Private or Government hospital, which one is better for childbirth?

"Bersalin hospital gomen (kerajaan) ke private nanti?", or "Where do you plan do deliver your baby, Government or private hospital?" was one of the most frequently-asked questions by my colleagues during the old days when I was pregnant for the first time.

Here, I would like to share something based on my personal experience, esp with my first child Alvin who is an ex-prem baby, as well as hearsay.  Which is better - private or Government?  Important tip: To keep an open mind to both options.

 Hospital Ampang

Introduction
I was born in a private hospital in Ipoh by my mom who was in the civil service, a.k.a. Government servant.  My mom had briefly worked in the Labour Room in a Government hospital. Being there means my mom was entitled to seek a GL which enables her to deliver her babies in any Government hospital free-of-charge, but then my mom chose not to.

The reason - I do not know.  But after all that I've gone through, I would say that I was a bit misguided prior to giving birth to Alvin.

Though not looking forward to anymore pregnancy after the arrival of Alvin's brother, nevertheless I shall be much delighted if the following note can be of help to those who happen to come across this humble blog, who are currently considering whether to go private or Government for delivery.

Myth vs Facts
On one side...

Folks from my side of family encouraged me to go private for antenatal check-ups and delivery.  Whether myth or fact, among the given reasons:

- freedom to choose an ob gyn for antenatal care and delivery;
- more attention due to a smaller nurse to patient ratio in a private hospital;
- "less likelihood" of getting scolded by nurses because private hospitals are business entities,  competition is stiff, and hence they have to treat their patients a.k.a. customers nicely;
- freedom to choose the type of ward, e.g. single room, twin-sharing, suite, etc... just like choosing hotel room hehe...;
- those around me who advocated for delivery in private hospitals would tell me "You think private hospitals want to risk tarnishing their good name?  They'll do their absolute best to make sure that both the mother and baby are safe". 

On the other side...
As for the other side of my family, having personally gone through pleasant delivery experiences at Government hospitals themselves, they encouraged me to choose Hospital Serdang for delivery.  I was also advised to go to the nearest KKIA for antenatal check-ups, which I did and was generally happy with the service at KKIA despite the long waiting time. 

Those who had gone through child delivery would tell "sakit bersalin tu sama sahaja tak kira di mana pun" (labour pain is the same regardless of where you deliver).

A little of both, but fingers-crossed
Being ambivalent as to where to go at first,  I went for my antenatal check-ups at both places - private and Government.

At the same time, the "campaign" from both sides of differing views continued to haunt me.  At that point of time, I was indecisive as to where to go for delivery should I make it to that stage.

Beyond my wildest dream
Thinking of it now, I am glad to realise that certain things happened for a certain reason, although I am disappointed with my body for failing to carry Alvin until he is truly ready for birth.  But for the stint at NICU and ward 4A at Hospital Ampang, I wouldn't have learnt things that I need to know in child care.  I might have ended up becoming highly-dependent on others e.g. my mom-in-law, to take care of even the smallest things because I had never taken care of babies before (never even held one earlier, because I was scared to carry others' babies for fear of upsetting their babies with my novice hands).

Now at least my eyes were opened wider and I know what is true and what's not.

The complacency in me when pregnant for the first time lies in being ill-prepared as far as handling a premature delivery is concerned, just because prematurity is rare.  Other than threatened miscarriage in the early days, my first pregnancy was otherwise uneventful and hence it didn't come across my mind to prepare for premature labour.

Beneath the initial reluctance
This is hearsay:  There was once I read at a local online forum of someone who went into labour at just 5 months (20 weeks?) into her pregnancy.  As contemplated, the baby did not make it.  Accordingly, one of the nurses at the Government hospital where she delivered her baby had scolded her and asked if she had been "very actively together" with her husband during pregnancy and thus led to labour at 5 months.  Huh? If the allegation of such what the nurse did to her is true, this is indeed very bad.

Having heard of such a nightmare story, I was initially afraid of facing the same ordeal of being humiliated or falsely-accused of doing what I did not do.  The above might or might not be a joke, but surely such a "joke" is too much.  This is also another reason why I thought that going private is good (ngeee... I was so innocent).  I was afraid of getting scolded by nurses for being an innocent first-timer.

Another Myth vs Fact...
Q: Is it true that private hospitals refer serious or high risk delivery cases to Government hospitals?

A: Yes, they do.  My case (with Alvin) is an example . 

It's not necessarily because the private hospital does not want to handle such case, but my doctor had advocated for it mainly due to cost factor.  In any event, other than a few very big private hospitals, not many have fully-equipped NICU.

Only if I knew...
... then I would have gone to a Government hospital straightaway upon the bloody show... saved some money on what I could have gotten for almost free... and most importantly, saved myself from looking silly with that initially reluctant face when Dr Teresa told that she wanted to refer me to HKL.  OMG, I generally knew that the cost of treatment in NICU in private hospital is high, but not as high as that.  After listening to a thorough explanation, I agreed.  At last, I was referred to Hospital Ampang, so call it fate that my kid was to be born there. 

The general rule
A nurse once told that in one private hospital in KL, it costs about RM1,000 per day for NICU.  Let's say a 29-weeker preemie is to live in the NICU for 50 days, that will be RM1,000x50 = RM50,000.  This surely does not include additional costs which may total up to more than the price of a VW Polo Sedan.

My brother's friend who works at Pantai Hospital KL (the one near Kerinchi) told of one extreme preterm baby who had lived in the NICU for 4 months.  The baby's medical bill came up to more than RM100,000.   But in that case, cost isn't a problem as the baby's father is a high-paying expat executive in KL.

Generally, the rule is as follows:

Ordinary working person with moderate amount of $$ + Low/Medium Risk Pregnancy = Any Government or private hospital of your preference will  do.  The FPP (full paying patient) scheme available at Hospital Putrajaya & Selayang for instance, is another good alternative.

Plenty of $$ + low/medium risk pregnancy =  Any hospital you like...

Plenty of $$ + High risk pregnancy = Can go private without problem.  Preferably private hospitals with tertiary-level care, e.g. Gleneagles, Pantai KL, or SJMC. 

Ordinary working person with moderate amount of $$ + High risk pregnancy = Major Government hospitals or university hospitals like PPUM and PPUKM.  Basically any GH will do because they are well-equipped and have enough expertise in the NICU, or even if they don't have the facilities available, they have the network to get you to the required facilities.

Let me share here, that Alvin's overall NICU fees at Hospital Ampang for 53 days is RM452.  The Government subsidy is more than 90%.  The service was very good, the doctors and nurses were helpful and nice, and totally different from the negative stories I used to hear about Government hospitals.

The saying goes "tepuk dada, tanya selera".  In normal cases, there is no hard and fast rule as to which is better - private or Government.  It boils down to personal preferences.

Another difference between private and Government hospitals are:

Private Hospital	Government Hospital
Newborns are taken care by nurses in the nursery.  If you wish to breastfeed, then you’ll need to inform the nurses so that your baby is brought to you for nursing.  Otherwise, you can rest after a long tiring day of labour and delivery.	Except for NICU cases, mothers are to take care of their newborns in terms of feeding and diaper-changing. Strictly breastfeeding, except for special cases. Almost everything is on DIY basis.

 
In high risk cases, major Government hospitals (e.g. HKL) /university-based hospitals are the best option.  Contrary to what many people believe, Government hospitals are good in many ways.  But the visiting hours at extremely strict at Government hospitals.

Conclusion
In conclusion, there is nothing wrong with choosing to deliver your baby in a private hospital as long as you are comfortable with the doctor and hospital of your choice.  If budget comfortably permits it, why not?

There is also nothing wrong with choosing to deliver your baby in a Government hospital regardless of what others say.  My personal observation is that, it's best to learn some basic baby care beforehand when you choose to deliver in a Government hospital in view of the summary highlighted in the table above. 

While I do not wish anyone around me to go through a very premature delivery like me, I would like to share that if that happens (touch wood no please!) the best thing to do is to go to a Government hospital straight unless one is financially able to fork out RM100K in cash without compromise for medical bill (this applies only to very preterm cases, and not late preterms who probably need only 1 week in the NICU).

It's also a good idea to have a "buku merah" or antenatal booklet from the KKIA for just in case it's necessary to go to a Government hospital.  Not as if Government hospitals don't entertain those without the buku merah, but doctors and nurses at Government hospitals tend to be a bit more receptive if we have the booklet.

But if I were to share my own personal preference, I would choose PPUKM (I went there for my second pregnancy; cerclage, bed rest, and delivery last year)... it's the nearest university hospital from my place although not the nearest hospital, it has the expertise and facilities for high risk pregnancy and delivery cases, and cost-wise, is reasonable.  Hospital Ampang is good too, but I was more closely-attended to in PPUKM.