Public or private: what’s the best way to have a baby?

“Please, please, please come to my rescue,” started a mail we received recently from a reader called Niamh. “I am three months pregnant and me and my husband cannot agree on whether or not we should go public or private to have our first baby.

“I am keen to go public (and have started my journey in the system) as I have sisters and friends that speak highly of their experience,” Niamh continues. “My husband wants to go private (he’s a snob) and is strategically pitching this as he wants the best for my care.

“From speaking to various people I have narrowed the difference down to some limited benefits. First, when you go private the one or two appointments that you have with your obstetrician ahead of having your baby will be with the same doctor. This cannot be said when you go public. Also when you’re private, that same obstetrician then oversees your labour. And you get two scans, the second one at 20 weeks. This is not necessarily the case when [you go] public.”

She says the fee for going private is about €2,500. “I have health insurance. I pay a premium of €800 a year but I do not know if this offers any advantages to me.”

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The public route

The email raises some interesting questions – ones faced by many people. Every woman giving birth in Ireland is entitled to free maternity care but the nature of the care available can depend on how the pregnancy progresses, where the woman gives birth and how much she wishes to spend.

Someone who goes down the public care route gets all antenatal care, all care during labour and childbirth and all postnatal care at no cost. All hospital accommodation costs – in a public ward – are covered. Expectant mothers are not guaranteed to see the same doctor or midwife at each visit to a public antenatal clinic.

Some hospitals offer midwives’ clinics for women with uncomplicated pregnancies. During labour and birth, midwives do the work and doctors may not be present at all. After the baby’s birth, mothers stay in public ward.

There are also the Domino Midwives Schemes, which are available in certain hospitals in the State. Again, they are designed for women at low risk of complications. Many of the appointments takes place in the home, and as part of the programme, mothers are entitled to an early hospital discharge and home visits from a midwife for up to a week after a baby is born. The Domino service is offered at the three Dublin maternity hospitals as well as Waterford maternity hospital, Wexford hospital and Cork University Maternity Hospital.

The semi-private route

Then there is the semi-private option. Depending on the hospital, that could mean a woman sees the same consultant privately before the birth and then whatever obstetrician is on call for the actual birth. Alternatively, it could mean a mother attends a clinic run by a consultant and senior members of their team. Once the baby is born, mothers stay in semi-private wards if available. That could mean a room with up to five others. The cost can be anything from under €1,000 to more than €2,000.

The private route

Going the private route sees mothers get access to the same consultant at each antenatal visit, and that consultant should also be present when the baby is being born – although that won’t happen if they are tending to another woman or are on holidays, playing golf or sleeping. After the birth, mothers tend to stay in a private room if available. The costs here can start at more than €2,000 and rise to more than €4,000.

When it comes to health insurance, the financial benefits are limited. Policies might cover private rooms for a spell, but typically, at the level outlined by Niamh, the policy will not offset any of the private or semi-private consultant costs.

Weighing it all up

So, what is the answer? Well, it really depends on the nature of the pregnancy, what people can afford and what they consider important. In Pricewatch’s admittedly limited experience, midwives do most of the heavy lifting during uncomplicated deliveries and they do so at no cost to mothers.

Continuity of care, extra scans, less waiting ahead of appointments and the allure of the private room are what draw a lot of women to the private system. There is, however, never a guarantee the consultant you have paid through the nose for will be present at the birth, and waiting times for private consultants can be as long or short as in the public system, depending on how lucky a mother gets on any single day.

Private ultrasound clinics can do scans for €125, and the quality of the images they produce are stunning.

As for private rooms, they are never guaranteed – no matter which route a mother takes, that depends on availability.

While we would be reluctant to point Niamh in one direction or another, we think she might be well advised to trust her own instincts, particularly if the pregnancy proceeds in an uncomplicated fashion. We also think the care offered by midwives in Ireland both before, during and after birth is excellent. And the €2,000-€3,000 she would save by taking the public route will come in very handy in the years ahead, as babies are not cheap.