MARINA FOGLE runs The Bump Class, antenatal classes that are informative, impartial and above all, great fun. Each course is tailored to meet the needs of parents who want to learn about the practical elements of pregnancy, child birth, breastfeeding, parenting and first aid from a supportive, pragmatic and unbiased point of view.
When girls first find out they’re pregnant, awash with emotions, turbo charged with hormones, they are asked to make a decision about where to have their babies. Many of the girls I meet make that decision unaware of what London’s maternity care has to offer.
The main decision that needs to be made is whether you plan to have your baby privately or on the NHS. The fact that one is free and one is pretty pricey is obvious, but what are the advantages and pitfalls of each and within each of those categories, are there different birth options?
Generally maternity care in the private sector is organised and efficient. It offers continuity of care which has been shown to be hugely beneficial for patients and provides a degree of luxury and privacy that the NHS cannot offer. Within the private sector there are various choices:
Private, Obstetrician Led Birth
At the most expensive end of the spectrum, you are cared for by a dedicated obstetrician who would see you throughout your pregnancy for check-ups and would ultimately deliver your baby.
Pros: You get a consultant obstetrician looking after you even if you are a low risk pregnancy. During your pregnancy you will get to know them and therefore will know who will deliver your baby. You’ll be cared for in a private hospital where they have more staff with more time so you will be well looked after. Do not however expect your obstetrician to do lots of hand holding. They are busy people so your check-ups will be short and sweet. When you go into labour, your obstetrician will be informed and will probably come to the hospital to check you but your main support until you get to the end of labour will be midwife led as long as there are no complications. Your obstetrician is most likely to arrive when you start pushing to deliver your baby.
Cons: While private hospitals are less busy and more organised, if you’re keen on a natural birth, it’s worth checking out what facilities they have and where your obstetrician is happy for you to deliver you baby. Some private hospitals don’t have the option to labour or give birth in water.
Cost: from about £12,000
Midwife Led Birth within a Private Hospital
There’s an argument that pregnant women are not unwell and that doctors need not become involved unless there are complications. Some private hospitals offer midwife led births so you have the benefits of being in a private hospital but the consultants would only become involved if they need to.
Pros: Midwives tend to have more time to get to know you than obstetricians and their time is less expensive. A midwife is fully qualified to deliver your baby as long as there are no major complications and many women prefer the more touchy feely attitude.
Cons: If a complication does occur and you need an obstetrician to intervene, you will need to pay for this so your birth could end up costing more than you’d anticipated.
Cost: from about £9,000
Private Hospitals: Are some better than others?
All private hospitals are regulated and deemed safe by an independent body. However it is worth looking at the facilities within the hospital should your birth not be straightforward. Generally in severe life threatening situations, the NHS is at the cutting edge of medicine and therefore private wings attached to major NHS teaching hospitals are the safest place to give birth. Should something really serious happen, you and your baby are already at the right hospital.
Private Birth Centre Birth
Birth centres are usually small, midwife led centres that offer a homely rather than clinical environment in which to have your babies.
Pros: Studies have shown that the homely environment makes it more likely to for women to give birth without the need for medical intervention and pain relief.
Cons: If you do require pain relief or emergency intervention, you would need to be transferred to a hospital.
Cost: Between £4,000-£8,000
Independent Midwife Led Birth
Independent Midwives are fully qualified midwives who offer one-to-one antenatal care and deliver your baby either at home or in a private birth centre. Should you deliver in hospital, the midwife will not be able to deliver your baby, but is allowed to support you in your labour.
Pros: Studies have consistently shown that continuity of care has a profoundly positive effect both on the mother’s experience and outcome. You will develop a relationship and trust with your midwife throughout your pregnancy which will help her to support you in labour as well as postnatally.
Cons: Private Midwives are currently unable to get professional indemnity insurance and the Association of Independent Midwives are trying to reach a compromise with the government who were trying to prevent them from practicing without insurance.
Cost: Between £2,000 – £5,000
The NHS makes me proud to be British. In spite of its imperfections, it provides comprehensive care for pregnant women from the beginning of their pregnancy, through their labour and recovery and after the baby has been born and is entirely free of charge as long as you’re a UK resident.
When you find out you’re pregnant, you need to speak to your GP and register with the hospital you would like to give birth at. It’s worth doing a bit of research to make sure they have the facilities that you want but consider booking somewhere near to home. But what a lot of people don’t realise is that there are options with the NHS.
What care can I expect from the NHS?
If you’re deemed low risk and your pregnancy is uncomplicated, you will be offered a scan at around 12 weeks as well as a blood test to calculate the risk of major chromosomal abnormalities such as Downs Syndrome. You will also have an anomaly scan at 20 weeks. This is a detailed scan to check that your baby is developing as it should. In between you will have regular checks, usually performed by a midwife, which increase in regularity as you near your due date. If your midwife is at all concerned about you or your baby, or you’re deemed high risk you will be seen by a doctor. Generally if there are complications in your pregnancy, you’re very well cared for by some of the most well regarded doctors in the world.
Are there different places I can give birth within the NHS?
Unlike a generation ago, the NHS has a range of places in which women can choose to give birth.
There are an increasing amount of midwife led birth centres attached to major NHS hospitals.
Pros: Birth Centres attached to hospitals are wonderful places to give birth as they provide the homely midwife led environment that labouring women tend to thrive in, while being attached to major hospitals should emergency care be needed.
Cons: As birth centres are midwife led, they are unable to administer any medical pain relief such as an epidural. However, since they’re attached to a hospital, women can easily be transferred to the labour ward on the hospital for this to happen.
This is traditionally where women give birth, essentially at the hospital. Once you’re in established labour you’ll be given your own room and one to one midwife care. Doctors and anaesthetists are on hand if you need them. Once your baby is born you will be transferred to a postnatal ward which can sometimes be slightly chaotic. In some hospitals there is the option to pay for a private room in which to recover postnatally.
Pros: Some mothers criticise the NHS for largely leaving them to their own devices once they and their babies are deemed safe. However, if they suspect something is not right, you are in the best hands…probably in the world.
Cons: If you’re healthy and not a priority, you can feel slightly neglected.
If you wish, the NHS will support you and provide midwife led care in order for you to have a home birth. The midwives will perform your antenatal checks and a midwife team will arrive to deliver your baby.
Pros: Studies have shown that women who are relaxed in their environment, particularly in their own homes have easier labours with less need for medical intervention. The same midwife team will care for you throughout your pregnancy and will deliver your baby so you will benefit from the continuity of care that has been shown to be beneficial to women.
Cons: Studies have shown that home births are slightly higher risk than hospital or birth centre births for first time mothers. Should you or your baby requite urgent medical attention you have to get to hospital. Although extreme cases are rare, it’s worth considering your proximity to hospital. You will be discouraged from having a home birth, for the sake of your baby and yourself, if you’re deemed high risk.
By Marina Fogle, The Bump Class