Private vs. public hospitals – What can I expect when I have my baby?

Many of you might be wondering what you can expect in our South African public and private sectors when you go in to have your baby and this post will shed some light.

Where should I go when I get to the hospital?

Public /State hospital:

Before getting to the answer, you should first understand the structure of the public system. Unlike in private, where you can chose which hospital to go to and which doctor/midwife you want to see, you will be allocated to a hospital or clinic based on your residential address and the health status of your pregnancy. If you stay in Area A and have a healthy pregnancy, you will attend the local clinic’s maternity services and have your baby there as well. If you develop complications during your pregnancy which make you a high-risk patient, you will be directed to the district or tertiary hospital that serves all the high-risk patients from i.e Area A, Area B and Area C. 

You will be informed by the clinic sister where to go if you go into labour. If your waters break or you start having contractions before 37 weeks, you will attend to your local clinic and from there they will refer you to the hospital that can manage a premature baby. This is just a general guideline, you must ALWAYS check with the clinic sisters/midwives where to go.

When you need any medical attention during your pregnancy before 24 – 28 weeks (depending on the hospital so please ask) you will report to the Casualty centre (Emergency Centre or EC) and mention that you are pregnant and have the following symptoms. They will know immediately where to refer you, usually it will be to the admission room for Gynaecology patients. In public, obstetric and gynaecology departments have their own triage and admission rooms because not all patients will be admitted and they are all screened first in this area and then either sent home or admitted to the relevant ward. 

If you are more than 24 -28 weeks pregnant (again, please ask the clinic sisters) you can go directly to the obstetric admission area to be seen by the midwife and doctor on call. 

Private hospital:

Depending on the hospital, you will be required to report to the Casualty centre (Emergency Centre or EC) if you are less than 24 weeks pregnant and you will be seen by the doctor on call there and then either your own Obstetrician (in other words your own gynae) will be informed or the one on call will be informed to come and see you. Depending on your symptoms, you will be treated and sent home or admitted to the Gynaecology ward, sometimes to the Maternity ward if there aren’t enough open beds.

If you are more than 24 weeks pregnant (Check with your hospital), you can skip the EC and report directly to the Maternity ward and the midwives on duty. They will do an assessment and subsequently inform the doctor on call or your own gynae to come and see you. Remember, doctors have many patients and cannot come out to see every single one during after-hours because they will never be able to leave the hospital then. So they take turns to stand in for each other during after-hours, weekends or holidays but you can rest assured there will always be a doctor on call to see you but it might not be yours. Sometimes if you have a high-risk pregnancy your doctor might make the exception that he/she will personally come and see you if you have any problems and need to be admitted, but that they will communicate with you.

What happens when I am admitted?

Public/ State hospital:

In most triage areas in hospitals you will first be seen by nursing assistants who need to do a baseline check-up. You might first get asekd to go the clerk station to open a hospital file so that they can have a record of your visit and you will go back to the triage room. That means you will sit and wait until it is your turn – if there is not something obviously or seriously wrong with you – and then they will take a short history of your complaints, your blood pressure, urine test, temperature, and other vital signs. 

If you are more than 28 weeks the midwife will call you to a bed where she will put you on the fetal monitor to do a tracing of the baby’s heart. This is about 20 minutes and during this time the doctor might also come and assess you and examine you. Afterwards you will receive a treatment plan, this can include bloods to be drawn, tablets to take home, admission to the ward etc. It all depends on your unique circumstances. 

If you come in in labour with strong contractions, the midwife on call can see you straight away without you having to wait, she will examine you and if the baby is on its way you will be taken straight to labour ward to continue there on a bed and a fetal monitor and you will also have the baby there. Either your partner will get send to the clerk station to open a file or someone will come and see you in the bed. You will be handed over to the midwife allocate to the room to manage the birth.

For scheduled caeesaren sections you will be admitted to the antenatal ward and await your turn but there is normally no set time. If emergencies are scheduled then you will have to wait until they are finished. If you are having an emergency caesarean, you will be taken to the theatre, normally a part of the labour ward as soon as possible.

Private hospital:

After 28 weeks (depending on the hospital) you will go straight to the maternity ward where the midwife on duty will assess you and take all of your vital signs as a baseline (blood pressure, temperature, urine test etc.). She will always notify your doctor (during working hours) or the on call doctor (after hours) about your condition. IF you are ready to have the baby, they will prepare you and if the doctor is too late, they will deliver the baby as midwives are trained to manage vaginal births). Normally there is enough time for your doctor to make it to the ward. If you are not in labour, the doctor can request for you to be admitted and to come see you the next day if it is late at night. They might not always come in to see you after hours if it is not serious.

If you have a scheduled caesarean section, you will normally be expected to report to the maternity ward around 5am – 6am in the morning of the operation, to be admitted and you will await your turn in the ward. For emergencies, you will be prepared in whatever area you are in and taken to theatre as soon as possible.

What happens after the birth?

Public/State hospital:

You won’t receive any baby goodies in the public setting so make sure to pack your bag with everything you need. Some hospitals might have some maternity pads or nappies on hand to help you out but please don’t bargain on being supplied with any accessories.

After a vaginal birth, you will be monitored and if stable, send to the postnatal ward with other moms who had vaginal births. Your baby will room in with you in its own crib (stay with you in the room at all times) and not go to a nursery. Many public hospitals are understaffed with a high burden of patients so expect to see the nurses during rounds to check up on all the patients or hand out medication, but a long time might go by without seeing anyone because they are busy elsewhere. On a busy day, a ward can discharge 23 mothers and their 23 babies and simultaneously admit 15 new mothers and their 15 babies with four nurses on duty and one sister to check up on everyone and give the necessary care. Therefore, if you are not feeling well or you are bleeding much more than you think you should be bleeding, ask a fellow mother if she can call the sister if you feel too weak or go find someone yourself to ask for assistance. If there is a bed bell, you can get their attention also. You will share a room with 1 – 6 mothers, sometimes up to 16 mothers in an open ward. You will receive pain medication as tablets or suppositories.

Mothers are very much encouraged to breastfeed but because it can be challenging, you should ask for help if you don’t manage. Normally the new moms admitted to the ward get extra attention in the first 6 hours after the birth and you will receive help with breastfeeding, but again, if you are in a ward with staff shortages you might have to call for help and if you are still struggling when you are discharged, go to the clinic for help.

After a vaginal birth as a low-risk patient, you can be sent home within 6 hours of the birth granted that you and the baby are both stable and that the baby has passed urine and stool. The first vaccination will be given and the baby will receive a clinic book that you have to keep safe as this is their vaccination and growth record. You will always take this with you to the clinic for checkups of the baby.

If you are a high-risk patient, you will go home after three days if you and the baby are well.

If you had a caesarean section, you will be taken from theatre to a ward with other mothers who had c/sections. On the first day ,you will receive 6 – 8 hourly injections and oral tablets for pain as well. From day 2 you will have tablets and/or suppositories, potentially stool softeners (to make it easier for your first bowel movement afterwards) and a daily injection in the leg as a blood thinner to prevent blood clots from lying down for such a long time. After a Caesarean, you will go home after four days, sometimes sooner.

Private hospital:

Most private hospitals provide you with a baby bag with the basics you will need but always bring backup. OR at least pack it at home so your partner can quickly fetch it if you need it.

You can request a private room that you will pay more for otherwise, you will share a room with 1 – 3 other mothers. The baby can stay in your room in its own crib or you can ask the nurses to take the baby to the nursery when you go shower or sleep. There are nurses to look after the babies. Towards the end of your stay, it is sometimes recommended to keep your baby with you to get used to having them with you all night when you go home, but that is up to you. After a vaginal birth you will stay for three days.

After a caesarean section, on the first day , you will receive 6 – 8 hourly injections and oral tablets for pain as well. From day 2 you will have tablets and/or suppositories, potentially stool softeners (to make it easier for your first bowel movement afterward) and a daily injection in the leg as a blood thinner to prevent blood clots from lying down for such a long time. You will stay for 4 days in hospital. There is only one ward for postnatal mothers unlike in the public settings where there is a ward for each purely because of the amount of patients.

Reasons for not being discharged at the abovementioned times

  • Baby’s blood sugar is too low and needs to be monitored
  • Baby developed jaundice and needs to be under the lights
  • Breastfeeding issues and baby not picking up weight
  • Mother picked up an infection
  • Mother  has lost too much blood during the birth and needs to be monitored. Might need a blood transfusion.
  • If baby is premature, mother can be discharged while baby stays in the hospital

Will visitors be allowed?

Normally yes, but each hospital has its own rules. You as a new mom can put your own rules in place for visitors as well.