Obstetricians - Are they a waste of money?

[nic]

My DD was born in a public hospital, and for #2 we are seeing an OB.
I didn't really have problems with the public hospital, they were great, looked after me and were genuinely concerned.
I had discussed the possibility of going to the public hospital this time round, but
DH said after all the time of TTC, and doing IVF, he would prefer to see the same OB all the time. I had 2 to choose from, and still have to travel 200klms to see either one of them. I have heard of there being a doula in our area (as in a few hours away) but that's it. I chose my OB as I had heard he was VBAC friendly and knew if anyone would help me out with one, he would be it. Sadly, after reading my medical records, he said it would be another c/s.

We don't have to wait forever for our appointments, we turn up pretty much on time and we usually see him within 10 minutes of getting there. And since it's another c/s, I know he'll be there LOL! His fee was quite reasonable i believe, especially from reading what other ladies have said they've paid.

In the end, it not only comes down to what you want, but also what services are available to you. regardless of my c/s with DD, I do not have the opportunity available to me to have a home birth, and at the time with DD, no doula a few hours away. Our little hospital does not deliver babies anymore, and hasn't for the last 20 years. If you go early here in town, there is barely any equipment for when bub is born. The call the resuce chopper if you show up with signs of being in labour.

Nic

[BellyBelly]

MummyTummy, no-one has judged anyone here. If you're referring to me, I am only adding a side to the discussion that has not already been contributed - the topic being are Obs a waste of money and I am giving my opinion. I believe in choice yes, but the choice is very once sided at the moment. It's all okay, you can have your c/s or epi if you want. But if you *just* want a midwife in the hope you can avoid all that, you have no choice. Many women cannot have waterbirths in hospitals... they talk about choice but they don't talk about the choice that is actually being taken away from them.

Willow, that 1300 you only paid, and mostly got back with the safety net - taxpayers pay for that and I think taxpayers should also be paying for midwives too if we want them, ykwim? We are paying more for a low cost, low risk choice because it's all backwards. It makes sense to me for having a free service for the essential things you NEED - the things that can get you through happy and healthy either way, but if you want premium service then thats where the extra cost comes in, not for basic service.

[olive]

DH and i recently looked into increasing our insurance and go private, but decided to put the money to better use and have a doula instead.
i did and will do again shared care midwife program, i saw the same midwife for nearly all my appointments and when my waters broke and i had to go for monitoring i was assigned one of the midwifes from the program, so i knew her, she also was on the next day and again assigned to me at shift change and delivered my baby, my GP was called but missed the birth, my fear of having a private ob, cant bear to pay all that money for them to miss the birth. if i need to mext pregnancy see an ob i will, i have already seem one for other issues, he is fantastic and still throught the public system. i shared a 4 bed ward and didnt ahve a problem with it!! my taxes pay for the public system and im happy to use it!

i think it is purly personal preference and you need to do whats right for you and partner and what makes you feel safe and comfortable.

[Willow]

I think taxpayers should also be paying for midwives too if we want them, ykwim?

Completely agree Kelly. I don't think anyone should have to pay huge expenses for something as basic as having a baby, whatever model of care they choose...(don't even get me started on the costs of IVF)

[olive]

Originally Posted by ~kaos~

Here here to Kelly's post.
Even private patients seeing an OB are subsidised by medicare (unlike me and my private MW). I believe that the medicare safety-net blowout had something to do with OB's and their fees.... Not to mention that you are not guaranteed continuity of care, especially when it come to crunch time (birth).

this what i dont understand, why should us as taxpayers subsidise private ob fees????????, you choose to go private, you pay the fees, not everyone else, the money would be better spend putting it toward the public system as a whole

[*Beema*]

I am only 16 weeks 5 days, but have had quite a lot of involvement with my midwifes and my OB, they all operate out of the same office, usually when I arrive for an appointment I go in and have a chat to one of the midwives as well, so far I have met three and they are all very lovely women, no question has been silly and they all take the time to care.

I met my OB at my first app with the Midwife, only because we had trouble finding the HB, and she squeezed in a quick scan and found the HB and explained a few things while we were there, only a short wait for the scan too.

Since then we have had 4 appointments with our OB, she always asks if we have any questions (last appointment I had a list) she is happy to discuss them all and we get answers on the day, she has a lovely bedside manner and I feel I have made the best decision for me. When i had some spotting the MW did a HB check and when I was still spotting a couple of days later she brought me in for a quick scan. Just to make sure all was fine (which they were pretty confident it would be) but to also give me piece of mind.

We will also be meeting another OB later in the pregnancy who may have to attend as from Aug, my OB is taking every second weekend off - she never has "time off" and I completely understand this and don't have a problem at all. But we get to spend some time and get to know the other OB incase she isn't working that weekend, in the end if Bubs come on one of the 2 possible days that our OB isn't working then so be it.

Excluding my 12 week scan, all my scans have been done in the OB's office as a part of my appointment, and are not further drain on the system. the only other scan I will be havin is the 19 week morphology scan and a 3D scan through a private company whom I will be paying in full - there are no rebates, jsut like going to see a photographer except a little different

The decision is up to the individual and what is right for them, I have private health and pregnancy has been one of the reasons I have maintained it (along with the heap of physio we do!!).

We are also not paying as much as anyone else, our fees only come to around 1k, that includes all of our appointments etc. Mind you I had a friend in Adelaide who paid over 2.5k.

EDIT: Also just a foot note in relation to Tax payers money being used to cover the 30% Government Rebate, we pay taxes as well, and some of those of us who may be earning more, we are paying more in tax, why should we feel bad about getting some of that money back. I do agree that PMW should be able to be a part of the rebate system, perhaps with the change of Government that it needs to be brought up in the political forum and push for change. This is not directed at any poster, just my opinion.

Goodluck with what ever decision you make, but you need to make the decision that you are most comfortable with. I feel so much more confident with the feeling that I know the people who will be attending and have had the time to develop a relationship.

[MummyTummy]

No Kelly, I wasn't referring to you or anyone else in particular - I was just putting that out there as I felt things were starting to heat up a bit, and I just think it is important for everyone to remember that it is personal choice in the end.

I do actually agree with what you are saying, it is all topsy-turvy. Even the private health system doesn't seem to make sense on it's own. I took a long time deciding which way I would go - ummed and ahhhed and talked to many different people and in the end made the decision that I felt was right for me.

It shouldn't matter how you choose to have your baby - again personal choice - home, hospital, pool, private or public etc, all choices should be available to every woman regardless. And having all these choices available would probably ease the health crisis we are currently in considerably. And having private health insurance should be covering the private options with the schmicko premium service. But then nothing will probably change until we sort out the personal liability issues. Everyone is so scared to do anything in this country for fear of being sued... which is why they all want us to know as little as possible and to just agree with what they tell us....

My other thought is that we are pregnant right now and are unable to make a change in the system personally, therefore we have to go with the choices that are available to us right now.

[Kailz]

Originally Posted by AJP

this what i dont understand, why should us as taxpayers subsidise private ob fees????????, you choose to go private, you pay the fees, not everyone else, the money would be better spend putting it toward the public system as a whole

I am going private, and I think that a lot of people who go through the public system don't really understand a few things...

* We pay our private health insurance, and if you don't have this, your up for a huge bill for the hospital stay and birth, whcih i don't think medicare gives a lot back

* Each ob sets their own fees, my pregnancy management fee is $3500, and I haven't reached my safety net, so I get 80% of whatever is left after I reach it. We are still out of pocket by a large amount, and Medicare is giving us the same treatment as they would if we were going public where you don't pay a cent your whole pregnancy.

* I believe that by going private, we are doing our part to the public health system, by freeing up that extra bed, midwives, doctors, and all of the appointment times for those people who are in desperate need for them.

* We pay our taxes just like anyone else. For one, I am not entitled to any centrelink whatsoever until my baby is born, and I am a single parent. There are a lot of people out there who use the welfare system, public health system, get their whole pregnancy for free, get free money put in their bank every 2 weeks, and then get a whopping $4000 from the government for popping out the baby. 3 years later they are back again... I am happy to say I work full time, I do my deed to the tax office, so why shouldn't I be entitled to get my ob fee's reduced? It's the same principal as the public system IMO.

I am probably going to get slammed for this, but I believe that people who do go through the public health system should be made to pay some sort of money toward the pregnancy and birth. Even if it is just $10 for a scan, or $10 for a midwife appointment, I don't think it's fair that our government is so generous in pregnancy to give people a free ride. People take it for granted and ultimately, we as tax payers are the ones who are paying for it.

As Kelly said, I do believe that Private midwives should be covered to some extent by medicare. I think the whole thing is that they don't see the benefits of them yet, and see it as a personal choice. If we could choose our ob and 1 midwife, birthing would be a lot easier.

[visitor1]

Originally Posted by Kailz

I am probably going to get slammed for this, but I believe that people who do go through the public health system should be made to pay some sort of money toward the pregnancy and birth. Even if it is just $10 for a scan, or $10 for a midwife appointment

I went public with both daughters and had to pay for every scan i had and all my health appointments. So not everyone that goes through public gets a 'money free' birth.

[Kailz]

Originally Posted by kimbaz

I went public with both daughters and had to pay for every scan i had and all my health appointments. So not everyone that goes through public gets a 'money free' birth.

I realise this, I was just saying in theory of those hospitals who do offer it 100% free, which I know a lot of women who have gone through a whole pregnancy and not paid a cent.

[meow]

Originally Posted by Kailz

I am probably going to get slammed for this, but I believe that people who do go through the public health system should be made to pay some sort of money toward the pregnancy and birth. Even if it is just $10 for a scan, or $10 for a midwife appointment, I don't think it's fair that our government is so generous in pregnancy to give people a free ride. People take it for granted and ultimately, we as tax payers are the ones who are paying for it.

I'm not slamming you, but I'm not sure why this is your stance? Why is free pregnancy care a bad thing that people are taking for granted?

[mgm]

I think I have to add my voice to this, as some of the comments have really irritated me! It is ridiculous to accuse people of being a 'drain on the system' - the medicare system is there to be used when needed. Yes, there are numerous problems with public health, medicare, obstetricians' fees etc. And of course there are all sorts of anomalies and exclusions that seem ridiculous, the non-rebatable status of midwife care among them (and don't even get me started on dental!). Then there is the fact that rather than getting the public system up to scratch, we are given financial incentives to get private health insurance (or penalties not to, depending on how you see it).

For better or worse, this is currently the way things are, but none of these issues affect the fact that each person is entitled to make her own decisions and not be accused of being a 'drain'. We all (presumably) pay our taxes, from which comes money for all sorts of things which we are then entitled to use - medical care, university fees, roads, schooling... etc. I really don't think judgemental comments have any place in this discussion!

[~kaos~]

Originally Posted by Kailz

If we could choose our ob and 1 midwife, birthing would be a lot easier.

Ahh, now this, I think, is what many women would choose and whether it is public or private, would also put a lot of efficiency into the health system and save $$.

If you were going private, you would choose your facility and your midwife who works in partnership with an OB and consults with the OB when necessary or refer you on if your pregnancy circumstances require it. An OB could work with a team of MW's and provide their expert knowledge when required. If going public, you would be assigned a MW/OB team rather than having the luxury of choice. But in the end, you'd get continuity of care throughout your labour and birth(which is evidence based best practise)

But in most cases this isn't an option (well, I can't think of one, but there may be a private program out there that does provide this service).

But the original question was are OB's a waste of money? And I still stand by my opinion that if you are a low risk pregnancy, then yes. It's like seeing an ENT if you have a cold, rather than a GP. I'm not saying that all OB's provide a bad service (though I've heard of many that do, especially in comparison to my experience with a private midwife).

And if we are talking about quality of service provision, I still stand by my opinion that for the money they get paid, there are better maternity care options for low risk pregnancies if you want to pay money out of your own pocket. How many private OB's provide in home antenatal care? How many provide in home post-natal visits. How many OB's provide appts that are more than 1hour long on more than 3 occasions. Is there one out there? (and I would really like someone to prove me wrong....). In a low risk pregnancy, what does an OB do differently that a MW couldn't?

ETA: Can I add that I don't think anyone is a drain on the system. I think everyone has the right to free/low cost health care (public). I also feel that everyone has the right to particularly choose their care provider and that that may entail a bit of a premium if they wish to do so (private). What frustrates me is the inefficiency of the current set-up and the way our choices are limited to inefficient care models when evidence suggests that there are much better ways that not only would be more cost efficient for us and the health system, but also result in better outcomes and better client satisfaction.

[meow]

Originally Posted by ~kaos~

Ahh, now this, I think, is what many women would choose

I actually wouldn't choose to see an OB at all... I'd love to have a private midwife publicly funded/subsidised so I could choose a home birth- which is also very efficient and would be a much cheaper option on our public health/tax paying dollars.

[olive]

i too had to pay for my scans and at the start of my pregnacy was told as of the next appt would have to pay around $25 each time as the government wasnt going to pay for the shared care midwifes, by the next vist that had been revoked, but i still would have been happy to pay !!
i also have private insurance! so yes im doing my part, and im not going private to 'get free birth' im going public for the midwives

[~kaos~]

Originally Posted by ren

I actually wouldn't choose to see an OB at all... I'd love to have a private midwife publicly funded/subsidised so I could choose a home birth- which is also very efficient and would be a much cheaper option on our public health/tax paying dollars.

That's why I said 'most' women (of course if it was the social norm - it would take society some time to get use to the idea and change of model of care, but it is a step in the right direction).

I'm with you

[satya]

I think for a lot of women OB's probably are a waste of money as they would receive the level of care they need via a GP or a midwife.

If I was in my twenties or early 30's I would not be seeing an OB. I am however 41 and although I am not considered high risk yet, this could change at any moment as it often does for women of my age. I also have a 13 year history of fertility problems. Because of that I am seeing an OB. It's early days yet but so far he's been worth every cent.

By the time I got to him I had seen 3 different GP's and another OB and although I thought I had been tested for everything under the sun I found that I hadn't. He sent me off for a whole host of BT's for things I'd never heard of which could affect my health during pregnancy. Had I kept to just a GP or midwife I would not have been tested for any of that, just the basic stuff that all the others had done.

I am giving birth in a public hospital so it will be their midwives that help me through the birth process. My OB is there for my care up until that time. I did not feel comfortable with the GPs I went to as their knowledge was just not enough to deal with anything but the very basics, in fact at times I felt like I knew more than they did.

As I had to go through an amnio procedure it was great to be under the care of an OB to have some informed information plus prior to that I got phone calls about my NT results from both OB's I'd seen so I felt very well cared for. So for me, so far I feel it's been very worthwhile.

As for the comments about medicare funding OB visits - I have paid my taxes having worked full time since I was 16 years old - so that's 25 years of taxes I've been paying - lots and lots of medicare levy - 1 day procedure hospital visit and maybe 3 or 4 doctors visits per year in all that time - so I think that entitles me to have medicare rebates on an OB thank you very much. If I was going to a GP I'd get a rebate, or it would be bulk billed so I don't see the difference. I have only had 1 of my 5 scans bulk billed - the others have cost in the region of $200 a go when you only get $70 back from medicare. Don't even get me started on the NT & amnio costs that I'm out of pocket for - even though I'm going public.

[smiles4u]

I went thru what is called "Primary Care Midwifery Program" at the Ballarat public hospital (BBH).

I went in as a private patient which means I got a private room & it made no difference 2 the care I received.

The PCMP consists of 4 midwives, one of which u r allocated 2 & hopefully she will b at your birth. She has a partner that u meet jst incase it's your originally midwives day off or sick day. You also meet the other 2 midwives.

Well, my midwife it ws her day off & she truely tried 2 make it 2 the birth but she ws in a supermarket aisle wen she got the phone call that my labour ws movin extremely fast (My bub ws born only 39mins afta arrivin at the hosp).

So, I got the 2nd midwive whom I had meet many times durin my appt's.

This ws the best decision I cld av eva made as these 4 women were all jst amazin

Can u believe the 1st two midwives came 2 my daughter's 1st birthday party ... Well, I'd love 2 c an Obs do that

It ws beautiful & reassuring 2 av known these midwives durin my pregnancy & then 2 av them at the birth ws jst the best feeling