My wife Robyn had lunch recently with a couple from church. Jenny told us that their daughter had a baby recently. She wanted to have private pregnancy care. Their daughter and her husband had private health insurance but had unintentionally not included pregnancy cover, so she found herself not covered for pregnancy care. Jenny said that was not a major concern as they could afford to pay for private care.
The couple lives in Newcastle. She phoned many obstetricians rooms but in all cases none would take her as a patient as she did not have health fund pregnancy cover. They would not agree to have her as a patient for pregnancy care as she was not insured for pregnancy care! Private pregnancy care was not possible because she was not insured.
She ended up booking as public patient, as that was the only option, but not her preference.
It was her first baby. She wanted to have a Caesarean section as the mode of the delivery. She was told she could not as there was no medical indication. She could not have Caesarean section by choice.
She went into labour at term gestation. She attended the hospital but was sent home by the midwives and told to come back when her cervix was 5cm dilated. She phoned her mum and said: “how am I expected to know when I am 5cm dilated!” Her mother told her to go back to the hospital. She did. The midwife did an internal examination and found her cervix was 5cm dilated. She requested an epidural, which was administered. The epidural started to wear off. The midwife said they were not authorised to give her an epidural top-up and the anaesthetist was in theatre and could not be contacted. So, she laboured on without the epidural pain relief. She couldn’t push her baby out, despite her best efforts. It was decided to do a forceps delivery. As she was public I suspect the forceps delivery would have been done by a more junior doctor (a registrar). This would have increased the risk. There was significant maternal trauma, which was repaired. Baby was delivered in good condition.
She told her mother it was horrible experience, and she never would do it again. She said she will make sure she has pregnancy cover include in her health fund insurance for next time.
I told Jenny I have in increasing number of pregnant patients who are self-funded. They either don’t have health fund insurance, or pregnancy care is not included in their policies. If her daughter lived in Sydney I would have been very happy to have her as patient. Norwest Private Hospital has 2-night stay and 5-night stay packages for uninsured pregnant patients.
I also told Jenny she was in her rights to have a Caesarean section delivery even though there was no medical indication. I do many Caesarean section deliveries when there is no indication but maternal request. The hospital had no right to deny her request.
I also told Jenny the anaesthetist should have given epidural top up instructions. As well the anaesthetist should have been available.
I said to Jenny that my preference today is a vacuum delivery rather than a forceps delivery, if an operative vaginal delivery is needed. The vacuum cup is attached to the top of baby’s head, while forceps are at the side of baby’s head. Therefore, there is less birth canal and perineum stretching with a vacuum cup delivery and so usually less maternal trauma. In the past vacuum cups were less reliable and so forceps deliveries were done routinely when an operative vaginal delivery was indicated. Another very important consideration is experience. I have done thousands of operative vaginal deliveries, whereas the public hospital doctor who delivered Jenny’s grandchild would have done only a small number of operative vaginal deliveries. This inexperience would have a significant impact on safety and risks of the operative vaginal delivery for mother and baby.
