What would you do? Public vs. Private dilemma

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beccadeaton

Registered User
I have been in contact with our insurance company (based in the USA) to find out what coverage I have for pre-natal care and L&D so that I can make decisions about a doctor and hospital.

I found out that they will cover all my costs for any OBGYN. Moreover, the hospitals that they will agree to work with include Matlida and Canossa. This means that they will cover the costs with the exception of our standard deductible (what we would pay if we were in the US).

So my dilemma is this. My last baby was born 6 weeks early at 34 weeks (in the USA). He didn't have major problems, but he did spend 2 weeks in the neonatal intensive care unit. Although his problems were minor, it could have been worse, of course! My OBGYN in the states told me later that I would be at higher risk of having another premie with my next baby. So, I basically have the choice of going to Matilda, which obviously is lovely but does not have a NICU or going to Queen Mary, which is obviously less "nice" but has a NICU on site. Which would you choose under the circumstances?

Thanks for your input!
 
well, if you go to matilda and you are in need of nicu, they will transfer the baby there....

personally, i find the high risk dept at qmh to be fantastic. would your insurance cover you for private care at qmh?
 
Nope...that is the kicker. None of the public hospitals are listed as covered. Actually, I can still go there but I would be responsible for the difference between the "allowable" costs and what the hospital actually charges (in addition to my basic deductible). And in reality, I feel like if I am at QMH, it doesn't really matter if I am public or private at that point. Same "basic" accommodations, same "bad" food...etc. Both my sons were born in the US and I never had a fully private room (usually 2 beds per room). It didn't really bother me as there was a curtain to partition the room.

I am leaning towards going to a private OBGYN but delivering at QMH. I guess I feel like if there is a chance of it being a high risk delivery, I would rather be right where the best care is. That is what it is all about right. Not the comfortable accommodations per se.

But is is hard to pass up the opportunity to deliver at Matlida! ;)
 
hi, I was having the same dilemma. I am 5 months pregnant with my first baby and am at risk of delivering pre-term. I have been seeing Grace Cheung who suggested that I see a doc at QMH just so that I am in the system. I am now seeing Dr Ben Chan at the Pvt Clinic at QMH. There is a difference in the service but I just figured that if QMH is safer for the baby then that should be priority. QMH for private patients is expensive too so you will need to figure out your insurance.

Having said that even I do miss the fact that i will not be delivering at Matilda.
 
Hi,

I too am in the same position and decided that I would book private OB but go to public hospital for birth. My 4 year old son was born at 28 weeks and was in NICU for 8 weeks when he was born and I was also advised that the same might happen again. Luckily I have now passed that milestone and am now 32 weeks pregnant. My OB (Alex Doo) has been very supportive and has tested me for early signs of labour etc to put my mind at ease. I do not feel like I will be missing out on the private hospital experience as I feel that I would probably be getting very stressed out at the thoughts that something may still go wrong and I would then be separated from the baby while they were transferred to QMH while I had to stay in the private hopsital.
 
I would advise consulting with a private OBGYN here about the exact circumstances surrounding your first early delivery, to do a current risk assessment for premature delivery this time around. There are many underlying causes for prem delivery that can be managed to better outcomes in subsequent pregnancies. I'm not exactly sure if you are already expecting, but even if you're not, an obgyn would welcome a planning consultation.

I highly recommend Lucy Lord for managing high risk pregnancies, and she delivers at the Matilda. She has managed my two pregnancies: the first a 32 week very small for gestation baby (who we chose to deliver in Australia, given the lack of options here) and the second an extremely well managed 37 week full term outcome (benefited from drug therapy all through pregnancy, even so we were ready to deliver at 35 weeks at Matilda, but managed to hold on with bedrest etc. for the last two weeks).

The Matilda does have what is termed a "Level One" Nursery (Special Care) which is opened on as needs basis and has space for, I think, 4 infants, and so actually does nominally cater for babies born at 34 weeks and over. As long as there aren't any other underlying medical conditions, Level One is usually all that is required for the average 34 weeker.

It is useful to understand that there are three levels of neonatal care nurseries: NICU is Level Three, Level Two is often called a High Dependency Unit and Level One most often referred to as Special Care. Usually only the large teaching hospitals have a true Level Three NICU (as does Queen Mary here in Hong Kong), whereas many small privates have Level One only. Queen Mary's Paediatric & Neonatal Intensive care is actually one nursery containing 7 PICU, 15 NICU, 1 HDU and 35 SCBU beds.

Ultimately your decision on where to deliver rests on the points that are most important to you in terms of care paradigms for your infant.

Personally speaking, we chose to deliver our quite premature firstborn in Australia, so we could deliver at a very large internaionally renown teaching hospital with both NICU and private facilities. He spent 6 weeks in hospital, only the first day of which was actually in the full Level Three NICU, as he was stable and breathing well, thus able to be "promoted" to the Level Two High Dependency Unit where he spent the majority of his stay in an isolette. These very large hospitals actually have separate nurseries for each of the levels of care, thus it was easy for us to make the distinction that our son, small as he was (less than 3lb), actually only required true NICU cot for 6 hours, before being moved to HDU for 4 weeks and graduating to SCBU for 2 weeks prior to coming home at a robust 4? lbs. :-)

Our decision was based on not the private facilities per se, but the paradigms surrounding the NICU and HDU outside Hong Kong being supportive of 24/7 parental access to the baby, full involvement in their care when their condition was stable and 100% support for exclusive breastfeeding of even a very small premature baby.

Again, personally speaking, I would rather deliver a healthy 35 weeker in Hong Kong at the Matilda for the excellent quality of midwifery support for breastfeeding and full access to my baby 24/7. Purely personal opinion.

Hope that helps.
 
I see you have covered off cover for pre-natal and L&D. Will baby be covered also as soon as it is born? This was a catch that I discovered when trying to get insurance in HK. Ended up going back to Australia for 20 days to give birth and come back because most of the insurers wanted a 6 month waiting period for the new born and I didn't wnat to risk it if something did go wrong (nothing did - but as you are doing, best to plan for everything).

If baby is not covered or has a waiting period then you may be better off going public...
 
beckveldman - thanks for all that info, it was really helpful. My son at 34 weeks was 5lbs, 7oz, so he was a giant in the NICU. Only spent 2-3 days in the higher level (not sure it was the highest) due to respiratory distress syndrome (breathing on his own, but labored so he had a cpap for a day, then just oxygen), then the remainder of 2 weeks in the lowest level of the NICU mostly because he had no sucking reflex (for either breast or bottle) so he was fed through an NG tube while we worked like crazy to get him to breastfeed (funny...i just weaned him from BFing last week...he is nearly two now!).

I am a natural delivery, breast feeding, be with baby 24/7 kind of mom, so that is important for me. That being said, this will also be my third baby, so I don't need as much support...just don't want them to stop me from doing what I need to do! ;)

I did not know that Matilda had a level one facility for newborns...that might sway my decision.

We have no idea why he was born early, although by his size and reflexes they thought he was more like a 35 weeker. I just went into labor and everything happened really fast. And my first son was born at 38 weeks, so I am expecting another one early...just hoping this time it is not quite as early!

I already have an appt with Lucy Lord for next week, so I will talk to her and get her professional opinion.

Thanks for all the advice!
 
Hi again,

You can request a private tour of Matilda's maternity facilities anytime, and if you ask in advance when you book your appointment (and remind them when you get there) you can usually also see the Special Care Nursery.

I'll warn you, it's pretty small! But it does show that they have all the monitoring equipment that you would have been used to in Level One SCBU back home, and they are equipped to do NG feeding and phototherapy, and they have isolettes.

Anyhow, I am sure that Lucy will be a mine of information for you. She was prepared to deliver my second child from 34 weeks onwards at Matilda, absolutely no qualms (and being a potentially second time prem Mum, I was confident that although the SCBU was small, I had learned the ropes of what a smaller baby should need in their first few weeks and would know what to ask for!)

I'm glad the info helped. I know that understanding the structure of "NICU" and the different phases of nursery care through long chats with the staff during our stay with our first child helped me to make informed and confident choices when we were expecting our second. (Actually, for the record, if she had at any stage looked like coming at or before 32 weeks, we would have gone to Australia again! Anything later I knew Matilda, and my baby, would cope just fine.) Every situation is different, and I had the advantage that my complications in pregnancy are able to be monitored and the end point guessed reasonably accurately, giving us time to make a "here or there" decision.

All prems are different! My 2lb 13oz boy had the benefit of me getting steroid shots in the days leading up to delivery, so he just required an oxygen mask for a few hours to get his sats up while they watched over him in NICU. If NICU hadn't been so in demand at this hospital (due to taking retrievals of much younger infants from all over the state), he probably would have stayed there for a few days just due to his small size for monitoring - but he was stable and doing well and they needed that NICU cot for another. Honestly HDU (Level Two) doesn't look much different from full NICU, and when they are in the same physical nursery rather than next door to each other you'd barely recognise the difference. It's usually about staffing ratios (NICU in our hospital had one specialist nurse looking after two babies only, on 12 hour shifts for continuity of care; HDU had 1:4 on 8 hour shifts), and ventilated babes or those immediately post-surgeries were in NICU. HDU had plenty of babes on c-pap, under lights, most were NG fed etc.

During our last two weeks in Level One SCBU (he graduated to that nursery when he made 3.5 pounds and could hold his own temperature therefore come out of the isolette into an open crib with hot water mattress), we saw a few "long-termers" like our son who had been promoted through the nurseries, but mostly newborns who came straight to Level One after birth around the 33 - 35 week mark who just needed a help getting to full suck-feeding and a little monitoring (lots of twins, and one 11 pounder I'll never forget!! He was jaundiced and needed lights for a few days, but compared to the little ones he looked about 4 months old!!) I remember the nurses affectionately terming SCBU the "Fat Farm" - i.e. babies mostly needing to get a little bigger and get the feeding thing sorted.

Anyhow, just rambling, but wishing you a long, healthy and close to full-term pregnancy.

Congratulations on your oustanding breastfeeding experience with your son given a rough start! I'm still BF my daughter at 19 months, my prem son fed that long too :-)
 
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beckveldman - I just noticed that you are located in Discovery Bay. We are moving out there at the end of Aug...perhaps we can get together and chat? My boys are 3.5 years and nearly 2. We will be living on Seahorse. :) Moving from a serviced apartment in TST.
 
The question I would ask yourself is, If you where to have a preterm or god forbid if anything to go wrong with your pregnancy, would you want to be travelling from Matlida or Canossa possible in traffic to the QMH?
The QMH only charges $100 per night inclusive of all surgery ect.
Yes you will be a lot comfortable at the private hospital but why take the chance of paying more and taking the change of complications?
 
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