Differences between Public and Private Obstetrics
The public system is designed to care for the population, the private sector focuses on the individual.
The public system’s role is to ensure that the population as a whole is provided with the best care their budget allows for. Often this care cannot take individual preferences and requests into account.
Patients have to fit in with a system where success is measured in things like “length of stay” (the shorter the better), “length of waiting lists for surgery” or “length of waiting list for an appointment”. If you are classed as a non urgent the benchmark is a 12 month wait for a clinic appointment and a 6 months wait for surgery. Sadly these targets are rarely met.
Being in pain or in discomfort does not make your case urgent, it only becomes urgent if you are at risk of complications or death. Once you get into a clinic you will often wait for hours to be seen. Despite public hospital being staffed by dedicated well trained individuals, the system they toil under often makes patients feel unwanted and uncared for. We know because we worked in these clinics and were often frustrated by the inefficiencies and understaffing. The “system” does not care and no individual takes responsibility for this lack of care. As long as randomly assigned targets are met, the bureaucrats are happy.
If you are pregnant you should get into the system fairly quickly (babies cannot wait that long!) but you cannot choose a hospital, you will be sent to the hospital of catchment area you live in or to King Edward Memorial Hospital if you are regarded as high risk.
Choice of doctor.
In the public system you are often cared for by teams. It is possible that you will go to your clinic visits and see a different person at every visit and be looked after by several shifts of doctors and midwifes during your labour. Handovers will take place to ensure your safety but the personal element is often lost. It can be very confusing and unsettling for patients, especially when there are complications and plans have to change. When you have a private specialist, they will be responsible for your care. If they are not available, the doctor covering for them will see you and be responsible for your care.
Trainee staff as primary care providers.
Front line medical staff in the public system are usually trainees. There are consultants (fully trained specialists) available but they are usually only called when things go wrong. Everyone has to start somewhere and this is how junior doctors get their experience. Inexperience is an important factor in medical error and public hospitals guard against these by having regular clinical rounds lead by consultants to oversee management and make decisions.
Women are often frustrated by the inability of their immediate carers to make management decisions. For instance when a complication come to light after hours they may be asked to wait till the next clinic to discuss their future treatment with the team assigned to their care as the staff looking after them either do not have the knowledge or the authority to make those decisions.
Antenatal care is provided through antenatal clinics which usually means long waits in overcrowded public clinics where you will be seen by a doctor or a midwife and where you will rarely see the same person twice. This makes it very difficult to build a relationship of trust with anyone. You have to trust the “system” and hope that you can communicate effectively with the people assigned to you. It often means telling your story over and over again.
Management decisions are restricted by protocols.
It is not unusual for a woman to request an induction of labour or even a Caesarean section for personal reasons. This is often not possible in the public system because if they do it for one they have to do it for everyone and the system cannot accommodate that. The system can only cope with so many inductions or elective caesarean sections. (That does not mean that we are pro caesarean section or pro induction. We are pro vaginal birth and believe in as little intervention as possible but you have a choice and we can discuss that with you in an open and honest way so that you can make an informed decision.)
Lack of Equipment.
We have an ultrasound at the bedside, this is not available in public clinics. We have the facilities to do colposcopies and insert contraceptive devices (eg Implanon or Mirena) on the day so no need to return later and again wait for hours to get it done.
Lack of beds and shorter length of stay.
Private hospitals generally have better facilities and food and you can stay longer. Currently the aim in public hospitals in WA is to discharge women within 36 hours after their first baby and 24 hours after their second baby. This is medically safe but terrible for women who have just given birth and gives them no time to learn new mothering skills. Health funds generally pay for women to stay in hospital for 4 days after a normal delivery and 5 days after a caesarean section (and as long as medically needed if there are complications)
As a private patient with the doctors at POGS you will receive:
- Quality care by a specialist obstetrician. Our doctors are fully qualified Specialist Obstetricians who have completed the 6 years of specialist training and have been working at POGS for 8 years.
- Personalised care because we value every woman as a person, we value her relationship with her partner and share her excitement in the new life developing inside of her. We see it as a privilege to be chosen to be your doctor at this very special time. Waiting times to see our doctors are much less than in a public clinic. Emergencies do happen and there can be a long wait but that is the exception rather than the rule.
- Excellent support staff. All our staff share our ethos and are accommodating and caring. They understand that they are an integral part of a team that is providing care to women.
- We do ultrasound scans with every visit and will usually provide images of your baby. We can check the baby’s growth, fluid volume and position at every visit.
- Labour care. During the labour women have one on one midwifery care. Your doctor will liase with your midwife and remain fully informed of your progress. We can also check your results and the fetal heart rate remotely on our computers. We are happy to discuss birth preferences and accommodate requests provided that your baby’s safety is not put at risk.
- Special requests such as inductions or Caesarean sections can usually be accommodated.
- Hospital benefits. We practice at both SJOG Subiaco and SJOG Mt Lawley. Visits to see the facilities on offer at these hospitals can be arranged. Women can stay as long as their health fund will pay for (discharge for uncomplicated vaginal deliveries is day 4 and day 5 for a caesarean section for most funds). You may go home earlier than that if all is well. Your partner can stay with you at SJOG Mt Lawley, SJOG Subiaco has some double rooms available.
- Liason with your GP. GPs hold the health system together and it is very important that you maintain that link with your GP troughout your pregnancy. Your GP is the best person to provide ongoing care after the birth of your baby thus we work closely with your GP who knows you and knows which professionals in your surrounding area to refer you to. Medical care can be very complex and sometimes there are several specialists and allied health workers involved in the care of a single disease.
Pregnancy is not a disease, it is mostly a condition of ultimate health! Unfortunately things may go wrong and we will manage and liase with all the people involved in your care during your pregnancy and in the immediate post natal period, (sometimes also called the fourth trimester).
But the time always come for you to go back to your GP who provides ongoing care for both you and your baby. Until the time comes for the next baby!
We work closely with physiotherapists, diabetic educators, psychologists, Maternal-Fetal Medicine Specialists, Obstetric Physicians, Cardiologists, Paediatricians, Paediatric Surgeons, Lactation Consultants, Psychiatrists, Endocrinologists, Haematologists, Infectious Disease Specialists and General Surgeons to name a few.
Differences between specialist obstetricians, general practitioners and midwives
Specialist obstetricians have specialist qualifications ie they have completed a medical degree and then obtained a post graduate degree (minimum 6 years of training in obstetrics and gynaecology). This training covers both low and high risk obstetrics, fertility management, antenatal (pre pregnancy), pregnancy, labour and post natal care.
They are also trained in assisted delivery (eg vacuum delivery) and surgery (eg removal of retained placentas, caesarean sections, suturing episiotomies, hysterectomies, pelvic floor repairs.) During their training they are taught to manage normal deliveries but also how to deal with all complications associated with pregnancy. Most obstetricians also practice in gynaecology which means they can deal with other gynaecological issues where needed.
GP obstetricians are trained primarily in general practice but they may also have a Diploma in Obstetrics (six months training) or an Advanced Diploma in Obstetrics (12 months training). Their training covers low risk obstetrics and certain aspects of high risk obstetrics but not to the extent of what is covered by the specialist curriculum. Some GP obstetricians can do caesarean sections.
According to the Australian College of Midwives, a Midwife is a qualified health professional, trained and committed to providing care, education, advice and support to women and their families during pregnancy, labour and birth, and the early postnatal period. Their training focuses on intrapartum (labour care) and post partum care, especially breastfeeding.
Midwives provide one on one care during labour and you will receive this care in both the public and private system. After the birth of your baby midwives will provide care to both you and your baby and assist with breastfeeding. Most midwifes do not provide antenatal care.