Maternity cover can be an important consideration for women of child-bearing age. Rachel Gordon investigates what benefits are on offer
Too 'posh to push' celebrity mums such as Victoria Beckham, Zoë Ball and Patsy Kensit have a lot to answer for, according to private medical insurers. All had babies by caesarean ' and it is thought avoiding pain and convenience were motivating factors rather than a medical necessity.
Most insurers say they have experienced an increase in recent years of elective caesareans ' and when the cost can top £10,000 as it is at London's swish Portland Hospital ' this has become a bottom line burden as unwelcome as a long, drawn-out labour.
The problem for insurers is caesareans are far more common in the private sector and are favoured by many obstetricians working in them.
Last October, AXA PPP healthcare bit the bullet and decided enough was enough. It has stopped covering the operation in all its new private medical insurance (PMI) policies and the benefit will be withdrawn from existing ones at renewal. Medical director at the time of the decision, Dr Adrian Bull, said most policyholders accepted the decision with good grace, although admits there were a small number of complaints.
Like most other providers of comprehensive plans, AXA PPP healthcare continues to cover complications of pregnancy such as an ectopic pregnancy or a haemorrhage.
This insurer is not the first to pull the plug on caesarean sections. WPA does not cover pregnancy and childbirth, for example. BCWA excludes caesareans, but does pay for complications.
Howard Hughes, BCWA's sales and marketing manager, comments: 'We have never covered caesareans and find this is not an issue for women taking out cover, although it is important the broker explains what is and is not included.'
He says that most women are happy to trust the NHS and he emphasises insurers do not see pregnancy as an illness.
Best for baby
Even in the case of complications, Hughes explains the NHS is generally preferred. 'Although we would pay for an ectopic pregnancy, for example, the expertise to deal with this would tend to be in the NHS. There are no waiting lists and the staff are on hand if there is an emergency, unlike most private hospitals which do not have intensive care units.'
One feel good benefit BCWA does provide is a cash payment of £150 on the birth of a baby. 'It is something that tends to be appreciated by our policyholders, if only to help out with nappies,' Hughes says.
Norwich Union, on the other hand, has gone on record to say it will cover caesareans that are medically necessary under both its own brand and Medios policies. Clinical development director Dr Doug Wright says while claims are increasing, they are not out of control.
Brokers need to manage expect- ations when advising women on PMI maternity cover.
Jan Lawson, managing director of broker The Private Health Partnership, explains wordings vary and says intermediaries should carefully check what is included.
'If a woman is starting a family, she should be aware you need to have been on cover for at least 10 months up to 24 months,' she says.
Similarly, to qualify for a maternity cash benefit, which ranges from £100 upwards, it will also be necessary to have been covered for at least a 10-month period.
She adds it is not possible to 'add on' pregnancy to a policy. 'It all comes down to the fact that they do not see it as an illness. The only area where you can make an add-on is with international plans.'
As for complications, Lawson says brokers should look out for policies that include the following:
• Caesarean when medically necessary.
• Miscarriage.
• Still birth.
• Ectopic pregnancy.
• Post-partum haemorrhage.
• Hydatidiform mole (abnormal cell growth in the womb).
• Abnormal presentation.
• Missed abortion.
• Retained placental membrane.
Again though, a woman's local NHS hospital may be the only place where specialist treatment is available and brokers should remind clients of this.
Small print
Lawson says it is important to declare any previous history linked to pregnancy. An earlier caesarean means a subsequent child is more likely to be born this way and so may be excluded.
She adds small print to look out for relates to cover if a child is conceived by artificial insemination or another form of assisted conception. This may be removed entirely, or there may be a waiting period after the birth before cover is available.
This affects the ability to claim for any medical problems that may arise with the baby. Normally insurers cover new born children automatically, but this is not always the case if assisted conception is involved. Medisure, for example, offers no cover if assisted reproduction occurs within 90 days of birth. And Norwich Union offers no cover if assisted reproduction is within 91 days of birth. WPA does not provide treatment for any newborn baby within 90 days of birth.
Although AXA PPP healthcare's decision to stop covering caesareans caused a few ripples, ask any insurer for their views on pregnancy and PMI and the stock answer will be the NHS tends to be safest. Furthermore, there are few private hospitals that allow childbirth.
The Portland Hospital is the only private hospital to specialise solely in childbirth and this has one of the highest rates for caesareans ' at around 44%.
The private Hospital of St John and St Elizabeth, is another popular choice for celebrity mothers ' Jerry Hall, Kate Winslet and Emma Thompson all had babies here ' the emphasis is on natural birth and alterative therapies.
Private wards in the NHS include the Lindo Wing at St Mary's Hospital, Paddington and Nuffield House at Guy's. Insurers certainly do not emphasise the fact that women may be able to access these units or that there are benefits from having complications handled privately.
Dr Wright of Norwich Union says his own children were born in an NHS hospital and he believes most women feel this is the safest option, given that emergency facilities are on site.
But, as with adults, he explains speedy treatment for a newborn baby might be useful under PMI. Wright says supernumerary digits ' where a baby has an extra finger or toe ' could be treated quicker privately as could cardiac abnormality. Again, the NHS could be just as quick to provide care.
A private affair
No matter how much providers argue in favour of the NHS, some women will want to go private. They may have had a bad NHS experience or be concerned about care at their local hospital, lack of privacy or indeed feel an elective caesarean can only be obtained if they go private.
Fiona Harris, actuarial and risk manager for BUPA, says her company will pick up the bill for essential caesareans but not elective ones. However, she points out that women who choose the surgery can arrange this through BUPA On Call, the company's self-pay division.
Harris agrees the number of caesareans are increasing year on year and that it is only fair on other policy-holders that elective ones are excluded.
Self-pay is one option and there are some polices that include pregnancy as standard. But according to Lawson: 'The plans offer cover for normal pregnancy but are very expensive and are, in effect, charging high premiums for the privilege of having maternity cover.'
The plans are AXA PPP healthcare's top of range plan, Platinum, where all routine obstetric care is included after three years.
An alternative is Clinicare's Carte Blanche plan, which provides £3,000 towards the cost of private maternity and delivery care or gives a £700 cash payment if the NHS is used ' but the policy needs to have been held for 18 months.
Rachel Gordon is a freelance journalist
Counting the cost and the risk of caesareans
• More than a fifth of all births in England and Wales are now caesareans ' in 2000, they accounted for 21.3% and 24.2% respectively, according to an audit carried out by the Royal College of Obstetricians and Gynaecologists
• If women have babies later in life, a caesarean may be safer in some of these cases.
• While 37% of caesareans are elective, the majority are carried out as emergencies. Over 70% are carried out for reasons such as failure to progress during labour, foetal distress, breech and as a repeat caesarean in cases where the woman had gone into labour but not wanted or not been able to deliver normally.
• The Royal College of Nursing (RCN) has spoken out against the trend, claiming the costs to the State are around £26.6m. It claims more medically qualified staff are needed, meaning standard births could be less well attended.
• It is argued caesareans cost more because women need to stay in hospital longer to recover.
• The RCN has also said giving birth by caesarean means a higher risk of complications such as infections and is also four times as likely to lead to potentially fatal problems as delivering a baby naturally.
• Even the famed Portland Hospital has not escaped its share of bad publicity following the deaths of two women following caesareans. In 1999, Laura Touche, 31, died nine days after giving birth by caesarean section to twin boys. She was not given basic medical checks for two and a half hours after surgery, and suffered a brain haemorrhage. The hospital paid an out-of-court settlement of more than £1m to the family.
• Last April, 36-year-old Tracey Sampson died of heart failure, 24 hours after a caesarean for her third baby, who survived. The doctor who administered the anaesthetic was accused of neglect at the inquest. Sampson had to be taken to St Mary's Hospital in Paddington as the Portland does not have an intensive care unit, where she died. Specialist malpractice lawyers Alexander Harris are handling the case.
