Too posh to push? Hospital shopping in Thailand...

We started looking at hospital options many months ago, back when it started to become clear that we were not going to have as much time to do research on location as we'd planned. We don't have health insurance, so though cost is not the main issue, we have a keen interest in getting value for money. After Ravi's birth being difficult resulting in an emergency cesarian section we knew we wanted a hospital with good facilities on standby in case something might go wrong again.

We started by looking up a few birth stories on expat websites. These were mainly centered in capital cities; Kuala Lumpur, Bangkok and Singapore, none of which we wanted to anchor at. We then looked at the maps and charts to find possible hospitals with sensible anchorages nearby. Then with a long list of hospitals we sent emails to them all giving a little information about ourselves and asking about the services they offer and possible prices.

The response was disappointing, we only got about four replies from around fifteen requests, one saying they do not have facilities to treat foreigners at present. We tried a bit harder calling and emailing a selection of preferred choices and in the end had a list of options as we sailed up the coast having left it all very late.

As it happened we had excellent conditions sailing north from Indonesia. For the first time in ages we had a lovely time sailing day and night. The current seemed to be with us much of the time, making sailing into the light to moderate north easterlies close hauled fast and pleasant. With the breeze being offshore the water was mostly pretty flat allowing us to make 7 to 10 knots much of the time. In the few patches of windless hours we motored happily on in calm water.

Our most favoured destinations had become Penang in Malaysia or Phuket in Thailand. Both heavily touristy busy islands; well populated with both private and government hospitals. The anchorages in Penang are not ideal and prices for cesarians were more so we decided to press on for Thailand where we dreamed of beautiful beaches and clear water in which to wait for the new babies passport.

Malaysia is very welcoming to yachts, clearance being totally free, the boat can stay indefinitely and we were given a 90 day visa as a matter of course. Thailand is a little trickier so we applied for our 60 day visa in Penang which can be extended once by a further 30 days which took two visits to the embassy and a small chunk of money.

So here we arrived in Phuket on Saturday and unwound our tightly coiled springs over the weekend at a nice Beach before clearing in and looking at hospitals on Monday. The first we stopped at could not help us; they either did not have a childbirth unit or possibly could not offer childbirth for foreigners. Our Thai is non existent so communication was tricky but they advertised obs and gynae services on the bill board outside so we're not sure.

The next was our first and most promising reply from back when we first started researching; the Siriroj international (private) hospital. We knew all the prices and details of their facilities and so were happy to have a check up and talk with the obstetrician. We didn't tell them that we were merely researching at that time; our due date being only 9 days hence at this point.

After a quick once over the upshot was that he would strongly recommend a c section. Not only because we'd had one last time only 16 months ago, but also because his ultrasound showed the baby to be on the big side and with its back to my back (as Ravi had been, though his main problem was a twisted head). We had expected this. Thailand in general and private hospitals in particular prefer cesarian births.

We had already decided that if it was recommended we'd go with that. When researching we found out that if we'd been at home in Bath (UK) they would have supported a trial of labour with close supervision but that if we'd given birth in Australia they would have strongly encouraged a cesarian due to the risk of rupture. So we left having paid for the consultation and with a date booked. (We were offered the next day but chose a little more time, it's wierd picking your kids birthday).

We knew we were happy with the place and thought the set price package to be reasonable. However thrifty to the end, I felt uncomfortable having not researched thoroughly every option. We looked down our list. The other private hospital was significantly dearer and since we were happy with this one we saw no point in visiting that. But there were two more government options. We'd already spent twenty five pounds on taxis, it was getting late and we were tired so we went home.

Duncan was very happy with our choice but I couldn't let it rest in my mind, so after we'd taken the boat back to a quieter much more protected anchorage I took myself off with Ravi into town on the bus. My reasoning was two fold. I wanted to find out the bus route and timings (there are no bus timetables in Phuket, supposedly to keep the tourists in the taxis) and I thought I'd take a look at the last hospital. By then I'd found out that one of the government hospitals would be a similar price to the Siriroj if we needed a cesarian due to rules about making foreigners pay so ruled that out.

The bus took hours! I went for it before 10am but didn't get to town until well after midday. The driver drove in first or second gear for the first half of the way, he only sped up once he'd picked up a few more passengers. It was a mile from the bus route end to the Vachira hospital so by the time we got there Ravi and I were hot and hungry. I bought him some rambutans of which he promptly scoffed the whole kilo. Again communication was a problem but I was able to speak to someone on the phone in English who gave me some estimated costs and said I would need to see the doctor in the private clinic at 5pm to see if they felt I needed a cesarian or I could just turn up when I'm in labour and take my chances.

The place appeared clean and well looked after. But it was also very busy and quite noisy with lots of old people being wheeled around in rusty wheelchairs and children getting underfoot. It's funny that in Fiji we'd liked that frenetic feeling in the hospital but there, they spoke English. Here it seemed a little intimidating and weighing it up I didn't feel the price difference to be worth it.

So what does it cost?

Siriroj hospital offers all inclusive packages which we are assured are much cheaper than if you were to pay an itemised bill (even if you get a cheaper room and stay less long, allegedly)

Natural childbirth package 46,900 baht about 1,060 gbp
Cesarian package 59,900 baht about 1,360 gbp

But if you were to arrange a natural birth and then have to convert to c section like we did with Ravi they would whack on an extra 10,000 baht. Always read the small print!

Government hospitals quoted around 20,000 baht for natural and 40,000 to 50,000 baht for cesarian. These were just estimates rather than packages so we don't know if these are worst case or best case figures. The price for Thai nationals here would be much cheaper, we spoke to one lady who's sister paid 13,000 baht for her c section, I don't remember which hospital that was.

We weighed up the costs and the risks and plumped for a known cost in a nice place with much less chance of anything going wrong. If we'd have been able to have a natural birth last time we would have made a different decision, but in the end and after the last few months'trials and tribulations we decided it's time we gave ourselves a break!