Obstetricians - Are they a waste of money?

[Liviam]

We decided to go with an OB for a few different reasons.
* If things went haywire my OB knew my wishes and we had a plan of attack before I even went into labour
* My OB does a beautiful stich job
* If I needed a c/s I love his c/s. He does a great job.
* He was on call 24hours a day 7 days a week
* No student doctors or anaethestic registrars sticking fingers and needles in me
* I birthed where I work and I had a few personality clashes/uncomfortable feelings with some of the doctors
* Single room.
For me my OB was worth every cent and we will have the same OB for our next baby.

[Angel Babies 3]

I have only given birth in a private hospital once (with private OB) and that was my last pregnancy (twins) and only because we were in America.

ALL my other births have been through the public system. We do have private insurance but I choose not to use it for having my babies. We have a top level of care in this country (Australia) and I don't see the point of shelling out extra cash for an OB that probably won't even be at the birth. I don't care about great meals and strictly private rooms - I just want to get home ASAP. For both of my losses where I had to give birth to my Angels, I was given a private room anyway.
I have never had a problem with either of the the public hospitals I have used.

But, as usual, everyone has their own thoughts and opinions.

All the best,
Debbie

[LuluHB]

I have an OB that would come across as being the sort to rush you through. Fact is, he is incredibly well respected and the man is just plain busy. My appointments are usually pretty close to being on time (except for the twice he has been at births), and I get through with him very quickly BUT if I have questions he is incredibly patient and doesn't rush through the answers - he just obviously takes the view that if I have concerns about my baby or my body I'll ask.

For my DD#1 I was induced but he let things proceed at my choice of speed when it was clear neither my baby or I were in danger. He called 4 times throughout the first night to check on me. He ended up only being there for 2 contractions of my DD's delivery so many would think however many $1000s he cost was a waste of money. For me, the peace of mind knowing that one of the most respected OBs in the state if not the country was looking after my baby and my welfare was well worth every cent. I didn't need his expertise, but I'm glad it was readily available if things had gone differently.

[MummyTummy]

I just thought I'd wade on in here with my personal opinion.

I have decided to go with an Ob as it is my first pregnancy I don't know what to expect and I don't like the idea of going to a hospital waiting room for my appts and not knowing who I would see each appt. I know that there are some programs that mean you only see a small selection of midwives etc but still I just wanted the reassurance, at least for my first child.

Secondly, I can afford private health insurance and the costs involved in going private and having an obstetrician so why burden the already overworked and overstressed public system. I would rather that my place in the public system be used for someone who truly can not afford private. Don't get me wrong, I'm not happy with how expensive it all is and would rather it be free, but I know there are many that have no other option and I'd like to think that I'm making their life a little bit easier in the teensiest way!

Thirdly, I am really lucky that I have a good Ob that I am very comfortable with and he never makes me feel rushed. I call up about an hour before I go in to make sure that he is running on time, (no probs so far!) and to confirm my appt so I rarely have to wait longer than 5 mins when I get there. I tend to only have short sessions with him, but he did explain that to me. He said things are quite mundane until further on in the pregnancy or unless I develop any problems in the meantime. But I can ask any questions I want to and I never feel like he is pressing to get me out for the next patient. I'm sure as my pregnancy progresses I will spend longer in his office discussing the various options available in my pregnancy and he will earn his money then!! And like Lulu, I may not need his expertise in the end, but it is very reassuring to know it is there if I do!

If I wasn't comfortable with my Ob or wasn't happy with the service he was providing I would seek alternative arrangements. Afterall, this is my pregnancy not theirs. In this case I would look at public as an option as well as seek out other obs that might be more suitable. I also feel that it is a very personal choice and certainly wouldn't judge anyone whatever direction they chose.

I'm only going by my experience here but I loved my OB.

We had continuity of care, he was there for most of my labour/birth, when we needed him 24/7, he was there, I never felt rushed at appointments, he was always available to talk to on the phone at anytime, when I went into pre-term labour at 24wks, he not only arranged the hospital I needed to go to, but he rang in a favour with a friend/fellow OB to care for me and rang me each day I was in hospital, then I saw him weekly until 36wks and in the end when I'd finally had enough of a difficult pregnancy and begged for a c-section, he refused it - even when I became panicky and asked for an epidural, while it was being prepared, he kept trying to talk me out of it.

Having said that, I'm classed a HR patient, so having one was a necessity. Private hospital/private OB, he was well worth the money and I have absolutely no complaints - although for next time, I will have Relle with me to make sure I don't beg for that Epi again

[~kaos~]

Here here to Kelly's post.

I have had a private midwife for a homebirth this pregnancy and the service and value for money is fantastic.

It has been great to have appts in my home, with my kids involved, not to mention that I don't have to drag them to hosp and keep them out the equip. If they are not interested in being involved, they are easily distracted by a DVD. The appts are really long and we have some great discussion and all my questions answered. I have great confidence in myself, her skills as a practioner, her ability to support me and my family in a way that works for us and what birth involves. She'll also be visiting heaps after the baby is born and give me the support I need, rather than just being sent home with a "good luck". That is value for money.

If only midwives had access to medicare provider numbers and I could get a little bit of a rebate like everyone else.

As for OB's being a waste of money, I think that for a low-risk pregnancy - definitely. Whether you are public or private, seeing an OB as a low risk pregnancy is a drain on the resources and funding in the health care system. 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).

[Suga]

Originally Posted by MummyTummy

Secondly, I can afford private health insurance and the costs involved in going private and having an obstetrician so why burden the already overworked and overstressed public system. I would rather that my place in the public system be used for someone who truly can not afford private. Don't get me wrong, I'm not happy with how expensive it all is and would rather it be free, but I know there are many that have no other option and I'd like to think that I'm making their life a little bit easier in the teensiest way!

I would probably go private if I could have a midwife rather than an Ob... but this really isn't an option. The only way to have continuous midwifery care is to go through the hospital or fork out the whole lot yourself and have a homebirth.

I don't feel bad about going public on this occasion even though I can afford private health. I've paid thousands and thousands in taxes in my 15 years working and this is the first time that I've used the hospital system. Given that my taxes are probably subsidising millions in care for smoking related disease and the like I don't feel bad using the system for a birth - to me that's what it should be there for.

Originally Posted by ~kaos~

Here here to Kelly's post.
If only midwives had access to medicare provider numbers and I could get a little bit of a rebate like everyone else.

I agree 100%... insurance companies should cover private midwives also... and you should be able to have one in a hospital if you wish.

[BellyBelly]

Originally Posted by ~kaos~

Whether you are public or private, seeing an OB as a low risk pregnancy is a drain on the resources and funding in the health care system. 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).

Yup, and to borrow something that has been used before:

Australia?s maternity system is a broken mess. Unlike the U.S we have a universal health care system, but within maternity that system is being rorted and private obstetric care is milking a huge amount of money from the public purse.

Obstetricians have raised their fees (and the public purse has footed the bill) by 269% since 2004

* Our caesarean section rate is higher than the USA. Our national rate is 31%
* We have had a considerable increase in post natal depression
* Nationally less than 5% of Australian women can choose a midwife for their pregnancy, birth and postnatal care
* Less than 5% of Australian women can choose warm water as pain relief.
* There is a cultural perception that mothering is not overly enjoyable and post natal support is essentially non existent.
* Over 50% of rural maternity units have closed over the last 10 years. As a result women are forced to mandatarily evacuate from their homelands to birth in large urbanised maternity units. This means they are travelling hundreds of kilometres to have their babies and are often separated from their families and communities. Some women in rural areas are giving birth on the side of the road. The outcomes for Indigenous women are dire.

That 30% private cover rebate gets footed by taxpayers. The safety net gets footed by taxpayers. Yet we cannot have a lower cost (to taxpayers/hospitals etc) midwife subsidised for care if thats what we want to choose. Where's choice for birth in that?

It's a joke, the Obstetric system along with the massive amounts of ultrasounds going on is draining healthcare dollars massively and the government are only making it worse. All of that money could go to more important things. It should be more like you get a low risk choice of carer for free, and if you want to have an expert, you pay more, not the other way around. So unfair for those who want continuity of care but cannot afford it. We are paying for overkill on birth care for those who can afford it. We get Obs through the system regardless, no-one gets sub standard care here. But if you want your own specialist you shoudl have to pay for it! Doesn't make sense. Midwives care for normal birth. Its the same system that works with general healthcare - you see a GP first. Most GPs can help you, if not you see a specialist and you pay more for it!

[~kaos~]

We are paying for overkill on birth care

This is so how I feel about low risk women seeing OB's. Great way to put it. I guess that women who are seeing a private OB are actually paying for it twice or even three times. Once in their health fund fees, twice through their gap payments and thrice through their taxes..... so is it really value for money?

And the sad thing is that in general, OB care doesn't seem to be quality, woman/family centred care. Not when you compare it with the kind of service that you recieve from a known midwife.

And I also agree, that no-one is going to receive substandard care in this country. Just because I have chosen midwifery care, doesn't mean I won't be able to access obstetric care if I need it. Actually, I've had OB input (fetal diagnosis, hyperthyroidism) and GP input (hyperthyroidism) in this pregnancy on more than one occasion, but I my main care provider is my midwife. I have fantastic maternity care from a range of care providers, but it all comes back to one main care provider, my midwife, who has walked the entire journey with me and will continue to do so until weeks after the baby is born.

[Mum2OneSweetBun]

Thanks for all the input.

Since this is my first pregnancy, I decided to go with an obstetrician (although, I should have researched more into it).

My husband and I visited both the private hospital and the public hospital and we really really loved the private hospital in a sense that it didnt feel like we were in hospital (eheheh probably doesnt make much sense).

Too bad private hospitals require obstetricians.

I would definately go public next time round. And you guys are right, the public system treats everyone equal. Even if you go in as a private patient and someone requires the unshared room more than you, you will be moved.

[happymel]

I just have to put a comment to Kaos, i DID receive substandard care in the public system, with an OB in the high risk clinic! He was a professor. I am a registered nurse, although not a midwive, there are things that you know about the profession, things that you know are not right. That doctor put my babies at risk and, in the future i dont think i would trust putting my care in the hands of the public health system. I am just glad i changed doctors when i did, now i am receiving fantastic care with a fantastic obstetrician who confirmed that i wasnt being cared for appropriately. He is very fanily oriented, never rushes me through, and always makes time for my husband and i. As for the money, i figure i pay so much for so long with private health care, tax etc... that i am entitled to see a private OB.
If perhaps circumstances were different and i had been able to see a midwive, then things my have been different, but i disagree in some of the comments made about private OB's. Fair go.

[BellyBelly]

So are the rest of us who also pay lots of taxes for so long not entitled to see a private midwife, also subsidised by tax payer dollars? Fair go.

[happymel]

No i did not say that. I am all for midwives but am unable to go through that care during this pregnancy. I have faith in the nursing profession.
Perhaps if the government changed how things worked then we would all be happier... In an ideal world....

[MummyTummy]

Wow! Hot topic huh??

I agree that private midwives should be an option in private health care. I think it is a fantastic idea.... however right now that isn't an option. And perhaps I will look in to it for next time, but I wasn't prepared to for my first pregnancy as I don't know whether I will be high-risk or low-risk.

I certainly don't think the Ob I have chosen is going to treat me like a high-risk case unless I actually am, plus with all the research I have been doing I feel confident and in control if he does start to push intervention for his own purposes that I will remain in control.

And like I said in my post I would never judge someone for the decision that they make in their care for their pregnancy and as such I expect that I will not be judged or made to feel guilty one way or another. As they say "Horses for courses" and we each have to make the decision that is right for us and we should all respect that.

[visitor1]

I went public. I had booked into private hossy with an OB but i just simply couldnt afford the money my OB wanted....when he hardly offered anything.

I couldnt see the point in paying 3.5k for a dr to come in, deliver my baby (if he made it) then walk out......when i could go public and have it all done for free.

Granted i never met any of my midwifes prior to birth, but i had however seen the attending doctor a few times throughout the pregnancy if he was on the day i had check ups.

[joss.00]

Hi Phoenix, I was in the same boat with you with my first child. I felt that my OB was a waste of money too, like you said you wait so long in the waiting room and then when you finally get to see him/her and it is just take your blood pressure and hear the heartbeat and see you later. My OB wasn't there for my 1st childs birth either and I had an 'on call' OB who I thought was absolutely fantastic!! I felt ripped off financially with my OB as he/she didn't have to do anything that I paid him/her for??? I tried to get in too see the OB who delivered my DD this pregnancy but she is totally booked out so I went back to my original OB. I have to say though, my OB has actually been fantastic this time around, I have had a few problems with this pregnancy but my OB has made sure that I am understading everything etc etc. I am very impressed this time around. I would definately have an OB for any pregnancy as I have had friends who went didn't have an OB and they have had so many terrible stories of students 'practising' on them and it was quite terrible. Stick with your OB you know you are getting the best of care.

[Willow]

I think the answer to this question is different for every woman. My ob to me was worth every single dollar I paid him. I did my research and I got the right Dr - that makes all the difference.

I went through the public system with my first baby, it was all very straight forward and I was happy with my care.

I then had some gynae problems, a few surgeries and a m/c and was not at all happy with the care I received in the public system. My third prg was an IVF prg and I knew that I would go privately this time. We were a private patient in a public hospital and had very limited out of pocket expenses thanks to the safety net.

Yes, I had to wait for appts (he is an ob, it's his job to go and deliver babies, sometimes they decided to arrive at a time inconvenient to me, but that happens!) and sometimes I felt a bit rushed through, but sometimes there's really not much to say is there? You're fine, bub is fine, see you in two weeks. For me, it was worth paying that money for the quick scan he did at every appt, I lived from scan to scan following my m/c. You can't pay enough for peace of mind.

When my due date came and went, we discussed in detail over several days how we would handle the birth, when and if to book induction, how the induction would be carried out if it came to that etc etc. If I'd been in the public system, I would have been booked in at 10 days post dates, drip in the arm, thanks for coming (and I know I could have disputed this, but who has the energy for that at 41wks?? I didn't).

My ob was at my birth, never missed an appt with us and was totally fantastic at bringing a sense of humour and enjoyment to what was a very stressful prg for me. I enjoyed my appts with him and never doubted I was receiving the best of care. AND he only charged $1,300 for our delivery fee, most of which we got back due to the safety net.

[teachmum]

For my first two pregnancies I had a private OB that worked in a public hospital. I liked seeing the same person everytime and he always spent time answering my questions and I never felt rushed. When I gave birth he was there both times and never rushed me. The midwives told my DH that he could be a pain to them but was great to have in an emergency which is what you need them for.

This time I have private health cover and would have gone down that path but was diagnosed with GD at 7 weeks. I've had unreal care in the public system. I see the same people each time, including OB and MW because they specialise in diabetic pregnancies. It's clear to me that the MW are the ones who'll be with me in labour with the OB swanning in at the end. The main difference I've found having the MW involved in my appointments is that she's made me aware of my right to say no to various procedures if I wanted to.