Choosing to go private

ANTENATAL

NHS

Ante­na­tal care dur­ing preg­nan­cy is com­mu­ni­ty-based and led by a mid­wife. All ante­na­tal appoint­ments will be with a mid­wife dur­ing nor­mal work­ing hours. All parts of the UK have intro­duced poli­cies for mater­ni­ty ser­vices based on female-cen­tred care, choice and con­ti­nu­ity. A woman should be able to choose whether to give birth in hos­pi­tal, a mid­wife-run birth cen­tre or at home and the same mid­wife should look after her through­out the preg­nan­cy. How­ev­er, the real­i­ty is that chron­ic staff short­ages and high ser­vice demand means the mum-to-be is like­ly to see more than one prac­ti­tion­er dur­ing her preg­nan­cy.

Through­out preg­nan­cy, the woman’s pres­sure, urine and grow­ing bump will be mon­i­tored. She will also be giv­en infor­ma­tion about folic acid, vit­a­min D sup­ple­ments, nutri­tion, smok­ing, drink­ing alco­hol, drug use and keep­ing healthy. Rou­tine blood tests will be car­ried out and she will be referred to a con­sul­tant for fur­ther tests if there is a prob­lem. Two scans are avail­able on the NHS – one at eight to four­teen weeks to screen for Down’s syn­drome and to con­firm the due date, and a sec­ond one at 18 to 20 weeks to check on the phys­i­cal devel­op­ment of the baby. Some hos­pi­tals may offer extra scans if there is a clin­i­cal need. Pol­i­cy on whether to tell the par­ents the sex of the baby varies between hos­pi­tals.

If the woman devel­ops com­pli­ca­tions and has to go into hos­pi­tal, she will be accom­mo­dat­ed in four, six or eight-bed wards. Pri­vate rooms are avail­able in rare excep­tions. Com­mon preg­nan­cy com­pli­ca­tions are dia­betes and pre-eclamp­sia (preg­nan­cy-induced hyper­ten­sion). Free par­ent­ing class­es are avail­able.

PRIVATE

One-to-one care is pro­vid­ed by an obste­tri­cian or mid­wife of the woman’s choice, and this will con­tin­ue through­out preg­nan­cy and labour. A woman choos­ing to give birth pri­vate­ly can book ante­na­tal care at a pri­vate hos­pi­tal through a pri­vate clin­ic, at a pri­vate wing with­in an NHS hos­pi­tal, or she can opt for a home birth with an inde­pen­dent mid­wife.
While most pri­vate mater­ni­ty clin­ics are clus­tered in the Lon­don area, pri­vate mid­wives oper­ate nation­al­ly.

Pri­vate hos­pi­tals and units offer a choice of con­sul­tant or mid­wife-led care. A typ­i­cal pri­vate pack­age will con­sist of nine to twelve appoint­ments with their con­sul­tant or mid­wife of choice and of fur­ther appoint­ments for scans and blood tests. Patients usu­al­ly have direct access to their con­sul­tant or mid­wife through­out the preg­nan­cy and can con­tact them if they have any con­cerns. Most clin­ics offer appoint­ments out­side nor­mal work­ing hours and at the week­end.

A woman opt­ing to give birth pri­vate­ly will receive the same rou­tine checks and blood tests as her NHS coun­ter­parts, but she will be able to request oth­er screen­ing blood tests not cur­rent­ly avail­able on the NHS. A min­i­mum of four scans at dif­fer­ent stages of the preg­nan­cy will be offered, includ­ing 4D scans and video record­ings. Some clin­ics offer a scan at each appoint­ment. Most pri­vate clin­ics offer a 24-hour tele­phone sup­port line, access to com­ple­men­tary ther­a­pies, such as acupunc­ture and reflex­ol­o­gy. From hyp­no­birthing to yoga, the chances are there is pri­vate ther­a­py and sup­port avail­able near­by, includ­ing lac­ta­tion con­sul­tants, for pri­vate breast­feed­ing tuto­ri­als, and mater­ni­ty nurs­es, who will help the expec­tant moth­er pack and pre­pare the nurs­ery for her pre­cious arrival.

LABOUR

NHS

The NHS offers women a choice on where to give birth – at home, a mid­wifery unit, birth cen­tre or in hos­pi­tal. A water birth is an option in some units or, if the mum-to-be is hav­ing a home birth, she can buy or hire a birthing pool. Guid­ance from NICE (the Nation­al Insti­tute for Health and Care Excel­lence) empha­sis­es that a woman should come to a deci­sion on where and how she gives birth after dis­cus­sion with the health­care provider. How­ev­er, choice will depend on whether the preg­nan­cy is high-risk and, to a cer­tain extent, where the woman lives.

Dur­ing labour the woman will be sup­port­ed main­ly by the mid­wives on duty. If there are com­pli­ca­tions, doc­tors will be avail­able to help and, if the woman is labour­ing at home and devel­ops com­pli­ca­tions, she will be trans­ferred to hos­pi­tal. Mid­wifery units and birth cen­tres are more com­fort­able and home­ly than hos­pi­tal mater­ni­ty units, but bath­room facil­i­ties are shared and wards may be unfa­mil­iar.

Since 2010, £68 mil­lion has been pro­vid­ed to make NHS hos­pi­tals clean­er, and ear­li­er this year the Depart­ment of Health announced a £25-mil­lion invest­ment to improve NHS mater­ni­ty units and increase the num­ber of en-suite rooms. Deliv­ery rooms will have a bed and an easy chair, and some will have bean bags and mats, as well as a bath or show­er.
Some units will have a birthing pool for water births, but they are assigned on a first-come first-served basis. If a deliv­ery room is not imme­di­ate­ly avail­able, the woman will have to be in a ward with up to six oth­er women until one becomes avail­able.

PRIVATE

Labour will be over­seen by the obste­tri­cian or mid­wife who the woman chose ear­li­er dur­ing her preg­nan­cy and who has seen her through­out. If the patient choos­es a con­sul­tant-led birth, then the con­sul­tant will be avail­able and on call for the birth, and would deliv­er the baby. In most pri­vate units, the woman would also have a ded­i­cat­ed mid­wife dur­ing labour and birth.

Accord­ing to Inde­pen­dent Mid­wives UK, the num­ber of women pay­ing up to £4,000 for a pri­vate mid­wife for a guar­an­teed home deliv­ery or water birth at home, if med­ical­ly fea­si­ble, is steadi­ly increas­ing. The oth­er option is to hire a pri­vate mid­wife who will accom­pa­ny the woman through­out labour in an NHS unit. This means there is always going to be a known per­son with her.

Clin­i­cal stan­dards of care in a pri­vate hos­pi­tal will be large­ly the same as in the NHS, and the expec­tant moth­er will have the same range of pain relief to choose from. The main dif­fer­ence is that care will be deliv­ered one-to-one through­out by a select­ed team. If she has booked a water birth, and as long as there have been no med­ical com­pli­ca­tions, she will be guar­an­teed avail­abil­i­ty of a birthing pool.
After deliv­ery she will recov­er in her own en-suite, soft-fur­nished room, and can expect hotel-like facil­i­ties, as well as peace and qui­et, and access to com­ple­men­tary ther­a­pies.
Pri­vate hos­pi­tals are well equipped to deal with med­ical emer­gen­cies. Very sick babies and women with seri­ous health prob­lems, will need to be trans­ferred to spe­cial­ist NHS units and the pri­vate clin­ic will make arrange­ments for this.

POSTNATAL

NHS

Fol­low­ing nation­al guid­ance, the baby will be kept with the moth­er at all times and she will be encour­aged to breast­feed. Pae­di­a­tri­cians will be on hand to check on the baby. After an uncom­pli­cat­ed preg­nan­cy, moth­er and baby can expect to be allowed to go home with­in 24 hours.

A mid­wife and health vis­i­tor will make home vis­its to weigh the baby and check the woman is phys­i­cal­ly and emo­tion­al­ly recov­er­ing from the birth. After this, she will be encour­aged to attend baby-weigh­ing ses­sions in the com­mu­ni­ty.

Com­mon prob­lems dur­ing this recov­ery peri­od include per­ineal infec­tion, urine and bow­el prob­lems, and back­ache. More unusu­al, but of greater con­cern, are depres­sion, haem­or­rhage and the for­ma­tion of blood clots.

The baby blues – emo­tion­al insta­bil­i­ty brought on by hor­mon­al changes – usu­al­ly starts three to ten days after giv­ing birth and lasts only a few days. Accord­ing to the char­i­ty Mind, it affects around 85 per cent of new moth­ers and is so com­mon that it is con­sid­ered “nor­mal”. New fathers may also feel it. More seri­ous post­na­tal depres­sion usu­al­ly devel­ops with­in six weeks of giv­ing birth and can be grad­ual or sud­den. It can range in sever­i­ty, and it is impor­tant that women are prop­er­ly assessed and receive appro­pri­ate sup­port.

NHS post­na­tal care has come under fire for being gen­er­al­ly sub-stan­dard and for pro­vid­ing inad­e­quate breast­feed­ing sup­port. A sur­vey by the Nation­al Child­birth Trust of more than 1,000 moth­ers high­light­ed a seri­ous short­fall in the phys­i­cal and emo­tion­al help they received.

PRIVATE

Imme­di­ate­ly after deliv­ery and while she recov­ers in hos­pi­tal or at home, the woman can expect the same lev­el of one-to-one care and infor­ma­tion that she will have received through­out preg­nan­cy and labour. The obste­tri­cian and pae­di­a­tri­cian will check the woman and baby before and after they go home. The hos­pi­tal or clin­ic should make arrange­ments for her to be dis­charged into the care of the com­mu­ni­ty NHS mid­wife, who will vis­it at home the fol­low­ing day.

Some women choose to sup­ple­ment NHS care and receive their post­na­tal care in the com­fort of their homes, enlist­ing a pri­vate mid­wife or mater­ni­ty nurse to check they are recov­er­ing from the labour and that the baby is doing well, and to offer advice and sup­port.

Pri­vate car­ers will come to the woman’s home as often as she wish­es, and tele­phone assis­tance will be avail­able around the clock. There is a huge range of pri­vate help avail­able and, if she is hap­py to pay for it, a woman can tai­lor her care to suit her exact needs. Dur­ing those first few weeks, it is pos­si­ble to hire the ser­vices of a night nan­ny, who will look after the baby while the woman sleeps, and some­body to come in and help around the house.

Post­na­tal class­es for new par­ents and new­borns are also see­ing a boom. Typ­i­cal top­ics on offer, in the weeks imme­di­ate­ly fol­low­ing the birth, are par­ent­ing and how to adjust to the new arrival, baby mas­sage, and baby calm­ing work­shops. For women, there are pri­vate post­na­tal fit­ness class­es to help get back into shape.

ANTENATAL

NHS

PRIVATE

LABOUR