An Obstetrician's Role

Obstetricians are highly skilled and highly trained medical professionals who care for women during pregnancy, birth and early postpartum. They are well versed in complex pregnancies and birth complications, but most importantly they are obstetric surgeons. Obstetricians are trained to recognise, diagnose, manage or treat complications, they are not trained in supporting physiological births, and many have never witnessed a true physiological birth.

Hiring an Obstetrician as a healthy woman with a healthy baby who is experiencing a 'normal' pregnancy and planning a 'normal' (vaginal) birth, is like hiring an Electrician to change your lightbulb. You can do it if you want to... but it's a bit pointless and very expensive.

When do you see an Obstetrician?

If you choose to have your care through a Private Obstetrician, you will see them (or one of their colleagues) at each appointment and likely at your birth. Your pre and postnatal appointments will last roughly 5-15min. They will do the same clinical tasks a midwife would (blood pressure, urinalysis, palpation, listen to your baby's heart, general observations, provide prescriptions, and refer you for major ultrasounds). The only major difference is they may have a bedside ultrasound available. Bedside ultrasounds are not diagnostic, the only additional thing they provide to midwifery care is the opportunity to see your baby.

If you are having your care through a Private Midwife, Midwifery Group Model, Birth Centre, or Public Hospital you will likely only see an Obstetrician if things stray outside of 'normal' parameters. Some of the reasons why you may be referred for an Obstetric consultation may include:

• Breech presentation
• Obstetric cholestasis
• Severe Pre-eclampsia
• Previous third or fourth degree tear
• Previous major postpartum haemorrhage
• Planning a VBAC
• Severe anaemia
• Post-term pregnancy (≥42 completed weeks or 294 days)
• Preterm cervical dilation or shortening
• Multiple pregnancy (twins, triplets etc.)
• Preterm labour
• Fetal growth restriction
• HELPP syndrome
• Placenta Accreta, increta or percreta
• History of preterm birth
• Suspected macrosomia (>4000g or 90th centile)
• Gestational Diabetes (uncontrolled or requiring medication)
• Rhesus antibodies
• Pre-existing diabetes

Full list of indications here: National-Midwifery-Guidelines-for-Consultation-and-Referral-4th-Edition-(2021).pdf (midwives.org.au)

Some hospitals request healthy women to have an Obstetrician review late in pregnancy (particularly those planning a homebirth or a VBAC), but this is hospital policy and not usually necessary.

Cost of a Private Obstetrician

Most Private Obstetricians will not accept self-funded patients. This means you must have private health insurance that covers pregnancy and birth at least 12 months before your estimated due date. This is usually referred to as gold hospital cover and costs roughly $2,500 yearly, plus you may have to pay your selected hospital excess of $500-$1000 to attend the hospital during birth. The following fees are approximate, and your private health insurance will cover some to most of the costs:

• Initial consultation: $250-$300
• Subsequent antenatal visit: $100-$200 each
• Pregnancy Management fee (with private care in private hospital): $2,500-$3,500 OR Pregnancy Management fee (shared care with delivery as a public patient): $1,000-$1,500. This fee often doubles for twins.
• Diagnostic Ultrasounds: $300-$500 each
• In hospital accommodation: $700-$850 daily (expect to stay 2-5 days)
• Delivery suite fee: $1,000 ($1,200 for caesarean)
• Anaesthetists: $1,000-$2,000
• Paediatricians: $500-$1,000
• Postnatal visit: $100-$200 each
• There may also be extra costs for pathology testing, medicine and other specialist fees, including anaesthetists and paediatricians.

As a private hospital patient with premium health insurance, you can expect to be out of pocket $3,000 - $5,000, plus health insurance fees of at least $2,500, totalling: $5,500 - $7,500 for uncomplicated singleton pregnancies.

If you find an Obstetrician who is willing to accept you as a self-funded patient, you should budget for at least $20,000.

In contrast, if you birth within a public hospital and see the public obstetricians and midwives your out-of-pocket expenses will only be for diagnostic scans and medication, usually less than $500.

Private Obstetric Birth Statistics

Caesarean Section Rates in Private Obstetrics

Private Obstetrics has the highest rates of Caesarean Section births. On average you have a higher chance of having a caesarean section (52.3%) birth than you do a vaginal birth (47.8%).

Additionally, if you include forceps and vacuum deliveries under the umbrella of 'surgical birth', as these methods usually require an episiotomy (which is a surgical cut to the perineum), your chance of having a non-surgical birth within a private hospital is only 35%.

Induction Rates in Private Obstetrics

We know that the best outcomes for healthy women and healthy babies are seen when we allow for labour to start spontaneously (without intervention).

Spontaneous labour, as opposed to induced labour generally sees:

• shorter duration of labour
• faster and more efficient transition for babies at birth
• reduced chance of caesarean
• less painful labour
• lower risk of bleeding and infection
• more positive birth experience
• more successful breastfeeding

References: Australia's mothers and babies, Onset of labour - Australian Institute of Health and Welfare (aihw.gov.au), Evidence on: Inducing for Due Dates - Evidence Based Birth®, Healthy Birth Practice #1: Let Labor Begin on Its Own - PMC (nih.gov)

The table below shows that in Australia the likelihood of experiencing spontaneous labour in a private hospital setting is only 27.7%. You are more likely to have a caesarean section (39.7%) than you are an induction (32.3%). These statistics do not account for labours that began spontaneously but were augmented (given the same drug 'syntocinon' as used in an induction), or those who began labour spontaneously but birthed via caesarean.

But isn't hiring the most skilled person going to give me the best care?

Yes, the most skilled person is going to give you the best care... but skilled in what, surgery or 'normal' birth?

If you are wanting a caesarean birth, then you should absolutely hire your private Obstetrician of choice.

But if you're wanting a vaginal birth, then you should hire the person most skilled in supporting vaginal birth, which is a Midwife, or even better, a Privately Practicing Midwife (PPM).

See a list of West Australian PPMs here: Privately Practising Midwives in Western Australia | Back to Basics Birthing (vickihobbs.com)

So, I don't need a Private Obstetrician, but what are my other options?

Want to learn more about your birthing options, then check out my blog post below: