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

confusedhubby, I really feel for you and your wife. Our first son (now 5) was a long-awaited IVF baby and I agree with those who say that an IVF pregnancy can induce much greater anxieties than those lucky enough to conceive naturally and easily. I still clearly remember going to our first NCT meeting when I was about 8 months pg and realising we were the only ones who had done nothing to prepare for the baby - his nursery was furnished and decorated when he was 5 days old .

I would highly recommend some counselling for your wife - I had counselling all the way through my pg to deal with my anxiety - and to find a doula. I was going to get a doula but my mum (who was a midwife) came with me instead. It was a godsend to have her. I also had a good friend on standby who was a maternity nurse and a very calm influence!

A section is major surgery and it would be a shame if your wife had to go through it unnecessarily when the chances are all will be fine.

Good luck x

If she wants a c section she doesn't wait until she's in labour to have it. It's done electively at about 39 weeks. You do have to consider what she will do if she does go into spontaneous labour before the planned date though (ie either go with natural delivery or immediate c section).

I agree with those suggesting a chat with consultant - her midwife can refer her. Maternal choice does have to be taken into account so if that consultant says no - ask another one. You shouldn't need to dork out privately to achieve an elective c section if that is what she really wants having had proper discussion with her midwife and consultant.

I was also very scared and worried and over anxious when pregnant. I think it's just some people's reaction to being pregnant and not being in control/having influence over something so precious to you.

I gave birth at Croydon Mayday hospital and all the staff were lovely. I had a consultant and a registrar look after me and when it all went a bit tits up, my DS was delivered via c-section really quickly and I felt truly very grateful to have had such competent people look after me.

Pregnancy is a really worrying time but try not get too caught up in going for a C-section without any real medical need. Help your wife enjoy the pregnancy bit as much as possible.

Thanks a lot for taking out the time to reply. I did start posting PM's to some users but then thought of posting this also.

My plan of action:

• Seek advise if a c-section is possible on nhs. I didn't know that she can elect to take one.

• Try and pick a hospital she is comfortable with. It's not going to be mayday as even though I have heard some good words about it our experience is a bit different.

• Try and get her tested for iron deficiency and other related stuff apart from the normal scans

• Explore the option of a IM while considering the experience they hold and finding out about their insurance

• Look up a local doula. Hadn't even heard about this till you suggested.

• Continue to explore pvt options attached to NHS and probably pay a consultant for a initial discussion. I will however try and keep some extra cash stashed away to meet any additional bills.

• Sign her up for antenatal classes when possible so that she can talk with people she can relate to. I guess those conversations will giver her a better perspective.

Thanks for getting back. It did help a lot. I will try and keep all updated.

PS: I do think that the NHS is great in some aspects. However I find it a bit overstretched.

I hope this might help.

Antenatal:

The NHS care is routine; in my case, I really did feel they did not know me or have much inclination to get to know me. That said it did the job, I paid for extras like private scans and a strep B test. We also did an NCT course which was run for couples over several weekends and 1:1 hypnobirthing which were both excellent. Mumsnet was also fab!

Delivery:

I started off wanting a section; realised that would require me staying in hospital and swung the other way wanting a private midwife and home birth. The reasons? I trained as a midwife (but didn't finish) so have a gauge of how overworked the NHS is; but more importantly our local hospital has dire reviews and I really did not want to go there.

Unfortunately the private midwife was slightly out of our price range and both private midwife and local birthing centre still carried the risk of being transferred to said hospital I wanted to avoid.

Whilst we were deciding what to do we started hynobirthing and our teacher mentioned St Richards in Chichester. I had looked it up and it was prefect (great reviews AND they let dads stay overnight postnatally which was a big issue for me) but thought it was too far (40 min drive). Our teacher said she doubted it would be an issue - they have people travel for all over to go there and if anything was wrong we'd have to go to the nearest hospital anyway.

So we switched and I was instantly happier. In the actual event I was not only 40 min car away but a taxi (10min), train ride (45min), taxi (5min) then car ride as I went into labour whilst having dinner in London!

I will not lie; full blown contractions on a packed train did freak me; we seriously debated getting off and going to the hospital I had been avoiding all along as its on the way home but i am very glad we didn't.

Got to the hospital with 1.5 hours to spare and delivered DD on 2 paracetamol and gas/air! Had I have been at home with more time to ponder I would have almost certainly gone in earlier and ended up with an epidural I didn't need.

DD was born at 11:24 and we went home at 14:00 the next day.

So in summary; have a look at hospital and birthing centres outside your local area!

Postnatally.

If I had the chance again; this is where I would pay for private support. DD did not poo for 4 days; the NCT breast feeding counsellor put the fear of god into me about having to go back to hospital. The midwives (I never saw the same one twice) were nice but didn't know me and evidently had not read the notes. The HV we saw once or twice and all of them ignored my concerns that DD only turned her head one way (she had a kink in it which was sorted by a osteopath at 3 months).

Apart from the IVF situation I have\had very similar feelings to your wife. Also due to the fact of bad experiences with the NHS. I am not a NHS basher and feel they do a wonderful job in lots of other ways, but my trust for them to deliver and care for myself and my baby was gone and there was nothing that could build it back up within 9 months.
Also ELCS are simply not an option (in relaity) on the NHS without a good fight. Which I\we did not have the strength to do. The way I felt I was being bullied into having a birth the NHS wanted me too scared me even more!
I done lots of research into ELCS and decided this was the birth choice for me. I would suggest reading "Choosing A Cesarean - A Natural Birth Plan"
I am due to have my ELCS in August in Herts. www.thebirthteam.com They provide delivery only, full care and antenatal packages. It is much cheaper than The Portland. They also provide antenatal classes.
I am having the Delivery Only option, so am using NHS up until 34 weeks. Using the NHS thus far (I am 26 weeks, has done nothing but validate my decision to go private!)
TBH the distance from the hospital I wouldnt worry about too much as the ELCS will be scheduled for 38 weeks and your private midwife is oncall 24 hrs a day to meet you at the hospital with consultant should your wife go into labour earlier.
Good luck and PM me if you want too!

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

Yes. Please don't assume you will have a nice uncomplicated delivery. Yes they can transfer you to an NHS hospital but they aren't going to do that in an emergency situation, sorting that out will take priority. They will transfer you afterwards.

If you can't afford it or don't have adaquate health insurance then don't do it. You could end up with a hefty bill.

The Portland has ITU facilities for children.

The Portland's NICU has a poor reputation in medical circles, to be honest. Be wary...

Drcharlie if the Portland,has such a poor reputation then how come most of Londons top consultants practise there? Why would they put their patients at such risk?

Hmm that surprises me. Only as I'm a paeds nurse and I know a lot of their surgeons also work at gosh.

I gave birth at St Thomas' and had a private room (on the NHS). It was great.

I wholeheartedly agree with GingerDoodle

Postnatally in particular - my baby lost a lot of weight and was slow to regain, I had a different person (midwifes, lactation consultants, community assistants, health visitors) visit every 48 hours for the first few weeks. None of them read the notes so the first ten minutes of each visit was 'what was your birth like', plus they cannot give you a time (appreciate the NHS is overstretched but basically meant I couldn't go out for a walk with the baby or anything which wasn't great as I really wanted to get outside even if just slowly round the block to get us some air).

They also often had slightly different opinions - one was pro formula, one was pro expressing after every feed, one was pro top up with formula after every feed - a bit confusing really, and the drop in weight I am tasking about was sometimes tiny - 20grams - thats a poo she just did FGS!

If I could have paid some money for set appointments and a consistent person I would have.

Birth didn't hurt anywhere near as much as I expected (I mean it hurt, but it was bearable) I delivered in the birthing pool in Midwife Unit, no drugs. I went to Daisy birthing classes and read Ina May Gaskin, both helped me be a lot more ready mentally.

I would say though that towards the end I was starting to get a bit twitchy and would have appreciated more scans/checkups - it was all fine but you are a bit abandoned on NHS.

What about thinking about hospitals to the south of you, rather than up into London? Might that be cheaper too?

I was terrified of giving birth, by the way, and with hindsight absolutely should have had an elective section but felt I was making a fuss asking. if that's what your wife wants, help her push to get it.

It is totally natural to feel worried about childbirth, especially in the context of an IVF pregnancy. I am 20 weeks with DC2 and had a difficult birth with DD 2 years ago, so I can understand where your wife is coming from. I am also a clinician myself, and my experiences in my training were only of seeing complex deliveries, so I felt very anxious about birth.
I would suggest a couple of things:

1. As an NHS clinician, and a mum, I would strongly suggest you and your wife do not discount NHS care entirely. As someone said upthread, one of the (many) advantages of care in an NHS hospital is the proximity to excellent neonatal care and emergency care. I found that very reassuring. Private hospitals can do well with routine care, but have less skill and experience (and equipment) should higher level care be required (although of course this is unlikely!) I chose St George's hospital in Tooting partly for this reason (they have excellent neonatal facilities). I cannot recommend their entire package of care highly enough: the antenatal, delivery and postnatal care were incredible and I am with them again for this child. It's just as good as it was 2 years ago. I am sure you could elect to book in there if you are in Croydon

1. I found hypnobirthing really helpful last time, to allay some of my clinical fears and allow me to feel more confident about my body's ability to deliver my baby safely. I plan to use the techniques again this time. It was not expensive, the practitioner came to our home in the evenings, and my DH was able to feel part of the experience and understand his role better as well.

1. Perhaps visiting the maternity departments of the hospitals you are considering booking in at would help? Most hospitals have scheduled and organised "show rounds" and this might allay some fears and also help in the selection of where you would like to have your care?

1. Mumsnet is a great place for support: there are brilliant antenatal groups which consist of women who are all due in the same month. They are very supportive and I would recommend your wife have a look at those too

Sorry for long post, and best of luck!

Maybe get your wife on here - the boards hold lots of advice and support.

tbh, it sounds like she is your 'oroject' - "get her on this...sign her up for that..." god forbid she make a decision herself

The problem with private hospitals like the Portland is not the obstetric care (I'm sure that's excellent). The paediatric consultants are likely also very good. However, they are not the ones there on site.

In an NHS NICU you would have junior and senior doctors on site 24-7 with access to consultant advice and presence at all times. In fact, these days most NICUs in big teaching hospitals have consultant presence 24-7 too. This is not the case in the private sector, and they are not subject to as rigorous review as the NHS is.

As for why the consultants do it? Well, I suspect the price tag plays a small role... I don't think it's a big risk to take, but it's not one I would take with my baby (especially as the cost of having a baby in the NICU is more like 2000/night)

Drcharliegirl,I am afraid you are talking complete rubbish!!!!

I have had 2 DS at the Portland, both needing the NICU. There was 24/7 consultant cover plus all the ones I met worked at GOSH or St Thomas, both world class hospitals. All consultants have to hold or have held senior NHS posts before they can work at the Portland. Frankly I would not be happy with just consultant advice for my baby!

OP you do have to be careful if you go down the Portland route if you are not insured as costs can become sky high if your baby needs extra care. Most consultants at the Portland work in the private wings in the NHS as well and would do you a fixed price package for an ELCS but you will have great NICU on the NHS if you need it. Good luck and I had 2 ELCS which were lovely. Perhaps it would be worth finding a Portland consultant who also does NHS work local to you, have a private consultation and see if you could get on his/her NHS list if you want to go down the ELCS route?

I'm sorry , but I have friends who work there and I'm not talking rubbish.

From the Portland's website itself - there is 24/7 paediatric resident medical officer cover (this is not a consultant)

I'll bow out again. Gah - does it always have to get personal?

Don't mean to get personal but I do know what I am talking about as I have delivered 2 children at the Portland and used their NICU!!!!!

A bit insulting to your "friends" who work there if you think the care is substandard. It really gets on my nerves when these type of threads turn into Portland bashing by people who have never set foot in the place!

Good luck again OP.

Mayday hospital has improved a lot in the last few years.
However I think you'd both really benefit from good antenatal classes to give you knowledge about childbirth as well as options. NHS usually only does an hour or two if that, so I'd call the NCT or search online for a course. NCT isn't anti Caesars though some tutors may be, so mention you don't want a course only focused on natural birth which some are. The tutor I had was fab but has had to quit.

Good luck!

At the Portland you always get seen by a lactation consultant and a women's health physio.

Anyway...

I did Nct and would recommend it. We covered natural deliveries, epidurals, forceps, ventouse and c-section. Plus it helps to meet other people going through the same thing and might be good for your wife after the birth to have some Mum friends.

OP I think your wife really needs to talk about her fears with a midwife. You can request an elective c-section on the NHS. I'm not sure how it works but I know that you can.

I'm having my second (of three) children with Mayday this year (this one is homebirth though). Shame your experience of them is crap - I find them excellent. We used Kings for DS1 and had a terrible time

Gah - I should say third (of three)

I had my one and only DD on the Lindo Wing at St Mary's. I had booked an elective but ended up with an EMCS at 33 weeks due to PE and IUGR. It was an outstanding experience from start to finish. I had a spinal for the section and then a mobile epi 4 days post op for pain relief and it was pretty much a pain free experience. Yes it was expensive but worth every penny and even though it was a high risk pregnancy I felt safe and looked after from start to finish. My wishes were always adhered to where possible ( eg elective booked because I wanted one and I didn't have to fight for it) I saw my consultant evey time and had plenty of time in appointments to discuss any questions/concerns I had. A good relationship with all the midwives so I knew them all by the time I delivered.

If I ever had another (which I won't) it would have to be the Lindo Wing again. I don't think I would risk am NHS delivery based on posts I have read on here and real life experiences of my friends and colleagues.

Added to this my DD needed SCBU and because it was the private wing of an NHS hospital there was no charge. SCBU at StMarys us considered to be one if the best in the country and my health care covered her from the point of birth so she was examined by the Pediatric Professor at delivery. I can't praise it highly enough!!

Hi OP well done you for asking mumsnet!

Can I give you my point of view- I have a 5 week old DD & have suffered awful anxiety & depression throughout the pregnant.
So I am not addressing the nhs vs private debate because I think her issues might be helped by the following. As of course you want the best care & outcome for her & baby.
But spending money in other areas might help just as much as knowing your hosp is 'top'.

These things helped me & might help your wife:

1-Reading the NICE guidelines. I literally read the whole bloomin document so I would know what best practice is, to compare my nhs care to.

2- Antenatal classes that you both go to. See what nhs one you can get on- and so learn your nhs hosp protocols. Also NCT. She will get (hopefully) a nice group of women to share the experience with (I did) as well as add to the nhs info.

3- hypnobirthing. Highly recommended. I would have demanded an ec if I hadn't been brought down off the ceiling by these classes.

4- doula. A woman who has had some births & attended many. The emotional & 121 support is terrific.

5- see your gp & ask to get referred to your perinatal mental health team. There are specialist people who can help her process her anxieties.
It turns out pregnancy can 'bring up' loads of issues. These manifest in anxiety & depression. So it seems sensible to me to work through these issues.

6- keep doing what you are doing
Your support is excellent.

Good luck xo