Guide to giving birth in Sydney: Should I go public or private

In our ultimate guide we’ve answered the seven questions most commonly asked by mums-to-be and compared what facilities, services and rooms are on offer at all 25 maternity hospitals.

Deciding where to have your baby is the first of many choices parents will agonise over.

Sydney has dozens of hospitals across the private and public spheres and the differences are vast.

An obstetrician with admitting rights to a public and private hospital and two new mums answer some of the most common questions.

1. What are the advantages of the public system?

Major public hospitals have the most sophisticated medical facilities, most notably a Neonatal Intensive Care Unit (NICU).

Obstetrician Dr Jason Chow delivers babies at both Prince of Wales Private Hospital and the neighbouring public Royal Hospital for Women in Randwick.

New mum Niki Hamilton-Irvine had Alfie at the Royal Hospital for Women. Picture / Monique Harmer

“The type of things where you’d want to be at the public hospital are if you have a condition which requires you to deliver prematurely before 34 weeks,” Dr Chow said.

“Multiple births, so twins or triplets, are higher risk and so you’d be wanting to have access to the NICU.”

Cost is the other obvious major consideration. While the gap for some private health funds goes well into the thousands of dollars, giving birth publicly is free if you are eligible for Medicare.

Large public hospitals often have more options available for labouring women.

These include giving birth in the water, at a birth centre or even at home while supported by the medical specialists.

2. Why would I go private?

Not only do you have the luxury of choosing your obstetrician but they will see you throughout your pregnancy and almost certainly be present for your birth.

“In the public hospitals there’s often a supervising specialist obstetrician but it’s the registrars, so people with a couple of years’ experience, seeing you,” Dr Chow said.

Dr Jason Chow. Image courtesy of Prince of Wales Private Hospital

“So there should be continuity of care in terms of the plan but you may have someone different actually at the birth who you haven’t seen before.

“If you want to have continuity of care from a specific doctor that’s where the advantage comes in a private setting.”

The other major drawcard are the perks.

Gourmet chef prepared menus, stunning views, private rooms and ensuites, gift packs … the list is endless.

Some hospitals offer services for private and public patients. Pictured is the Northern Beaches Hospital (AAP Image / Julian Andrews).

“As an obstetrician I think that should be secondary (to care) but I know for some people that is their primary consideration,” Dr Chow said.

“For some people those things are really tangible.”

3. Is there a middle ground between public and private?

You can give birth in a public hospital under the care of a private obstetrician.

Make sure to confirm your obstetrician of choice has admitting rights to the hospital.

Dr Chow said this option was particularly popular with mothers who didn’t have the appropriate level of private health cover.

In this scenario you would pay out of pocket for the obstetrician but not the hospital stay.

4. Can I go to any hospital regardless of where I live?

You can attend the private hospital of your choice regardless of your postcode.

When it comes to public hospitals, things are not as clear cut.

While some hospitals are happy to accept patients outside their local health district, others are stricter.

However, if you have a compelling reason or have birthed in the hospital before and then moved out of area, many will accommodate your request.

Gregory Hills mum Ally McGookin, 28, gave birth to little Rory at Campbelltown Hospital in January.

“I wasn’t really presented a choice as we left it a bit late to get private health insurance cover for pregnancy,” Ms McGookin said.

“My sister had both her children at Campbelltown and she had positive experiences.”

5. What are the different models of care?

While some women find comfort in seeing an obstetrician for all their check ups, for many women, especially those who are low risk, it’s unnecessary.

Most public hospitals offer a vast array of models of care.

The intricacies of these care models and their names can vary from hospital to hospital, for example the Royal Hospital for Women currently offers seven different models of care, but essentially they boil down to the following.

1. Seeing an obstetrician for the duration of your pregnancy. You could come to this model because you chose a private birth or because you have been assessed as “high risk” and have been assigned obstetrics care in the public system.

2. Midwifery lead care. There are varying models of midwifery care. In the public system, you may be allocated to a primary midwife, a core team of midwives or revolve through whichever midwives are available during pregnancy and birth. If you are going through the hospital’s Birth Centre, a relaxed homelike environment within the hospital for low risk women to give birth without medical pain relief in proximity to emergency care, you will see the Birth Centre midwives for your appointments. In the private system you could choose to hire your own private midwife to ensure that person is present for your birth. This last option is particularly popular for women choosing a hospital supported home birth.

3. Shared care. Women may choose to split their pregnancy care. You could see a GP, midwives, obstetricians or pregnancy clinics to receive your care. You will be given a schedule all the way to 40 weeks telling you which appointments will be with which medical team. Advantages of this model of care include continuity of care for public patients seeing their GP for most appointments and logistics as you don’t need to visit the hospital for each appointment.

Ms McGookin chose the Midwifery Clinic model for her pregnancy and the midwives were also front and centre during Rory’s birth.

“I can’t speak highly enough of the midwives, especially John and Tiarne, who helped deliver and care for Rory,” Ms McGookin said.

“They were all highly competent and I was blown away by the little need for a doctor.”

6. How can I get continuity of care outside the private system?

Randwick mum Niki Hamilton-Irvine, 33, gave birth to baby Alfie at the Royal Hospital for Women in January.

She had initially hoped to snag a place in the sought after Midwifery Group Practice but was instead pleased with her experience in the Maternity Antenatal and Postnatal Service model.

Both models offer a level of continuity of care with the same midwife or group of midwives.

“My experience of shared care was still amazing,” Ms Hamilton-Irvine said.

New parents Gary & Niki Hamilton-Irvine pose for a photo with their newborn son Alfie. Picture / Monique Harmer

Opting to share care with your GP taking on most of your appointments or having a student midwife follow your journey are other ways of having someone familiar around.

7. What should I look for when choosing an obstetrician?

Dr Chow said the two most important things when choosing an obstetrician are their specialty, (his is interventional pain) and personality.

“It’s also good to check when you make the booking to see if they have planned leave around your due date,” Dr Chow said.

“Make sure you know who is acting as their cover and that you are comfortable with everyone on that team.”

COMPLETE GUIDE TO EVERY MATERNITY HOSPITAL IN SYDNEY