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The safest place to have a baby in Canberra.

emd 23 June 2011 23

Canberra obstetrician Dr Andrew Foote is in today’s Canberra Times saying that “public hospital is safe, but private hospital is safer”. He is concerned that since government capped the Medicare Safety Net payments for obstetric services, women with private health insurance are choosing to have their babies in public hospitals because of the gap fees. He wants Medicare rebates lifted to cover the $2,000 average out of pocket costs.

For anyone wanting to know where is the safest place to give birth, it is worth having a look at ACT Health’s maternal and perinatal health statistics. For example, in 2008 the caesarean rate in Calvary Private was 32.6% and 43.6% at John James. In Canberra Hodpital public it was 23.9% (this includes the Birth Centre and high-risk Fetal Medicine Unit) and 26% at Calvary Public. Induction rates and caesareans with no prior onset of labour were highest in 2008 at Calvary and John James.

The rate of serious tearing (3rd or 4th degree) is higher in public hospitals – 3% at TCH compared to 1.2% at Calvary Private and 0.9% at John James. But the rate of intact perineums – no stitches at all – is 38% at TCH compared to 23% at Calvary and 23.7% at John James. There’s no breakdown of babies stay in special care by hospital, but TCH having the only NICU means they will have the babies who need the most acute care.

What Dr Foote hasn’t talked about in the Canberra Times article are the other factors that affect decisions about where to have babies. Both Calvary and John James hospitals are now run by Little Company of Mary. For women who prefer not to be in a Catholic hospital, which does affect the range of procedures and the information care providers are able to give women, TCH is the only alternative. Some women might prefer the model of care offered at the Birth Centre within TCH, which is quite different to the hospital maternity units. Equally, some women may be choosing Calvary Private or John James for the private rooms in recovery, which can only be accessed if you have a private doctor. Or they may prefer to see a doctor who works primarily at one particular hospital. Choosing a maternity hospital is far more complex than just the cost.

There are some statistics that are not available in the ACT Health publications, and the most recent data is from 2008. And of course, personal health history and philosophy (eg what risks and outcomes you can best cope with) are more important than stats in deciding what is best for an individual situation. No birth is risk-free, and it is good to be informed about how different outcomes can come about when choosing your model of care.

Women who medically require a surgeon are referred to a public obstetrician at TCH if they cannot afford private care. Increasing the Medicare Safety Net for obstetric services will almost certainly increase the costs to taxpayers for payments to private obstetricians. Around half of the total Medicare Safety Net budget was paid for obstetric services before the limitation was put in place. It will not necessarily improve the health of mothers and babies.

A better plan, in my opinion, would be to provide ACT healthcare consumers – women – with more detailed and up to date information about maternal and perinatal health outcomes, and all their options for maternity care. Perhaps as a booklet available from GPs and pharmacies, so women can get this information when they first find out they’re pregnant. The birth care that suits one woman might be unacceptable to another, so it is good to have multiple models of care offered in our community.

Dr Foote’s own research shows that women will choose what they believe is best for their baby and their own health, so why not just give the women the information and then respect their right to choose?


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23 Responses to
The safest place to have a baby in Canberra.
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luther_bendross 11:13 am 10 Jul 11

grunge_hippy said :

well, if modern medicine fails in child birth, there is always this….

http://koibirth.blogspot.com/

how many different types of crazy can you pick?

Um…. woah. Is is just me, or was FAQ #1 not answered? Oh then this:
Q: How long does the baby stay under water?
A: Well, I plan to let the koi guide him up to me. But Shane will be standing by with a net, just in case.

Jethro 5:09 am 10 Jul 11

grunge_hippy said :

well, if modern medicine fails in child birth, there is always this….

http://koibirth.blogspot.com/

how many different types of crazy can you pick?

Wow.

minniemay 10:09 pm 09 Jul 11

I went through the birth centre at TCH – but the birth didn’t go according to plan. So my natural birth ended up being an emergency forceps delivery in the operating room, with obstetrician, anesthesiologist, theatre staff and midwife. As soon as it was evident it was necessary, we were given the maximum assistance extremely quickly.

Everyone was brilliant through the whole thing. We had our own private room afterwards, and my husband stayed the night. While I fully support people having the right to choose public or private (and certainly choice of doctor can factor into that) my experience just reaffirmed my faith in our public hospital system. (Going through the birth centre also ensures a continuity of care model – same midwife before, during and after the birth, up until 2 weeks, including home visits.)

That said, the wait list for the birth centre is crazy. (I rang them 5 minutes after I got the positive test result.) I’m hoping that may improve with the new women and children’s hospital.

grunge_hippy 5:40 pm 09 Jul 11

well, if modern medicine fails in child birth, there is always this….

http://koibirth.blogspot.com/

how many different types of crazy can you pick?

Watson 4:30 pm 09 Jul 11

BimboGeek said :

The birth centre only has private rooms, each of which has its own bathroom.

Anyway why would you hang around a miserable hospital for a few days after having a baby? You’re allowed to go home after 6 hours, that’s what I did!

If everyone was a little less precious about having a baby there would be a lot more resources (space and specialist staff) available for the people who really need them.

Not everyone has the luxury to use the birthing centre, Bimbogeek. First of all, you had to book at least nine months in advance when I was pregnant. And if you’re in a higher risk category, it makes total sense to be close to obstetric care and the operating theatre. I get a bit miffed at people who seem convinced that giving birth is without risk and we’re all being too precious about it. They obviously haven’t read their history books.

I managed my labour without any pain relief and was fine with just the midwives guiding me for most of it. But stubborn baby got stuck and if the obstetricians wouldn’t have pulled her out quicksmart, I would not have this healthy 6yo sitting here next to me now. So yay for hospitals and modern obstetrics!

BimboGeek 3:10 pm 09 Jul 11

The birth centre only has private rooms, each of which has its own bathroom.

Anyway why would you hang around a miserable hospital for a few days after having a baby? You’re allowed to go home after 6 hours, that’s what I did!

If everyone was a little less precious about having a baby there would be a lot more resources (space and specialist staff) available for the people who really need them.

Watson 9:11 am 09 Jul 11

Oh and the anesthetist at Canberra Hospital was fantastic too! I ended up not using his services during the birth, but he spent an hour in the late stage of my pregnancy working through some of the concerns I had relating to epidural and c-section in relation to my existing medical condition.

He was great to talk to during labour and he came to visit me on the post-natal ward the day after just to tell me how brave I’d been! (He was extremely good-looking too, which my female birth partners highly appreciated, though it was a bit lost on me at the time. ;))

Good luck with the birth whatever you choose! The only thing on my birth plan was “Go with the flow” and I still have no regrets about that. The vast majority of births end well, and being anxious during labour doesn’t help the cause, believe me. You’ll be fine!

Watson 9:05 am 09 Jul 11

kakosi said :

As for where to have a baby. The choice between a public shared crowded ward or a private room pretty much isn’t much of a choice. As for what the doctor offers to do, well that’s really more to do with the doctor you go to. I wouldn’t want to put my trust in some new registrar on duty at a public hospital.

As for the safest place to have a baby, I’m not sure any public or private hospital in Canberra is a safe place for any type of operation or health care…the risk of contracting MRSA (once called Golden Staph until it mutated into a potentially flesh-eating bacteria) or other serious bacterial infection is very high. They don’t tend to tell people that infection control is out the window, they don’t test for spread of these bacteria unless you have an obvious infection – and these bacteria can live on your skin for months or years before causing serious problems, during which time you would have infected your family and anyone else you’ve touched.

Hospitals know it’s out of control and have placed those hand sanitising pump bottles everywhere with some guff wording about how you should clean your hands to “protect patients”. Most people think these bottles are to stop the spread of flu only.

Worse still is that the main culprits for spreading bacteria are the staff – some nurses and a doctor in the infectious diseases ward told me that most health workers have MRSA on their skin and don’t worry about it as it is more serious for sick, immune compromised and elderly people. At the moment they isolate “known cases” at TCH but it’s known that certain wards are more ‘infectious’ than others at the hospital. Calvary Hospital doesn’t even isolate known cases but puts them into the general population even though it is extremely contagious through skin to surface contact.

Next time you are admitted to hospital make sure you ask this simple question before you let a nurse or doctor examine you – “Have you washed your hands?” and take along your own disinfectant to clean your shared toilet and shower if you are in a public hospital. It could save your life.

I had a private room at Canberra hospital. The midwives both during and after the labour were fantastic. But unfortunately I had one of those new registrars (and some trainee, it seemed ) when things went a bit pearshaped and I can tell you, they are not the kind of people you want to trust with forceps. Things worked out in the end, but it took me a little while to get over the trauma of the obstetricians’ atrocious service. I intended to lodge an official complaint about them (with a compliment about the midwives) but I got a bit side-tracked after the birth.

However, can you trust that the obstetrician in the private hospital will always be on call when you need them? Unless you opt for an elective caesarian, you really don’t know when you’re going to need them and no human being can be on call 24/7.

kakosi 12:56 am 09 Jul 11

As for where to have a baby. The choice between a public shared crowded ward or a private room pretty much isn’t much of a choice. As for what the doctor offers to do, well that’s really more to do with the doctor you go to. I wouldn’t want to put my trust in some new registrar on duty at a public hospital.

As for the safest place to have a baby, I’m not sure any public or private hospital in Canberra is a safe place for any type of operation or health care…the risk of contracting MRSA (once called Golden Staph until it mutated into a potentially flesh-eating bacteria) or other serious bacterial infection is very high. They don’t tend to tell people that infection control is out the window, they don’t test for spread of these bacteria unless you have an obvious infection – and these bacteria can live on your skin for months or years before causing serious problems, during which time you would have infected your family and anyone else you’ve touched.

Hospitals know it’s out of control and have placed those hand sanitising pump bottles everywhere with some guff wording about how you should clean your hands to “protect patients”. Most people think these bottles are to stop the spread of flu only.

Worse still is that the main culprits for spreading bacteria are the staff – some nurses and a doctor in the infectious diseases ward told me that most health workers have MRSA on their skin and don’t worry about it as it is more serious for sick, immune compromised and elderly people. At the moment they isolate “known cases” at TCH but it’s known that certain wards are more ‘infectious’ than others at the hospital. Calvary Hospital doesn’t even isolate known cases but puts them into the general population even though it is extremely contagious through skin to surface contact.

Next time you are admitted to hospital make sure you ask this simple question before you let a nurse or doctor examine you – “Have you washed your hands?” and take along your own disinfectant to clean your shared toilet and shower if you are in a public hospital. It could save your life.

emd 11:27 pm 23 Jun 11

astrojax said :

the only option is tch? what about queanbeyan? i know this data is about act hospitals, but regionally, queanbeyan is a very realistic – and quite brilliant – choice…

True, I have heard a lot of good things about QBN hospital. And about the private midwives from NSW who do home births here. NSW Health shoud have stats for QBN.

astrojax 4:16 pm 23 Jun 11

the only option is tch? what about queanbeyan? i know this data is about act hospitals, but regionally, queanbeyan is a very realistic – and quite brilliant – choice…

emd 2:43 pm 23 Jun 11

Mr Gillespie said :

What’s wrong with having a baby in hospital the normal way? Don’t doctors know how to assist in pulling it out???

The training for obstetricians and midwives is quite different, as it should be. Obstetricians are experts in what to do when things are outside the bounds of normal and require life-saving intervention. Midwives are experts in what to when things are within the range of normal, and will refer the woman to an ob if it goes beyond that. So as an example, an obstetrician may have been trained to use an ultrasound to check baby’s position, or do a caesarean for breech birth, while a midwife may have been trained to feel for baby’s head with her hands and do vaginal breech deliveries. Obviously there is variation, some obs will do vaginal breech delivery if you’ve birthed vaginally previously. But my point is that they are different models of care and women need to consider their individual care provider’s philosophy as well as the comfortable room etc.

PigDog said :

Thanks, emd. But I meant does Dr Foote publish the results of his work as an Obstetrician? I.e. compared to his counterparts, what are the outcomes like for his patients. I assume he is safe, but is he the safest?

As far as I know, no obstetrician publishes stats on their own results, and the stats themselves could be misleading without context. For example, there are some obs in Canberra who specialise in high risk births, so their caesarean rates could be expected to be much higher than an ob who doesn’t have that specialisation. In the same way that John James’ higher caesarean rate could be in part attributed to their higher (than Calvary Private) rate of multiple births and older first time mum demographic. I do think it would be useful, though, for women who want a private doctor to easily find out what each private doctor’s specialisation or focus is, so you can choose the doctor that best suits their personal philosophy.

I also think we need more info in the ACT on how the new Medicare for midwives system and homebirth midwife registration works, who our private midwives are, and ensure they have visiting rights at the public hospitals in case of emergency transfer. Homebirth happens anyway, regardless of RANZCOG’s opinion, so we need to ensure that women have the protection of indemnity insurance, can claim back the same from Medicare as they would with any other care provider doing the job, and can transfer to hospital without worrying about whether they will be treated with respect.

Ernie 2:29 pm 23 Jun 11

When I saw this article in The Canberra Times the first thing I thought of was the high rate of caesarians in private compared to public. Also, how dare he use the term ‘safer’. This makes me angry and is a load of scaremongering in my opinion. The ob is rarely at the birth anyway. I had my babies at The Canberra Hospital and both times had my own room (you will always have your own room if they can) and found my level of care outstanding.

We didn’t have to pay for our parenting classes or breastfeeding classes or any others that we could have gone to where my friends going private had to pay. They also had to pay about $5000 upfront to see an Ob and then if they had to have a caesarian they had to pay for all kinds of costs associated with that too. I might have seen the same midwife a couple of times during my routine visits but all were very nice, friendly and caring. Indeed if there was an issue while I was pregnant then I would have hired an Ob but it’s up to the woman to make a choice of the type of care she wants.

I completely agree that women need to have all information at hand and make an informed choice.

Holepunch 11:22 am 23 Jun 11

The private hospitals are too under-staffed when having a baby. If you need care and are not concerned about having your own room then you are better off going Public. The out of pocket expenses are huge and you may not even see the OB you have paid a fortune for.

PigDog 10:52 am 23 Jun 11

emd said :

PigDog said :

Does Dr Foote publish the results of his own work?

Yes, his research has been published by ANU Medical School. It was about why women are having elective caesareans. ….

Thanks, emd. But I meant does Dr Foote publish the results of his work as an Obstetrician? I.e. compared to his counterparts, what are the outcomes like for his patients. I assume he is safe, but is he the safest?

Mr Gillespie 10:40 am 23 Jun 11

What’s wrong with having a baby in hospital the normal way? Don’t doctors know how to assist in pulling it out???

Angelina 10:21 am 23 Jun 11

Sorry in advance for the giant post…I agree that women need to be provided with current information so that they can make an informed decision about these things.

I also think that some statistics presented can be misleading. For example the elective caesarean rate presents as higher at the private hospitals. I think people can interpret this as meaning that if you go private you’ll definately have a higher chance of being bullied into a caesarean. The numbers are always going to be higher for elective caesareans at private hospitals because some women choose to go private specifically so they can have an elective caesarean, a decision that these women have made long before the baby is due.

And as far as I’m aware (from people I know who’ve been through the public system) that’s not usually an option available to them. So someone who really wants an elective caesarean with no real medical need has no choice but to go through private.

I went through John James, a decision that was based on friends and relatives experiences in the public and private hospitals in canberra, as well as any research I was able to find. I think the decision was affected by my sister and two friends having absolute nightmare deliveries in the public hospital.

Things that I liked about going private were seeing my same obstetrician through the entire pregnancy and then having him there at the delivery. It was extremely familar and comforting. I also liked being able to choose to have a private room which helped with the recovery. I found there was exceptional care and instruction for me after the birth which was invaluable, they had a lot of time for us. I also didn’t find one hint of religiousness coming from anyone at the hospital. They were a bit over-zealous with the breastfeeding, but I’ve heard thats standard across the board. I’m sure plenty of people have had great care in the public hospital too.

red_dog said “Now I’ve no objection to an obstetrician being on hand if complications arise but I believe the vast majority of births do not (or should not) require their presence.”

This is a decision that should be made by the woman. Some women, like myself, found the obstetrician a good choice, and in hindsight having him there ended up saving mine and my kids life when things did get complicated.

But say you wanted a really natural, water-birth, home-delivery-feel you might find it hard to get an ob. who is comfortable with this and start to look at the birth centre, etc. Women need all the information, the positives and negatives about all of their options.

Not all obstetricians are cynical butchers just waiting to cut you open. A lot of them just support a womans right to choose to deliver however she feels like it. They’re going to have their own opinions on what is the best way too. They are human after all.

Of course they have to look after their own interests to an extent, their fees are high for a lot of reasons (insurance for the rest of their life being one of them) not just because they want to feather their own nests. If you do a good job you want to be paid for it, yes?

rescuedg 10:20 am 23 Jun 11

Good job to the OP and others on picking up Canberra Times lack of scrutiny on this more than slightly self interested Dr. In addition to the stats pointed out in the OP Dr Foote also doesn’t seem to take into account the different types of people using the different services. I imagine it is a very rare occasion that Calvary John James sees to the needs of junky mums in its private rooms. Surely the public sector, in taking the majority of people who are likely to have complications should be commended. I wonder if the statistics Dr Foote uses take into account this sort of discrepancy; and if they did would they in fact show that for a ‘run of the mill’ pregnancy you are actually safer in one of the public hospitals?

emd 10:15 am 23 Jun 11

PigDog said :

Does Dr Foote publish the results of his own work?

Yes, his research has been published by ANU Medical School. It was about why women are having elective caesareans. He found that the vast majority did so because they believed it was best for their baby or their own health, based on the advice their doctor had given them.

WHO recommends a safe caesarean rate of 15-20% – above that and there are probably women having major surgery and the accompanying risks who don’t medically need it. So when we read about rising caesarean rates – such as John James at 43% in 2008 – we should consider what advice doctors are giving and what training they’ve had, rather than putting all the pressure onto women (who in Canberra usually have only 1 or 2 babies in their lifetime) to research it.

PigDog 10:04 am 23 Jun 11

Does Dr Foote publish the results of his own work?

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