Tuesday 25 July 2017

Private too pricey for prospective mums

As money gets tighter, mums-to-be who would previously have chosen private maternity care are now being forced to take the public route instead

Mary Kirwan

RECESSION-hit families have been forced to cut back household budgets -- and not even maternity care has been spared the chop. Last year over 40,000 people cancelled their private healthcare policies. In addition, the Pfizer Health Care Index for 2010 found that 56pc of people were finding it hard to make ends meet because of the recession, compared to 48pc in 2009.

The recession is also hitting private maternity care. In our maternity hospitals it's not a case of being too posh to push anymore; it's more like we're all becoming too poor to go private.

Anecdotal evidence suggests there's tumbleweed blowing through consultants' rooms as mums-to-be desert expensive private care options, opting instead for semi-private and public maternity care.

Figures obtained by Health & Living reveal a stark decrease in mums availing of private maternity cover at some of our major maternity hospitals.

In the Coombe Women's Hospital between 2007 and 2009 the birth rate increased but there was a decrease of 17pc in the number of patients going private. In 2007 1,968 women gave birth privately but this figure dropped to 1,620 in 2009.

Private care consists of access to your own consultant for every antenatal visit, a private room after the birth of your baby depending on the resources available in the hospital at the time and your consultant usually attends the baby's birth. Fees can range anywhere from €3,500 to €10,000 for private consultant care, to be paid on top of private health insurance.

Slide

Last year the trend was also dramatically downwards. Figures for the period January to October 2010 show that only 1,193 women chose to give birth in the private system. Although these are not full-year figures, it represents a near 40pc drop in the three-year period between 2007 and 2010.

There has been a slide in semi-private delivery figures there as well. There were 1,398 semi-private births in the Coombe Women's Hospital in 2007, but this had fallen to 1,270 in 2009, representing a near 10pc drop.

The cost of semi-private care is mostly covered by health insurance. Semi-private cover differs mainly from private in that you won't necessarily see the same consultant during each antenatal visit.

In the Coombe Women's Hospital there had been a drop of 479 women availing of semi-private care, or 34pc, between 2007 and 2010.

Between 2007 and 2009 there was a 15pc increase in public patients. This translates as 5,769 babies born in the public system out of a total of 8,659 babies delivered.

Dublin's Rotunda Hospital, which historically caters for a lower percentage of private patients, has also seen a decline. There was a six per cent drop between 2007 and 2009, with a 31pc fall in the first nine months of 2010.

There was an increase of 226 women having their babies semi-privately between 2007 and 2009 in the Rotunda. There has also been an increase in public patients during this three-year period.

In the National Maternity Hospital in Holles Street, private patients represented 20pc of all births in the hospital in 2007 but this had fallen to 15pc by 2010.

When private births in the NMH in 2007 were directly compared to private births in 2010, there was a 28pc drop (or 489 women) going private.

A spokesperson for Holles Street said their semi-private numbers haven't changed since 2007.

Culture

So how is the recession affecting mother's choices in terms of the type of care they are opting for?

Charlie Gallagher moved from London two-and-a-half years ago with her Irish husband Killian and they have one daughter Lorelei (12 months).

The culture of private maternity care in Ireland came as a shock to her because it isn't the done thing in the UK, where the service is provided by the NHS.

She took out VHI healthcare but discovered on becoming pregnant that she would have to pay nearly €1,000 on top of her policy for semi-private care.

"I didn't see how I would benefit from going semi-private so I decided to go public. The only real difference between the two was that there were less people on the ward when you have your baby semi-privately," says Charlie.

The wait for appointments in semi-private clinics is about 30 minutes while Charlie had to wait up to three hours to be seen.

Her experience of the public system was good but she had some gripes.

"The appointment system was shocking. I'd have to take the whole afternoon off work and could be waiting up to three hours to see someone. It was just bad organisation."

There was also a delay in her first scan, which occurred at 20 weeks.

"We paid for a private scan at the 12-week mark because we felt it was too long to wait.

"My doctor assumed I was going semi-private. I got the impression there's a bit of keeping up with the Joneses going on!" she says.

"By going public you have to make some concessions but on the day they were brilliant and the birth care was fantastic, even when I had some complications," says Charlie, who was attended by a consultant and midwife at the birth.

"It's obviously up to every woman to make a choice based on their own personal circumstances.

"If people have complications or severe phobias, private care may suit them better," she adds.

Someone who has experience of both private and public care is Jene Kelly. She is the co-chair of the Association for Improved Maternity Services in Ireland (AIMS).

Jene went public on her first child Niamh in 2003. After spending 14 hours in a pre-labour ward on her own, and being put beside a woman who was losing her baby, she decided to go private on baby number two, Aidan.

All went smoothly but after the birth she was diagnosed with haemorrhaging and was heavily managed. As a result of this she had few options available to her and went private on her third baby, Niall. When it came to her fourth child, Meabh, she wanted to go public to avail of midwife-led care.

"I really pushed for midwife-led care. I believe it is a great service for women," explains Jene.

But Jene couldn't get what she wanted in the public system while pregnant with Meabh. She was diagnosed with placenta previa at 34 weeks after a scan and was immediately taken off the midwife system.

Jene was categorised as a high-risk pregnancy and booked in for a caesarean to be carried out at 38 weeks.

Not taking this at face value, Jene moved to a second public hospital where the diagnosis of the first hospital was accepted without her being scanned again.

She was booked in for a scan a few days later but this was cancelled due to a strike, so she and her husband decided the only option was to go private to Mount Carmel hospital in Dublin.

"I didn't get anything from the public system. I felt I couldn't trust them. While going private nearly broke us I couldn't put my body in the hands of people I didn't trust."

Evidence

Jene was taken on at Mount Carmel at 35 weeks pregnant. Even though there was only eight days between the two scans they couldn't find any evidence of placenta previa.

"They scanned me for over an hour just to be sure," she says.

"I just felt like a number in the public system. There was no consideration for individual assessment. I was told by my new consultant that there was nothing wrong with me and I gave birth naturally standing by the bed," adds Jene.

"It all went so wrong. It can be a very 'one size fits all' system. Mount Carmel were the only ones to give us a chance and gave us a voice," says Jene.

Author Lucy Taylor recently published 'The Mum's Guide to Having Your Baby in Ireland'. She argues that information is key in having a good maternity hospital experience, whether it's private or public.

"There's nothing wrong with the public system and it suits a lot of women. What people need is information. Everyone is different. Some women couldn't bear it while others find it fine.

"There are lots of options within the public system now. The Domino Scheme is proving very popular," Lucy explains.

The Domino Scheme allows mothers with low-risk pregnancies to receive their antenatal care through their GP and have their baby in hospital with a community midwife.

They are usually home within 12 hours of giving birth.

"When you find out you're pregnant the most important thing to do is to act fast as time is crucial in getting early appointments," adds Lucy.

"Having a baby isn't elective, you can't put it off like other things so busier services are going to mean longer waits," she says.

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