services

Emma is a general gynaecologist and particularly enjoys contraceptive counselling, menopause management, vulval dermatology or pain with intercourse, dealing with heavy periods and prolapse. She works to help women with endometriosis with medical management (most of their care) but has taken to referring them to an expert gynaecologist for their actual surgery. She does not do investigation and treatment of abnormal pap smears (colposcopy).

What does Private Obstetric Care Look Like?

Emma likes to meet her patients for the first time at about 8 weeks gestation, so she has time to discuss their options for Down’s Syndrome screening and genetic carrier screening. She recognises and respects that not everyone wants to undertake these tests. Other tests in pregnancy include ultrasounds at 13 and 21 weeks, which may be done locally or by a specialist obstetrician in Melbourne if there are concerns. Diabetes in pregnancy testing is done at about 28 weeks pregnancy. Ultrasounds for baby growth later in pregnancy may also be needed.

Generally, Emma sees patients monthly until 28 weeks gestation and more often after that. Some patients, who have had miscarriages before, see her weekly in the first trimester for reassurance. Emma provides basic ultrasound of pregnancy including confirming a foetal heartbeat and due date early on, and foetal wellbeing and position later in pregnancy. Routine vaccinations and anti D injections are offered at the appropriate appointments during your pregnancy. Patients are given a copy of their notes and results (a pink folder) updated throughout the pregnancy to take with them if they travel and to bring to hospital when they are admitted.

If you need admission to SJOG during pregnancy (for a pregnancy complication, IV fluids for morning sickness, an iron infusion or for a concurrent illness) this can be arranged by Emma and she will see you on the ward. She will be nearby and visiting often whilst you are in labour, present for the birth of your baby and see you at least daily whilst you are an inpatient. Her care continues for 6 weeks after the birth, and she is available to help you with any issues to do with breasts, wounds, bleeding or mental health. The six-week appointment is to review how the parents are coping with their new roles, to check the body has gone back to normal, the baby is growing well, and to discuss contraception or plans for another pregnancy.

Emma is available for her patients Monday to Friday 24 hours and 1 in 3 weekends, which she shares cover with Dr Cameron Sharp and Dr Peter Roessler. She delivers almost all her own patients. She has about 5 weeks holidays per year. Emma usually organises these about 9 months in advance so that women can consider choosing another obstetrician if they know Emma will be away and another obstetrician will be covering for her.

Shared Care

Emma takes on a maximum of 3 shared care patients per month. These are ladies who don’t have private health insurance but choose to pay to see Emma for their obstetric appointments during the pregnancy but deliver as public patients at Bendigo Health with the doctors on duty there. Emma co-ordinates their care, communicates with the doctors at Bendigo Hospital and helps plan their delivery. On discharge from hospital, Emma takes back their care to help them through the first 6 weeks and see they are ready for discharge back to the family doctor.

Originally these spots were meant for ladies with previous poor obstetric outcomes or mental health issues that needed to see the same senior doctor for all their appointments. The advantages of continuity of care are being recognised by an increasing number of patients and many studies have shown it leads to better outcomes.

For these patients the 28 week fee is about half that of the private patients. Emma is available at the Norfolk centre to see them for most problems but for an overnight emergency the patients go straight to Bendigo Health.

Fees

Private Obstetric Care

The planning and management fee is charged at the next appointment after you turn 28 weeks. It is Emma’s promise to continue to be on call for you 24 hours per day and to be there for the birth of your baby. The fee is currently $3700 which is in keeping with the recommended rate by the Australian Medical Association. This is much less than charged by many Melbourne obstetricians. Remember, the money you pay Emma also pays for the running of the Norfolk Centre and its staff and for Emma’s insurances which are in excess of $100,000 per year.

The charge for a new appointment is $200, of which Medicare pays about $100. During pregnancy the other appointments are bulk billed. The birth cost in hospital is charged to your health fund. The amount paid for items 16519 (low risk delivery) and 16522 (complicated delivery) varies between health funds. If your insurance company pays significantly less than the others (i.e. Budget Direct, NIB, APIA or Qantas) you will be asked to make up the difference.

Gynaecology

A new patient appointment is $200, of which Medicare pays $100. Follow-up appointments are variable in price depending on what they are for. Procedures such as IUD insertion are charged extra and attract extra Medicare rebates. Emma charges the health fund rebate for surgical procedures in hospital.

Other specialists involved in your care, for example anaesthetists, paediatricians and physicians, may charge out-of-pocket fees for their services.

The Norfolk Centre

These rooms were designed and built by Dr Roessler specifically to house an obstetric and gynaecology practice. The midwives, who are on duty at the Norfolk Centre Monday to Friday, can answer your questions, provide information and advice, and perform CTGs (baby heart tracing) if there are concerns for your baby. They also assist at minor procedures, such as IUD insertion, colposcopy or biopsy.

Our reception staff can discuss appointments and the financial aspects of your care. The Norfolk Centre keeps stocks of pregnancy vaccinations and anti-D, and these are offered as part of routine obstetric care to the mother and her partner.

Having a Baby… Private or Public?

Maternity Care at St John of God Bendigo

The benefits of private care are that you see the same senior obstetrician for all your appointments through your pregnancy and have them at your delivery. An Australian study last year showed that things are less likely to go wrong in a private obstetric unit compared with a public hospital. Your care is managed by senior doctors who can talk to each other directly to coordinate your care and midwives who have experience and knowledge and are exceptionally caring. We have access to the intensive care unit for mothers if needed and theatres are always available if needed.

Going private, you get to stay in hospital longer (usually 4–5 days) after you have your baby, resting and learning about how to feed and care for your new baby. By the time you go home your milk will hopefully have come in and you will feel confident in your new job as a parent. We will support you to breastfeed if that is how you want to feed your baby, including seeing lactation consultants as well as being guided each shift by the midwife looking after you. If you choose to formula feed, we are happy to teach you how to do this.

The patients always rave about the food at SJOG. There is an extensive menu from which patients can order any time during the day, like room service at an expensive hotel. The ward has a small kitchen where you can make hot or cold drinks and get a small snack, or reheat food from home if desired. The rooms are bright and there is a fold-out bed in each so your partner can stay with you.

The midwives are available by phone 24 hours per day during your pregnancy and for the next 6 weeks after you have your baby and you can come in and be seen by your doctor if needed. There is a terrific childbirth education class included for first-time mums and a SJOG mothers’ group for all to allow you to connect with other new mums in the area.

The nursery is in the maternity ward and is run by our midwives. They can care for most babies, except for those that need to be on a ventilator machine. If your baby needs to be transferred to a bigger nursery, we will facilitate the mother’s transfer as well to keep the family together. This only happens a few times each year.

If we know prior to birth that your baby will have a significant health issue (i.e., a heart defect) we can share your care with an obstetrician in a big maternity hospital in Melbourne so the baby can receive the intensive care it needs as soon as it is born.

“Experience Joy??”

SJOG Bendigo also runs the “Joy” program. This is lower-cost, midwife-led care for women with low-risk pregnancies who have private health insurance covering obstetrics. It is especially suitable for women having their second or subsequent baby who have previously had no problems. You will see a small team of midwives through the pregnancy for your appointments, and the hospital’s obstetricians take turns to supervise and be present for your birth, just in case they are needed. You will be a patient “of the hospital” rather than under a particular obstetrician.

The Nitty Gritty…

To have a baby at SJOG Bendigo you need private health insurance including obstetric cover—this generally means gold-level cover. Usually, you need to take out the policy at least 12 months before your baby is due.

If you have a Medicare card and wish to “self-fund” the cost of having a baby without insurance at SJOG, the cost is about $10,000 for hospital costs and about $3,000 which might be needed for anaesthetics, paediatrics, and pathology. The hospital offers a “have a baby” package which covers all costs no matter what happens.

Many patients on working visas from overseas have private insurance which covers them for delivery at SJOG rather than at the public hospital. If you have neither Medicare nor private obstetric insurance, you will need to discuss your options with accounts at SJOG and Bendigo Health.

Public Hospital Care

In Australia, healthcare through the public hospital is free for those who hold a Medicare card. Bendigo Health provides pregnancy care on level 3 of the hospital. Care with them usually starts at about 20 weeks gestation and is managed by your family doctor until then. There is an 8-bed birth suite and a level 2 nursery. It has a large postnatal ward. Theatres are shared by the surgical, cardiac, and obstetric teams. They have to balance the demands of patients needing emergency surgery with the needs of obstetric patients.

As a public hospital, Bendigo Hospital is a site of training for both nursing/midwifery and medical students/junior doctors. Medically, you will be mostly cared for by doctors in training of variable experience. Some of them are just starting, hoping to be GPs and provide pregnancy shared care, up to some who have almost completed their 6 years of post-university training to become a qualified obstetrician and gynaecologist. They are all supervised by a qualified obstetrician/gynaecologist each shift, who will be consulted or called in if needed.

The care can be a bit fractured as you will see a different doctor or midwife each time you come to the hospital. The staff follow protocols based on best practice to ensure that everyone has good, safe care. As the hospital is busy, you will usually be sent home in 24–48 hours after birth. Postpartum problems are usually dealt with by your family doctor.

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The Political Message…

In no other area of life would you expect to have an expert with at least 15 years of training on call 24 hours per day for 9 months! It is a great honour to be trusted with caring for you during this especially vulnerable, stressful, and (almost always) joyful time of life.

Women’s health generally is very underfunded, especially compared to our surgical colleagues. It is not fair that obstetric insurance is only available on the most expensive policies, and that private health insurers and Medicare pay the hospital less to care for you during birth and postpartum than if you had an operation such as gallbladder removal or a knee replacement.

I am aware that women having babies are at a time of life when financial pressures are great, and so I strive to keep prices at a point which is both affordable and allows me to run a financially viable business.