Paying the delivery charge

PERSONAL FINANCE:Maternity policy in public hospitals means that it is possible to have a baby without paying anything – but for those who opt for private care, the costs can mount up

HOW MUCH does it cost to have a baby in Ireland? To the uninitiated, this may seem like a trick question – surely it’s free? And indeed it is, if the mum-to-be goes through the public system, but if she chooses to go private the bill can easily top €5,000. Is it worth paying such a gasp-inducing sum? Now that times are tighter, many women who might have gone private in the past are opting for semi-private or public care instead.

Women are entitled to free maternity care, which means antenatal visits, labour and delivery costs and postnatal care will be covered by the State, regardless of whether you have health insurance or a medical card.

The option also exists to go private. The fees charged by consultant obstetricians vary considerably, even within hospitals. For instance, private consultancy fees in the Rotunda vary from €3,000 to €4,500.

Alternatively, you can go down the semi-private route, which generally costs in the region of €1,200. Although some hospitals may charge a lower initial fee, once extras like scans and blood tests are factored in, it tends to creep back up to this sort of level.

Private health insurers will make a limited contribution towards antenatal costs, which helps to ease the burden somewhat. For instance, Quinn Healthcare’s Family Care will refund up to €400 of out-patient consultation costs, as will Aviva’s Hospital Level 2 plan, while Vhi’s Family Plan covers €300 of pre- and post-natal care. Tax relief at 20 per cent is also available on the element that is not covered by insurance.

People who opt for private care cite a number of reasons. The first is continuity of care. Private patients see the same consultant obstetrician at each antenatal appointment. They will attend the delivery of your baby if possible, but this is not guaranteed. If they happen to be on holiday or at a meeting, then you’re out of luck – another consultant will cover for them.

Semi-private patients do not always enjoy the same continuity of care. The system varies between hospitals but generally you will attend a clinic run by a consultant and senior members of his team. They try to have the same person deal with you each time, but this may not be possible. Someone from this team should be available for your delivery, although you may be attended by the doctor on duty at the time. Public patients attend their chosen hospital’s antenatal clinic (or a community-based clinic), and may or may not see the same doctor on each visit. There is also a perception that waiting times are longer in public clinics.

Dr Sam Coulter-Smith, master of the Rotunda, says private maternity patients are paying for “insurance” that they are going to be seen by a more experienced person than a standard hospital registrar. He also makes the point that whether you have to see your consultant four times or 40 times during your pregnancy, no additional charge will apply.

Niamh Healy of Ciudiú, the Irish Childbirth Trust, believes the attitude of going private to ensure you’ve access to the best care is “quite harsh” on the public system. If a woman is going through labour, then midwives are the experts to deal with her, she says. “If anything deviates from the norm, if medical advice is needed, they will be quick to call in a doctor. It might not be a private consultant [but] they will call in expert obstetric care if needed. For the vast majority of women, the care of a midwife is the best care.

“A lot of people who pay for private care are very surprised to know they are going to be randomly assigned a midwife from the labour ward, who will spend most of the labour with them,” she adds. “The doctor really only pops in and out, if all is going well. They’re only really there if he or she is required. The doctor is not with you for 10 to 12 hours unless there are medical issues.”

The second issue is accommodation. The consultancy fees outlined earlier are unrelated to the cost of staying in the hospital for the delivery of your baby. For those with private health cover, insurers will generally pay for three nights’ stay in a public hospital, and if you choose a private hospital they will provide a grant to offset some of this expense.Aviva offers a “grant-in-aid” of €4,000.

“One thing people do like about private and semi-private is that typically they get into better post-natal accommodation,” says Healy. Instead of sharing a public ward, you may be lucky and get a two-bed room or even a private room. However as the number of deliveries have increased in recent years, so too has the demand for beds, and there is no guarantee of a private room.

Anecdotally it seems that women are thinking twice about going private because of financial constraints, and figures from the Coombe Women and Infants University Hospital support this. Although the overall number of babies born at the hospital rose by more than 300 to over 8,800 in 2009, the number of private antenatal registrations fell by 283 to just under 1,600.

By comparison the number of public registrations jumped from about 6,100 to 6,632. Final figures for 2010 are not yet available, but initial data indicates that the trend continued.

Even Mount Carmel, the State’s only private maternity hospital, has had to respond to these straitened times. “We looked at the prices of our [maternity] packages and reviewed them to make them more affordable,” a spokeswoman for the hospital says. It is now offering a new shared-care maternity package – whereby patient care is shared between GP and consultant – starting at €1,250 which includes five visits with a consultant.

A hospital package for first-time mothers costs €4,837. This includes two nights in semi-private accommodation, three pregnancy scans, two blood tests, an epidural if necessary, hearing tests for your new-born and a six-week development check with a paediatrician.

“From that fee they deduct the grant from whichever insurance company they’re with,” she explains. With Vhi Family Plan Plus the grant is €4,000. Vhi settles that with Mount Carmel directly, so the balance is €837. So the combined cost for the maternity and hospital packages works out at €2,087. You can also claim tax relief on this at 20 per cent, reducing the cost to €1,669. “Some people are entitled to a further grant towards consultants’ fees so they should check directly with their insurer,” she says.

Health insurers may apply a waiting period of up to a year to maternity benefits if you are a new customer. Also if you’re considering switching to HSF Health Plan (hsf.ie), familiarise yourself with the way in which its maternity benefits are structured, as the approach differs from other health insurance products.

Under HSF health plans you will receive a birth grant of €1,000 per child, and up to €1,700 towards costs such as consultant fees, depending on the particular plan.

The fees charged by consultant obstetricians vary considerably, even within hospitals. Private consultancy fees in the Rotunda vary from €3,000 to €4,500

How to make a mother of twins laugh: tell her two babies are as cheap as one

THE SECOND QUESTION I was invariably asked when I told people I was expecting twins was, would I have to change my car. The first was whether they were identical. They weren’t. But I did have to change the car. And a perfectly good, fairly new family saloon at that. However, having a two-year-old already, I could not fit three car seats across the back seat and suddenly we were in seven-seater territory.

This is one of the hidden costs of adding twins or higher multiples to your family and one many don’t realise. The Department of Social Protection certainly doesn’t, having recently published a report saying there was “no evidence” to justify higher rates of child benefit paid to the parents of twins and triplets.

You won’t find many parents of multiples agreeing. You need to double pretty much everything for each baby born at the same time. While the babies can sleep in the same cot initially, you will need two. You can spend anything up to €1,000, but a standard cot will set you back around €100. Add two car seats (€150 x 2), a double or triple buggy (from €350-€800), two high-chairs (€100 x 2), two bouncy chairs (€55 x 2) and the costs quickly mount up. And that’s before nappies, wipes, clothes and formula. One mother of twins, with an older child still in nappies, estimates she was spending €140 a week on nappies alone in the early weeks.

A trip to the local GP with two babies can leave parents over €100 lighter before paying for medication. Costs don’t stop after babyhood either. Childcare costs for two babies of the same age are astronomical, making returning to work not viable in many cases. Footwear and school-book costs will be doubled.

A mother of triplets recently moved her boys from cots into beds, necessitating buying three beds in one go. The solution is to beg or borrow baby equipment. Any notion of it being nice to “buy new” goes out the window when you find out he or she plans to arrive with a little pal in tow.

If friends and family can’t lend you anything, check out freetradeireland.ie or the buy and sell sections of parenting web sites, magicmum.com or rollercoaster.ie.

Join the Irish Multiple Births Association (IMBA) and receive a discount card that can be used in shops throughout the country. An example of the many discounts available include 10 per cent off in Clarks shoe shops, 15 per cent off in McCabe’s pharmacies and five per cent off in Tony Kealy’s baby shop.

See imba.ie for details.

– Aoife Carr