What will my birth cost?
The cost of having a baby in Australia has been explored over recent times in the media and by government. The total cost in terms of the care required, the consumables needed and the ongoing cost to raise baby is beyond the scope of this article but recently we have been asked to consider the cost and value of services provided in relation to what women and babies need during pregnancy, labour and the post birth period. The costs for families for the actual pregnancy and birth vary so widely and this article attempts to examine some aspects that may assist you to get value for money for your care.
What do you have?
So there are many elements of pregnancy, birth and post birth care that you cannot change. You need to examine whether you have Medicare – which fortunately is available to most Australians – which will provide you with relatively free access to the public health system. This will allow you to see a hospital antenatal clinic for pregnancy care, enter the hospital as a public patient for birth, and will provide for usually one contact or visit after baby is born. Your local public hospital may have different options for antenatal care, birth and post birth care including midwifery continuity of care which is discussed below.
If you have private health insurance, then you have a few different options. Private obstetricians work in private hospitals. Private midwives work across both private and public hospitals. The out of pocket costs will be discussed below.
In some areas, particularly in regional and rural and especially in remote areas, what is available may be limited. GP’s in these areas will possibly provide some of the care, but travel may be required. Some services such as scans and pathology may be conducted in areas away from home and telemedicine may be needed.
What do you need?
At a minimum you will need antenatal visits, usually around 8-10 sometimes more, sometimes less, with a professional trained in antenatal care. Most women will choose to have a trained professional with them to care for them in labour and birth and most will birth in a hospital. After baby is born generally the minimum is to see your GP at one week and six weeks after birth. You will also probably need two or three antenatal scans, although some women will have less and some will have more, blood tests around 3 or 4 times during your pregnancy and if it is your first baby you will probably want to undertake some form of antenatal education.
Evidence would say that this minimum does not provide for the ‘best’ outcomes necessarily for mother and baby. The various forms of care have been evaluated by researchers. Many studies demonstrate that midwifery continuity of care, where you see the same midwife from early in pregnancy, they are available on call for you throughout your pregnancy, care for you in labour and birth and then follow your care with many visits in the first week after birth and up to six weeks after baby is born provides the best outcomes for mothers and babies. This models is available in many public hospitals (please check locally) or from private midwives who also birth with women in a variety of settings including hospitals, birth centres and at home.
What does it all cost?
The cost varies significantly and the higher the cost does not necessarily mean a better outcome for mother or baby.
Women having a baby in a public hospital may have the majority of their care covered by the public health system. However sometimes you may still have to pay for scans and blood tests and other costs may also need to be considered, such as transport or parking. If you are seeing a GP as well as the public hospital you will need to consider any out of pocket costs your GP may have.
Most births with a private obstetricians require an admission to a private hospital. Without private insurance, the fees associated with birth in a private hospital are quite high. In terms of the medical costs occasionally there are some doctors who offer no out of pocket costs for their services, but the majority will have out of pocket costs. Hospital admission to a private hospital depends on your hospital insurance, and may have a gap, excess or co-payment associated with your admission. In a private hospital you must also factor in costs for an anaesthetist if you are having an epidural or caesarean, costs for a paediatrician, any drugs you may use will also have a cost and allied health such as physio needs to be factored in. Private health insurance may cover some, most or all of these costs depending on your level of cover. It is very important to ask all the questions about this BEFORE you make a choice of care provider and hospital.
Private midwives work mostly in public hospitals and therefore private health insurance is not essential to book their care. For women with private health insurance, the hospital costs may be covered depending on the level of private health cover. For women without private health insurance it is possible to be admitted as a private patient in a public hospital and therefore continue to receive private midwifery care as the midwife’s admitted private patient.
In 2018 the ABC reported on research from Queensland based Dr Emily Callander which indicated that out of pocket costs for private obstetric care ranged from $2500 to $20,000. Some of the figures and discussion in this article (link below) were staggering and really demonstrate how important it is to ask the questions early on. Private midwifery care was only discussed in the article linked below but does vary. For women birthing in hospital with a private midwife the fees are likely to be around $2500 and $3500 including all pregnancy, labour and birth and postnatal care up until six weeks.
Other variables regardless of the model of care include antenatal education – some women will explore options including specialist classes and hypnobirthing, ultrasound scans, pathology and extras such as birth photography.
Where to from here?
The most important thing is to research! Go and visit different options and make sure all the out of pocket costs are listed. If you have private health insurance don’t expect that this will cover all elements of your care – you need to ask. And explore alternatives, don’t think that just because you have private insurance that you need to use for private obstetric care – talk to private midwives, explore your options.
Your pregnancy care and education are the most important investments in your childbirth journey. Make sure you budget to your priorities and make sure you have considered what happens after you go home from hospital. Leave yourself a little room to add on some extra care if your situations changes after bub is born.
Liz Wilkes has been a midwife for 24 years and is the Managing Director of My Midwives. My Midwives provides midwifery continuity of care to women in Brisbane, Melbourne and Toowoomba. Liz is presenting a special short form antenatal class series at the Baby To Toddler Show