Health insurance for Cesarean sections

If you’re getting a C section, you’ll need more time to recover. Private health insurance lets you do that in comfort.

C-sections are used in one-third of all Australian pregnancies, so there's a decent chance a C-section could be on the cards for you. Most doctors don’t recommend having one unless it’s medically necessary, so the decision to have a C-section is between you and your doctor.

Medicare and private health insurance will cover you, but the private system offers more in the way of comfort and consistency, which is why more than 45% of all 2016 births took place in a private hospital. You can choose your own obstetrician, choose your own hospital and get your own private room.

Compare quotes from funds that cover a Cesarean

Most private insurers will have a policy that covers pregnancy. It will cost you some money since it’s considered a Gold level treatment. First, you'll need to find a hospital policy that covers it and then you'll have to serve the waiting period – usually 12 months. The following table shows insurers from Finder partners.

Provider Policy Treatments included Excess Price Apply
Hospital Gold
  • Pregnancy
  • Birth related services
$500 $164.05 Go to Site

*Quotes are based on single individual with less than $90,000 income and living in Sydney.

What is a Cesarean section?

C-section is a common nickname for caesarean section, a procedure where your baby is delivered surgically. It is relatively safe and can take anywhere from 45 minutes to an hour, although it can take longer in emergency situations. C-sections can be performed while you are awake or knocked out with a general anaesthesia.

Here is what happens during a normal C-section:

  1. Nurses will hook you up to monitors and to an IV. Either before you reach the operating room or once you're in it, nurses will start monitoring your vitals and hook you up to an IV to keep you hydrated and nourished.
  2. Nurses will prepare you for the procedure. Nurses will scrub down your belly to prepare you for the surgery.
  3. You’ll get something for the pain. An anaesthesiologist will numb the lower part of your body with a general anaesthetic, allowing you to stay awake to witness the birth.
  4. Doctors will deliver the baby. Your obstetrician will cut open the abdomen and uterus, pull the baby out, cut the umbilical cord and remove the placenta.
  5. You’ll get some baby time. You'll get a short amount of skin-to-skin time with the baby before you need to be sewn back up.
  6. Doctors will stitch the wound. Nurses will take the baby for routine testing while the doctors stitch you back up.
  7. You’ll recover. You’ll stay in the hospital anywhere from 5-7 days as you recover from the surgery.

What happens during an emergency Cesarean?

An emergency C-section is a C-section that you doctor decides to do after you've gone into labour and because a complication could threaten the life of you or your baby. In NSW, 12% of all births (38% of all C-sections) were done by emergency C-section in 2016.

While these are fairly common, you shouldn’t fret because they are still considered safe. The word “emergency” refers more to what would happen if you didn’t have the C-section.

With an emergency C-section, there may not be enough time to numb the lower part of the body, so they may just have to knock you out completely with a general anaesthetic.

The surgery will then go on as normal, but you'll need a little longer to recover.

All of this is not quite the same as a C-section that your doctor decides to do because of a prolonged labour. In the second case, it’s still a last-minute decision but there's no rush to do it and you can avoid having to be knocked out completely.

When would you need a C section?

You can have a C-section for a variety of reasons, most of them being medically necessary. Some women decide to have a C-section out of personal preference, but it is strongly discouraged and it’s difficult to find a hospital that will do one for you if there is no good reason.

Doctors can tell if you’ll need a C-section anywhere from several months before the birth up until the due date. In some cases, an emergency C-section is required at the last minute.

Here are the most common reasons why you would need a C-section:

  • The baby is positioned awkwardly inside the womb. If the baby's head is not pointed toward the birth canal, a C-section may be the best way to go.
  • Your labour lasts too long. This can occur for any number of reasons, from your cervix not dilating completely to your baby not being in the right position.
  • Your baby is large. Sometimes the baby's head it too large to pass through the mother's pelvis, in which case a C-section is necessary.
  • You're having twins. Having twins increases the chances of a prolonged labour and/or one of the babies being positioned awkwardly.
  • The baby is distressed. This means the baby isn't getting enough oxygen and you’ll need an emergency C-section. One cause of this is cord prolapse, where the umbilical cord slips through the cervix and your contractions put too much pressure on it.
  • You've had a C-section before. Having a prior C-section doesn't automatically mean you need to have another one. However, there are some risks to having a natural birth after caesarean (VBAC), so doctors will need to run some tests and may require you to have another C-section just to be safe.
  • You have other health issues. If you have health issues as a result of the pregnancy or independent of it, you might need a C-section. Examples include high blood pressure (called preeclampsia during pregnancy), diabetes (pregnancy-related or otherwise) or an outbreak of a sexually transmitted disease like herpes.
  • You've had past psychological trauma. Women who have psychological trauma related to their sexual organs can often get a licensed psychologist to refer them for a C-section in order to avoid triggering traumatic memories.

What is an elective C section?

An elective C-section is basically any C-section that is not an emergency. This includes most medically necessary C-sections where you've had enough time to organise the procedure, as well as non-medically necessary C-sections that you choose to have based on personal preference.

Again, most doctors do not recommend a C-section unless it is medically necessary. In fact the World Health Organisation strongly recommends against it. C-sections have been linked to increased rates of obesity and asthma in the child and rare but serious complications in the mother including complications with future pregnancies.

How much do C sections cost?

The cost of any medical treatment depends on a number of factors, including whether it is done in a public versus private hospital, how bad your condition is and whether the treatment is medically necessary or not. The best way to view it is by looking at what happens when you go the public route versus the private route.

How does Medicare treat C-sections? (aka the public system) How does private health insurance treat C-sections? (aka the private system)
Procedure fees Medicare will pay for the entire cost of your delivery. Medicare will cover 75% of the amount it would have paid for the procedure if you had gone public.

If you have private health insurance that covers pregnancy, it will pay the additional 25%.

You are responsible for paying any amount above this that the doctor chooses to charge (because private doctors can charge whatever they want).

Other fees Medicare will cover the hospital accommodation fees, theatre fees, doctor's fees, medication and tests. You and/or your private insurer are responsible for the cost of hospital accommodation fees, theatre fees, doctor's fees, medication and tests.
Where you’re treated You’ll deliver in a public hospital and you may or may not get your own private room. You’ll deliver in a private hospital and can request your own private room.
Who will treat you You will be treated by a public doctor that is assigned to you. You will be treated by the doctor of your choice.
Getting a C-section that is not medically necessary Medicare covers all births but public hospitals won't perform a C-section unless it is medically necessary. That means it is essentially not covered and you'll have to use the private system. Not all private hospitals will agree to perform an unnecessary C-section, but you may find one that does. You can do this with or without health insurance, but the costs can skyrocket without a private insurer helping to cover you.

What is an epidural?

People use the term "epidural" as if it refers to a particular drug, but it actually refers to a space within your spinal canal near the spinal nerves. Your anaesthesiologist will insert a tube into this space where they’ll inject a regional anaesthetic that will continue to flow throughout the delivery. This process is called an epidural block.

Regional anaesthetics relieve pain in one region of your body (in this case your lower body) rather than "put you out" like a general anaesthetic would. The result is that you are still awake and conscious, yet pain-free.

When would you need an epidural?

Epidural blocks are mostly used during births, because the medicine is meant to be delivered continuously. That’s perfect for a prolonged labour.

For a C-section, your anaesthesiologist might give you a spinal block instead. This is a one-time injection that comes on stronger and wears off quicker than an epidural.

If the doctor makes a last-minute decision to do a C-section and you already have the epidural tube inserted, they may just keep you on the epidural instead.

How much do epidural and spinal blocks cost?

Just like the C-section itself, the total cost of the anaesthesia depends on the circumstances: whether you go public or private, how long the anaesthesiologist needs to be there to monitor you and whether or not the treatment takes place after hours.

If you need an epidural, a spinal or both, you may see the following charges:

  • A initial consultation with the anaesthesiologist
  • The initial injection
  • Ongoing administration of the block including the anaesthesiologist’s time if they’re required to be there to monitor you
  • Any doctor's fees the anaesthesiologist charges

If you're in a public hospital, all of this will be covered by Medicare. If you go private, Medicare will cover part of the cost of the first three items and it will be up to you and/or your private health insurer to cover the rest of those costs, plus any fees.

Compare your health insurance options today

Use this free tool to see more options from Australian health funds. On the results screen simply tick 'Refine Search' then head to Hospital Cover and select 'pregnancy & birth' to see a side by side comparison.

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Picture: Unsplash

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