Moving to London 26 Weeks Pregnant - Need Advice

[gaby0422]

My husband recently accepted a job offer in London and we will be relocating from the US in 2 1/2 months. I will be 26 weeks pregnant and need advice on how the NHS works.

• How do I find a doctor/midwife that is likely to accept me into their practice being so far along in my pregnancy?
  
• In the US you are seen by your doctor every 2 weeks during the last trimester... is this also typical in the UK?
  
• Will I likely have to wait a long time before being seen by a doctor/midwife once I am able to make an appointment?
  

I know I am not the only pregnant woman to relocate to the UK, but I get a little anxious at the thought of not knowing anything about the healthcare system there and not knowing where to start looking for a doctor or midwife. I am sad to leave my wonderful doctor here in Boston since I have had a very good experience with her so far but I'm sure I can find just as good care in London.

I appreciate any advice you have for someone in my position. Thank you!

[time2deal]

Hi, Sorry I can't answer a lot of your questions as this is my first, but I would ask do you know what kind of visa you will have? I don't believe that all will allow you full access to the NHS.

Will your husbands job come with private health insurance?

[PenguinsHatchedAnEgg]

I have no idea whether you will be eligible for free NHS treatment. If you are used to the US system and are used to being seen by doctors, you may want to look into whether your DH's job comes with health insurance to cover private antenatal care and delivery.

The next thing is that it isn't a question of finding a doctor who will 'accept you into their practice'. You register with a local GP. If they are currently taking on new patients, and will register someone based on your address, they will register you.

If you are low risk, the normal thing in the UK is midwife led care. I have only seen a doctor once in this last pregnancy (I came out high risk for Downs and had amnio, I saw a consultant for the apt). In the previous two, I saw a GP for 10 minutes to register the pregnancy. All other appointments would be with a mw in most areas (though some share care with a GP, a general practioner not an OBYGN).

In terms of frequency, no, nothing like every two weeks. Again, assuming you are low risk.

[PenguinsHatchedAnEgg]

Sorry, wasn't very clear. DD1 was delivered in hospital and was forceps, so I saw doctors during her delivery. Both DC2 and DC3 were homebirths.

[Pobblewhohasnotoes]

Definitively depends if you are a high or low risk pregnancy. If you're high then you'll be under consultant care and if low you'll be under the midwives, which is very normal over here. The midwives do all the antenatal checks. You aren't seen every two weeks.

I'm not sure how it works when you're from abroad but I've just moved house within the uk and registered with a GP who did my referrals to the hospital as I'm high risk and also got the midwives to come and see me.

[gaby0422]

Thanks for the answers.
We will have a tier 2 visa and will be paying taxes. According to his employer we will therefore be eligible for NHS treatment, but his job does not come with private health insurance.

So, once I arrive in London I will register with the local GP (Do I find them on the internet?) and then go on from there?

[PenguinsHatchedAnEgg]

Try this website for details on finding a GP. Yes, you register and take it from there.

I presume you will have had scans in the US and a full anomaly scan before you arrive (done at 20 weeks ish here, is that the same). So it's just general antenatal checks if you are low risk.

[Pobblewhohasnotoes]

You'll be in London, you'll have load of GPs near you. Think you can look on the NHS website, but if you look them up you can see how people rate them too. It's all done by area.

You will need a GP regardless of your pregnancy. Some hospitals self refer to the midwives, some only take GP referrals. I would look up where your local hospitals are and find out. It'll either say on the website or you can just phone the maternity unit and ask.

[PenguinsHatchedAnEgg]

Sorry, I hadn't registered that you would be in London. Bear in mind that you may realistically only have a choice of a couple of your very closest surgeries. GPs in London can be very over-subscribed and only take patients from a tiny geographic area (sometimes just a few roads).

[Helpys]

I don't know whether you'll qualify for NHS treatment, not an expert, so get it in writing that if you don't work will cover it.
If you do have an NHS birth, the whole experience will be very different from what your used to. Much less interventionist but also fewer bells and whistles. Be reassured that you're less likely to have a forceps, ventouse or Caesarian. It's comforting to know that the treatment you get on the NHS is 100% safe outcome driven, rather than with an eye to bumping up the insurance bills or making you happy in the short term.
I've had 3 babies on the NHS and private treatment for other stuff; while I enjoyed the schmoozing and biscuits of going private I would definitely always chose the NHS for anything big.
Good Luck!

[Duckstar]

Here's the nhs web page on registering with a GP, including finding one:

www.nhs.uk/chq/Pages/1095.aspx?CategoryID=68&SubCategoryID=158

You will probably need to take proof of your entitlement to nhs treatment (visa) when you register.

I would personally go into GP surgery you wish to register and explain situation (you'll need to do this to hand in forms). Your best option is to probably get a GP appointment in first instance and they can make an assessment if you should be referred urgently for consultant care or can be midwife led.

If you are a low risk pregnancy it is unlikely you will see an OB, as others have mentioned antenatal care very different in uk to USA - your care will be midwife led with some GP appointments. You will have regular appointments (about every 2 weeks in first pregnancy). Any concerns they can refer you to hospital to be reviewed.

Do you know where in London you are moving to? You'll probably be offered a choice of hospitals to give birth in (or have a home birth team from if that's something you would be interested in/prefer).

[gaby0422]

Excellent. This is exactly what I was looking for. Thanks for all the advice, I now know where to start!

[weebairn]

This is quite a good summary of standard antenatal care for a low risk pregnancy, including when you would normally have appointments (you get a lot more nearer the end as you can see). If you had any complications in your pregnancy you might move to consultant-led care which would be hospital based.

First step as others have said would be to register with a GP who can then refer you on to midwife/consultant.

I found antenatal care both thorough and excellent in my first pregnancy (not in London), mine was all midwife-led.

Good luck with the move, and the pregnancy!

[extraneous]

You might want to think about enquiring into private care at least - if you have a great doctor you have a close rapport with in the US system you will find the UK system very, very different in that resources are frequently overstretched and there is often very little continuity of care. The majority of NHS staff do a fantastic job and work tirelessly, but resourcing is very different to what you are used to. At least enquire and then make your decision with full information.

[dreamingbohemian]

Actually I will be brutally honest and say that if you are used to US healthcare, especially good Boston healthcare, you will probably have quite a culture shock dealing with the NHS in London, which is very overburdened. You might struggle to get a doctor's appointment, if you are low-risk you will only see midwives and might struggle to see them outside of scheduled appointments. There are no scans after 20 weeks, they do not test for Strep B. There is usually no continuity of care during labour (i.e. it will be a series of midwives you've never met before). Postnatal wards are grim.

It's not uniformly bad, some people do have excellent experiences, but it is very very different and I think adjusting to that while already being 26 weeks will be tough.

Given your pregnancy I would strongly suggest your husband negotiate private health insurance as part of his relocation package (this is common). It is also possible to just 'go private' for the birth, there are private hospitals. I would at least look into it beforehand so you are prepared.

Do you know what part of London you will be in? It's a good idea to post here for specific advice, as services do vary a lot.

I don't want to scare you, but I had my baby in London after several years of getting used to the NHS, and I still really struggled sometimes remembering my lovely US healthcare. I think 'hope for the best, prepare for the worst' is a good way to go here.

[PenguinsHatchedAnEgg]

Hmmm, I understand a lot of what you are saying Dreaming, but I am not sure it is totally fair. Definitely if you like the way the US does things, it will be a shock, and I agree about continuity in London (different story in some other parts of the country, at least as far as antenatal is concerned). But there are also plenty of people (I'm one) who would be scared as hell to give birth in the US system.

[dreamingbohemian]

And that's fine. It's not about whether the US or UK system is better as a whole. But the OP has a good ob-gyn and is happy with her care, I think it's only fair to warn her that the NHS in London will be very very different.

For example, as an American, I found it crazy that I might not be able to get an epidural during labour, even if I was in excruciating pain for hours. You can argue over whether it's a good idea to have epidurals, but basically if you are used to the idea that you can always have one if you really need it, it's a bit scary to think it might not be an option at all.

I don't want to knock NHS staff, or even the NHS concept, but the actual system in London is completely overtaxed.

[weebairn]

I agree with Penguins.

I don't live in London myself and don't really know how badly it compares to the rest of the country, but my friend is a midwife there and they case-load (i.e. follow the same woman through pregnancy and then to the birth whether at home or in hospital). So it's not all bad!!

I was incredibly well looked after for my pregnancy and birth (in Sheffield) and almost all my friends say the same. Yes the intervention rates in this country are higher than they could be, and no one is denying the NHS is stretched and the staff work far too hard (I work for the nhs myself) but I don't believe the US statistics for complicated births etc compare favourably at all??

I agree no one I know has enjoyed the post natal ward and I have heard some very poor reports of breastfeeding support, though not in my city. I've not known many people unhappy with antenatal care though.

As a small point, there isn't good evidence for routine screening for Strep B as it is usually a transient infection, and routine (rather than targeted) screening would result in many many women being given unnecessary antibiotics (and also needing unnecessary drips during labour, which can impact things). It's not that straightforward. link

[nyldn]

I agree w dreaming regarding continuity of care in London. it's fairly frightening after leaving the states. instead of going private, I've gotten an independent midwife who I'll have throughout and with me at the birth. this has provided a tremendous amount of comfort. also, some hospitals do offer a 32/33 week scan. I'm at UCLH and getting one today.

[TravelledByVacuumTube]

The chances are that in London you will have a number of GP practices near you. I'd suggest you look for one which has a bigger stable of doctors (ie more than two), as that means you have a better chance of getting the doctors that particularly suit you.

You will get plenty of scare stories about the NHS (hell, I could give you a few myself), but on the whole it is a wonderful, wonderful system. I had a really medicalised pregnancy and had to have specialised, resource-heavy care, with frequent hospital visits and monitoring and drugs and so on. As it happened, the NHS teaching hospital I went to to have my baby (nearest one) was also the location of one of the world authorities on my particular condition, so I got the kind of care that money just couldn't have bought. And indeed I didn't have to buy it - everything was free at the point of demand.

dreamingbohemian I'm really surprised about what you say re epidurals. I got offered choice at every stage of my pregnancy, by consultants who explained everything in detail, and that included epidurals.

[TravelledByVacuumTube]

weebairn makes a good point about postnatal, which is really where I think practice in Britain could be vastly improved. I had world-class care right up to the birth, but below-par in the postnatal ward.

[sixlive]

Surprised you are not being offered private healthcare if it's a professional job in London. Even if you were it doesn't cover normal pregnancy care so you either have to pay for it yourself or go with the NHS. My experience of NHS especially midwives in west London was really grim. When you become high risk and get consultant dare it's excellent. Postnatal just get the hell out of hospital ASAP!

[dreamingbohemian]

Travelled but if you had specialised, consultant-led care, that is more like what you get in the US as standard. It's not what your average woman will get in London. There's a huge difference.

[PenguinsHatchedAnEgg]

dreaming I do see what you are saying. But the OP hasn't told us her preferences birth-wise. If she is aiming for a natural water-birth for example, the US system is less likely to enable that than the UK one. I wasn't trying to say one system was better, just that it wasn't as cut and dried as 'if you are used to the US system you might want private'. There are advantages to both countries.

[ephpa95]

Most companies have a private healthcare package that you can buy into (BUPA, AXA etc). Get your husband to check that out immediately.

However, most private insurers do not necessarily cover the cost of birth. When I expected DD2 in London, we checked with a private wing of an NHS hospital (our local hospital was pretty grim) and we found it worth the "investment" - it cost less than buying a used car, let me put it that way, and we found it worth having a consultant whom I saw throughout my pregnancy and who delivered my daughter and I got an epidural fast when I needed it. It was at St Mary's Paddington (Lindo Wing) NHS with private wing, and the benefit of any NHS hospital is that it has the full machinery in place if there is any bigger problem rather than a posh private hospital. The Lindo Wing has been jazzed up since, so I don't know what prices are nowadays, but at the time (ten years ago) it made sense to us. That said - all in all, the staff at NHS hospitals are extremely competent - just not in aftercare which is shoddy. But do get your husband to check with the company about an additional healthcare package. I'd just ask a neighbour immediately when you move into your new home regarding a good GP. Or, if you have a relocation agency get them to find out for you. Good luck!

[imme]

I have had both my children at kings college hospital and had an epidural with my first and could have had one with my second had the birth not been as fast as it was (thankfully). So it was not true for me that there was a problem with getting an epidural. I also had good antenatal care with mostly the same midwife. At Kings they offer another routine scan at 30 weeks and more if you're high risk. I agree with previous posters postnatal care isn't brilliant so would recommend getting contact details of a breastfeeding counselor arranged in case you want to bf. also, as a side note... There is loads to do in London with little ones. You shouldn't have problems meeting other mums with babies and there are plenty of free or super cheap activities eg sure start centres, library rhyme time, church groups, paddling pools, nature reserves. Check local Facebook pages once you know where you move to.