We’re All in This Together

The week of 6-11 September was Women’s Health Week, a nation-wide campaign centred on improving women’s health and helping them to make healthier choices across all aspects of their lives. Women’s Health Week attracts the support of organisations, high profile ambassadors, businesses, community, sporting and media groups across the country and draws attention to all areas of Women’s Health. Importantly, it also acts as a timely reminder for women to maintain their regular health checks with GPs and gynaecologists.

This year, the same week also marked Birth Trauma Awareness Week, reminding Australians that not every childbirth experience is pleasant and straightforward for a woman, nor necessarily what she had planned or wanted.

Research over many decades has repeatedly shown that continuity of care (seeing the same person throughout the antenatal, intrapartum and post-natal period) is reported to have the highest patient satisfaction scores as well as being an important driver in avoiding  birth trauma, both physical and psychological.

Pregnancy and labour care delivered by a private obstetrician gives the greatest chance of continuity of care as only an obstetrician can manage all forms of labour and delivery from normal to complex and include all delivery methods including spontaneous vaginal, assisted vaginal and caesarean delivery.

A Sydney based study published in January this year in the International Urogynecology Journal found that so-called “passive”  management of labour, a model of labour care instituted in Sydney public hospitals by a government directive in 2010, seems to be associated with a significantly higher rate of obstetric anal sphincter injuries (OASIS) than was observed in adjacent private hospitals where more “traditional” labour and birth management was undertaken by specialist Obstetricians. (https://link.springer.com/article/10.1007/s00192-019-04183-6)

It is common knowledge that in recent years, fewer Australian mothers have been giving birth in the private system. The reasons for this are complex and varied but include affordability issues associated with inadequate and non-indexed patient rebates from both medicare and private health insurance. In addition, many women find out that their insurance policy does not cover, what is for many Australian families, their first foray into the private medical system. What may have originally seemed like a sensible saving on health insurance can turn out to be a nightmare as women find that pregnancy care is currently excluded in all but the most expensive “gold” polices.

This anomaly unfairly punishes women who become pregnant and is a source of ongoing lobbying by NASOG to both the federal government and the private health insurance industry.

Because of these reasons, many women and their partners can find it difficult to navigate private health insurance when planning a family. Some couples start with the assumption that the Out of Pocket costs will be prohibitive and go no further. A significant number start the process with a private obstetrician but do not progress past the first visit.

Lack of public awareness around birth trauma may also contribute to decision making about private obstetric management, with an assumption by many that they can expect a normal vaginal delivery and will be home within 24 hours, to focus 100% on their new baby.

As specialist obstetricians and gynaecologists, we know that this is not always the case and for some women, the birthing experience is neither pleasant nor what they were expecting and this can be the cause of ongoing distress and trauma both physical and psychological.

NASOG believes that Australian women deserve the right to easily make a choice about their birthing experience when they are planning their family. In fact, even if they are one of the more than 50% of women whose spontaneous pregnancy was not specifically planned, deciding on and arranging pregnancy care should be simpler than it currently is.

Everyone deserves clear and complete information about the features and benefits a of all available models of care, so that they can make an informed choice about which model best suits them as individuals and their family situation.

Women and their families, need consistency in the rebates they receive, independent of which fund they are a member of, or in which Australian state or territory they reside in.

The many urban myths surrounding the cost and experience of private obstetric care, have resulted in increasing birth numbers in the already crowded and under resourced public system.

While families may have saved the out of pocket costs related to the 12 months around their pregnancy and the birth of their child, a birth related trauma requiring surgery, physiotherapy and ongoing psychological care, can generate many more unexpected costs.

NASOG is determined to restore the private/public balance to maternity care in Australia for the benefit of women and their families and is working with many stakeholders to bring that about.

Improving community understanding of all of the benefits of private obstetric care is one of the most important aspects of boosting patient engagement with private obstetrics.

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