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.

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.

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.

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.

“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.