Questions from a confused husband

[confusedhubby]

Apologies but this is not a 'to be mum' but a husband who is looking for answers. I just want the best for my wife and it's apparent that she is pregnant and a bit panicky. So if you can help that would be great.

Context: She is 12 weeks pregnant and expecting in Nov. She had two cycles of IVF but only 1 imputation as the 1st cycle was unsuccessful. She is expecting a single child. She is 30 years in age and of average weight.

The problem: She is scared. Big time regrading her delivery.
We live in Croydon and aren't impressed with the NHS facilities in miles. She already had a botched day surgery prior to us shifting our IVF treatment to far away central london.

Questions for the forum:

1. She wants a C-Section delivery rather than natural. Is it best to go private and is this our only option?
   

1. My problem is that someone like Portland are at least 30-40 minutes away in a ambulance from CR7. Won't she have a issue if I book a delivery mid-wife or consultant and she goes into labor with all the travel time.
   

1. I ideally want her to get some antenatal private care also as she frets that she isn't be checked for so many additional things that can be..for e.g. iron deficiency if any to mitigate which she could take some vitamins
   

1. Let's say if Portland say that £10k is the delivery charge for a C-Section but a complication happens. Can they give me a amazingly high £30k inflated bill to handle it or will that complication get treated on NHS. I don't have a £30k budget:-(
   

My ground work: I have got a list of obsterician's from Portland and I made a few calls who said that they would charge £280 for consultation, £1000-1100 for delivery + Portland charges of around £8-10k for doctor led delivery. Any advises on this also plus the above 4 points will be greatly appreciated from a confused husband.

Apologies for storming into this forum

[MmeLindor]

No idea about Croydon, but wonder if you'd be better seeking help for her to cope with her fears, than the 'right' hospital.

Have you thought of a doula?

It is perfectly normal to be worried about the birth, but if the worry is spoiling the whole pregnancy experience, and making her v anxious then it might be good for her to talk to someone about this.

[TerrysNo2]

why don't you do some research and find a recommended independent midwife, I think someone like that would be best placed to help you.

It sounds as though your wife is acting like a normal woman going through pregnancy for the first time, everything is new and scary. But, childbirth is also totally normal and been around for ages so try to remember that and focus on enjoying the pregnancy.

Childbirth is quite frankly, painful, BUT it is a very small part in the journey of pregnancy and parenthood (albeit a key part) and I wish I hadn't spent so much of my first pregnancy worrying about it!

you sound like an awesome DH by the way

[TerrysNo2]

have you been to the mayday centre in Croydon? I haven't but I read about it and it sounded great, although not if she wants an elective c-section.

[Minifingers]

The birth centre in Croydon hospital is outstanding. Really, really good. The labour ward less so.

If your wife is thinking of private care, I can recommend South London Independent Midwives. Tina Perridge from this practice lives in Croydon. She delivered both my two and several babies of other women who post here. She really is wonderful. And would help your partner with her fears.

If you don't go to the Portland and decide to stay at Mayday I advise your wife to write a full account of her anxieties about the birth and send it to the supervisor of midwives at the hospital, or the head of midwifery , asking for support with organising a care plan for labour, or asking to be referred to a consultant for a elcs.

Good luck!

[Minifingers]

Can also recommend a lovely local doula if you want to PM me.

[elliejjtiny]

Not sure about the other things but iron levels should be checked routinely at booking (10-12ish weeks) and at 28 weeks on the NHS. She can also ask for her iron levels to be tested at any time if she is worried.

[tomatoplantproject]

I don't know what is on offer in your neck of the woods but I went to an antenatal yoga class each week from c14 weeks. We spent so much time talking about childbirth and preparing for it (breathing exercises) that by the time it came around I felt mentally really ready. The lady that runs the class is a doula and if I had needed the support I would have had no hesitation in asking for assistance. That it north London though.

[FunnysInLaJardin]

I really think your wife needs to go with the flow and see what happens. You are a mile off from the actual birth and anything can happen in-between. The birth bit really is a teeny tiny bit of the whole pregnancy.

Good luck to you both, but at 12 weeks really don't be stressing so much about an event which is 30 weeks away. Take it as it comes.

BTW 'natural' birth is fine you know and not nearly as awful as you might be led to believe

[drcharliegirl]

Please be careful approaching independent midwives and ask whether they have insurance and what would happen if there is an emergency (joined up care between NHS midwives and obstetric services is vital to the safety of the service).

I think you and your wife (many congratulations, by the way) would be best to book an appointment with an NHS obstetrician to discuss your wife's desire for a caesarian (does she understand the potential risks to her and the baby? is there another strong reason to pursue it?). He/she should also be able to refer on for counselling for anxiety or there may be a midwife who specialises in this working with the hospital team.

It's perfectly natural to be scared about delivery. And about a desperately wanted pregnancy. You both have plenty of time to research the options but it sounds like maybe having the independent midwife/homebirth might not be an option at this stage...

Good luck with everything.

DOI: I work in the NHS.

[5madthings]

Iron levels can be checked and will be checked routinely.

Also if she wants a c section she can have one, the new nice guidelines say women can have one at their request. You may have to be firm/bolshy with consultants but it us your wife's choice and if that is whats she wants she can have it.

She can speak to her midwife about her anxiety etc as well and finding a doula may be helpful :)


Good luck and congratulations xx

[Overberries]

I totally know why she's not keen on Mayday, but so many hospitals have very different maternity units. There's so much time for you both to suds things out. Speak to the midwife team about your concerns, take a tour of the unit (if they still do that) etc. your money may be better spent on some councilling or hypnotherapy in the first instance. As someone who's had one traumatic birth and one planned section (two healthy babies) if say ther're both as bad/good as each other!!

Congrats on fantastic news and best wishes for a healthily pregnancy

[Highlander]

NICE guidlines now state that women can have a CS as ther birth choice. If it's what she wants, she needs to start now, and stand her ground. Change consultants if necessary.

There was nothing that angered me more than people patronisingly patting me on the head with their unhelpful comments..... 'Have you tried counselling?' ' natural birth is fine and not as awful as you might be led to believe' ' have you understood the risks of a CS?'

Whatever she wants, help her fight for it.

[kllews26]

drcharliegirl gives the best advice.
Do not use an independent midwife unless they can show you a valid indemnity insurance certificate. Legislation (long overdue) is about to change to make it compulsory for such practitioners to be insured, just like their NHS colleagues. Until then, avoid.

[littleginger]

I agree with others that your wife should speak to someone about her concerns regarding giving birth as if there are no medical reasons for elcs it would be a great shame if she missed out on those first few lovely weeks of a much anticipated newborn that might have been unnecessary.

[QTPie]

I freaked at a similar point in pregnancy: was worried about the very rushed nature of antenatal care locally (Bath) and friends' experiences of the local hospital (lack of access to epidural etc). I was worried about natural childbirth, but hoped that my worries were mainly because of lack of resources/support at the local NHS hospital...

I decided to go private in London (I did my research and it was the closest place - well, I suppose that Oxford actually was, but time-wise it was no closer than London). Fortunately the in-laws have a house in London: we tended to stay up there the night before prenatal appointments and then moved there two weeks before my ELCS date at 39w1d (DS was diagnosed as breech early, so I never did get to test a natural birth).

I did feel that my antenatal care was a lot more relaxed done privately: helped me to feel much more relaxed, cared for and confident. I also felt that - if I had had a natural birth - that I would have had one-to-one midwife care, access to a consultant and anaesthetist as needed, access to birth pools and epidural on demand. I felt that, if I had had a natural birth, I would have been as supported as possible.

I would say that I think "about £10k" may not be realistic for a delivery at the Portland.... I would be surprised of it is less than £15k+ - you may want to recheck your figures (don't forget to allow for a couple of extra nights in hospital).

Have you looked at the major NHS hospitals with private wings? Are any of those closer to you? They may well be closer, cheaper and have the back-up of NHS scbu/nicu etc (so, of the unelected happens, you are not saddled with massive extra charges).

Since we live in Bath, until we "moved" to London (at 37 weeks), we still considered the local hospital our back-up - if I went into labour early.... Fortunately it didn't happen!

[helterskelter99]

Ivf pregnancies can be much more anxiety filled than a straightforward conception. My anxiety was immense I never believed this was my happy ending.
Tell her to take 1 day at a time I found not focussing only her than the next 24 hrs the okay way x

[Minifingers]

"Do not use an independent midwife unless they can show you a valid indemnity insurance certificate. Legislation (long overdue) is about to change to make it compulsory for such practitioners to be insured, just like their NHS colleagues. Until then, avoid."

The midwife I mentioned further up the thread is becoming part of a organisation of independent midwives, headed up by some very senior and experienced figures from the RCM, with excellent links to NHS services. They will have indemnity insurance.

That said, some of us have been willing to accept an uninsured midwife and it is our right to do so (and will continue to be our right until October when the law changes).

Remember - damages are awarded only for malpractice, not for accidental birth injuries which could not be prevented even by the very best practice.

Some of us did a lot of thinking and decided that we preferred to reduce the risk of malpractice in the first place by opting out of over stretched NHS maternity services and buying care from someone who provided a better and safer standard of care.

[Minifingers]

Should also add, that this study of outcomes associated with independent midwife care: here found that outcomes for low risk women cared for IM and their babies were excellent.

In fact the study concluded that the significantly lower rates of admission to neonatal intensive care of babies born to mothers looked after by IM compared to babies cared for by NHS midwives, was something that needed looking into.

Should add, this study found higher rates of perinatal mortality for women booked with IM who had complicated pregnancies. However, the study concludes that this was probably associated with the very large number of twins and high risk pregnancies in the IM arm of the trial where mothers opted to deliver at home.

[drcharliegirl]

Of course independent midwives are everyone's right to choose.

however, they will tend not to take on the complex pregnancies and therefore their results cannot be compared to obstetrician-led hospital care (that's apples and oranges). There are always exceptions, but their populations are different.

They certainly cannot facilitate a C-section!

There are excellent private facilities at Chelsea and Westminster hospital which is a little closer than the Portland. St Thomas springs to mind. St Georges has a good name too. I wouldn't go anywhere privately which was a standalone hospital (I am a paediatrician). Private maternity is great for comfy rooms and big bathrooms, but in an emergency can prove slower and less safe than NHS care.

NHS maternity services are stretched but are actually some of the best in the world. Not that you would know it with the vocal opposition to all things NHS which you may find on fora wherever you go. There seems to be a sense that as long as you pay for care, it must be better. It's not necessarily so.

I think the idea of a Doula is an excellent one. That way your wife would get support pre-delivery, during delivery and after delivery which complimented the care she received from the midwifery and obstetric personnel, whatever you decide is right for your family.

PS all NHS personnel have indemnity. Independent midwives cannot find an insurance company to indemnify them (they have been quoted upwards of 30000GBP per year - similar to the insurance premiums paid by obstetricians). I think that may speak volumes. As far as I am aware, none of them are insured unless working in a hospital setting.

[Minifingers]

"however, they will tend not to take on the complex pregnancies and therefore their results cannot be compared to obstetrician-led hospital care (that's apples and oranges). There are always exceptions, but their populations are different."


DrCharlie - with respect, are you coming out with all this from the top of your head? IM take on many 'high risk' cases, and usually share their care with an NHS obstetrician during pregnancy. Some of these mothers may have a home birth with just an IM in attendance (as I did with my second baby). More will have an IM present at a birth in an NHS hospital but not acting in a clinical capacity (as I did with my third, delivered in an NHS hospital). In fact the study I referred you to (which you clearly didn't look at) specifically mentioned the 'high risk' caseload of IM.


"PS all NHS personnel have indemnity. Independent midwives cannot find an insurance company to indemnify them (they have been quoted upwards of 30000GBP per year - similar to the insurance premiums paid by obstetricians). I think that may speak volumes."

And what is it saying? That awards for birth injuries caused by malpractice tend to be very high indeed, hence the need for high insurance premiums.

But of course it's a good thing that NHS personnel do have insurance, given the number of malpractice cases currently coming to court. For me, I'd rather not end up with a baby in NICU in the first place, which is why I chose an uninsured midwife who I knew to be highly conscientious, skilled and experience, over care from NHS staff at a maternity which lost 3 mothers over the course of 8 weeks a couple of years ago, and which has one of the highest perinatal mortality rates in the country.

[drcharliegirl]

I don't doubt the skills of independent midwives generally. ESPECIALLY when they work alongside an NHS obstetrician.
I'm not sure they're right for everyone - though I'm glad you had a good experience with your homebirth.

If acting in a complimentary (non-clinical) capacity, then of course there is no issue (though they are a good deal more expensive than a doula I would guess?).

Please don't make this family feel that NHS care is unsafe though. There are always bad cases in every system (I used to work in the USA, and it was MUCH worse). Anecdotes are unhelpful to a stressed and scared family who may be persuaded into spending thousands of pounds unnecessarily thinking that the care will be safer when private care is not demonstrated to be so.

[drcharliegirl]

PS I'll bow out of the discussion at this point. I have no interest in getting into a major disagreement when I was only trying to help!

Good luck OP and congratulations again!

[MotheringShites]

I gave birth to my twins at Portland. We live in Herts so a similar travelling time. Remember you are likely to have plenty of time when/if labour starts. To alleviate the worry, my consultant recommended we took tandem care with our local NHS in case we needed to be somewhere in a hurry. He told us not to tell the NHS we were planning private as a first choice. I didn't like this but went along with it to ensure the best care for my babies.

Twins were born by c-section due to one baby's slow growth at 36 weeks. The care was good. Not excellent, and on reflection there were several aspects that were poor. If you do go private, look at all the options and don't be sucked in by Portland's celeb status!

10k is an underestimation. My consultant fees alone were 14k plus all the hospital bills which are separate. In unforeseen circumstances you will have to pay (or transfer to NHS). Thankfully our insurance paid.

The other thing I should add is that when expecting DS2 I never considered going back there or any other private facility. DS2 was born by Vbac at our local NHS and my experience was fantastic. Your wife is understandably anxious as a first time mum and you must find the option that suits her best. However I'm not convinced going private is the way.

Good luck!

[munchkinmaster]

I think start at nhs and see where you get. You will need to have several consultations before they will okay a c section. Some anx management may help. Best if there is a psychologist attached to obstetric team but also possible to go private. A doula may be a good suggestion?

If you are decided to go private I would go to a private wing at an nhs hospital (Mary's, charlottes, Chelsea, st Thomas). Private hospitals including the Portland do not have appropriate itu facilities.

The bun fight above aside, it doesn't sound like your wife fancies a home birth, so she probably shouldn't have one.

At the end of the day, birth is unpleasant but for most people it's safe and it ends.

What is she worried about pain? Tearing? After effects?

Another side issue may be to do some antenatal classes to help her realise everyone is a bit anxious.

[festive]

Hi
Firstly congratulations! I did not have IVF but I took a very long time to get pregnant and was also extremely anxious my first pregnancy as a result. I have a wonderful 23 month old, born in an NHS hospital and while it wasn't perfect I feel the hospital did their very best for me and was so glad to be at a large teaching hospital with fantastic neonatal care as my DS needed some special care after the birth. Am currently 40+7 with DC2 and going back to same hospital.
I absolutely agree with everything Drcharliegirl has said - really good advice.
I did not go private, but i did not choose my local hospital either so just wanted to add that you do also have a choice on the NHS and can be referred elsewhere if you prefer (within reason of course, you wouldn't want to be booked at a hospital too far from home). I would also not consider private anywhere that was standalone - would only go private if attached to an NHS facility.
I would discuss with your Gp and see if your wife can be referred elsewhere in the NHS to begin with - and as for a C-sec it's her right to request one under new NICE guidelines.
Good luck.