Independent Midwifes

[robbie]

I'm thinking of using an independent midwife for my antenatal care and to go into hospital with me for the birth of my child. Basically the hospital I'm down for is so short-staffed I can't actually get through to them by phone and the waiting times are horrible. What's more I've heard some pretty bad stories about people's birth experiences. Yet they have an excellent special care unit and I'd like to be there in case anything went seriously wrong. So taking my own midwife might be the answer. Has anyone done this - do you know how much it costs - will they guarantee to come to the hospital with you when the time comes?

Robbie, I believe the answer is yes to your last question, that is mainly what you are paying for, but I can't help otherwise. If you are SE London by any chance I can find out the contact details of Dot, our brilliant local independent. She comes highly recommended by friends.
Congratulations by the way!

Robbie
Congratulations on the pregnancy! There should be a thread somewhere else about independent midwives because its a topic I raised a few months ago when I was getting increasingly upset and frustrated by the policies/attitudes of the hospital I was 'theoretically' booked into. Anyway, long and short of it is that I booked an independent midwife for my pregnancy and birth and am now 37+ weeks pregnant, so the next few weeks will prove whether I think I made a good decision. Where in the country are you? I'm in Surrey, so booked mine through Surrey Independent midwives - as SueW says, have a look at the independent midwife website she refers to.
I think the key questions you need to ask yourself are exactly why you want an IMW and have a thorough chat with any prospective ones before committing yourself. In my opinion, their real advantage is for people who want continuity of care (i.e. seeing the same midwife) throughout their pregnancy & birth and also for people who have had previously traumatic experiences/ or had caesarians and want to try for a vaginal delivery 2nd time (many hospitals aren't very supportive of this) or want to have a home/water birth.
You need to ask an IMW what her views/relationship with your local hospital are, since there is a 'grey area' surrounding what an IMW can do once she enters a hopsital e.g. she may not be registered to practice in your hospital, and although she should certainly go with you into hospital it may be that she then has no greater influence/status than that of a birth partner. A lot of this is to do with hospital insurance policies etc. Many independent midwives have left NHS practice because they strongly believe in the 'pure concept' of midwifery i.e. one-to-one woman-centred care, and they fundamentally disagree with the high levels of surgical intervention/ obstetric practice that occurs in hopsitals these days. It's probably the case that most IMW would prefer to help you labour at home and only suggest you transfer into hospital if there is a problem/ medical emergency (if you are within 30 minutes of a hospital then this is perfectly possible, since very few birth problems appear suddenly). However, all that said, it may be that there ARE IMWs who are registered within your local hopsital and can deliver your baby there if thats what you want. However, my only point here would be that hospitals are hierarchical places and terms of seniority consultants/registrars rank way above midwives, so once you are in hospital a consultant may have a different view to your MW on the need for e.g. ventouse/episiotomy/caesarian etc and have the ability to 'enforce' this (with your consent of course, but have you ever tried arguing your case when you are tired/ scared/ half-naked/ in pain?)
Anyway, sorry if I've painted a slightly different picture, but like you, I assumed an IMW was just someone who took over the antenatal stuff and then came with me to hospital, but the reality was a bit more complex.
Oh, incidently, the cost seems to vary upwards from about £2000 depending on the part of the country you live in. Do let me know how you get on? Good luck!

Slightly tongue-in-cheek...

I would take issue with the idea that Consultants/ Registrars rank above midwives. Most hospital deliveries are handled by midwives and doctors are only called in as a last resort. Our local MH has a "Midwife-led" unit that is very plush- private rooms, ensuite facilities, carpets throughout (except in the room that has the birthing pool, of course). You only get one of these rooms if you are having a doctor free labour!! Plan to have an epidural and you get the bog-standard delivery suite. As I was having a Caesarean, I didn't get to find out what happens on the midwife led unit if you change your mind about an epidural halfway through!!!

Take your point, Tissy - I knew something I wrote would become controversial in such a long post but I think it depends very much on different hospitals and culture within them. The hospital closest to me is certainly very much 'obstetrician led' (I have heard this from so many people - midwives working there as well as other staff) that induction/ C-section/ ventouse/episiotomy rates are well above the national average.Recently a friend of mine ended up with a very painful episiotomy about which her midwife (who was there at the time) said " yes it's a shame - I feel sure if we could have just let you try a bit longer we might have avoided that, but Mr. XXXXX won't let anyone push more than 1.5 hours...."
However your local unit sounds great, and in fact, as a result of my last birth experience and recent friends experiences I chose to book into a different hospital which is slightly further away, but has a very strong active birth/ midwife led approach.
I guess my real point was that if you hire an independent midwife, the last thing you will want is her and the ob arguing over you whilst you're in labour!

Thanks for your replies - I'm in North London and am booked into UCH, which seems to have trouble offering the most basic levels of care at the moment. I've been trying for two weeks to get through on the phone to the antenatal clinic to re-schedule my first scan, to no avail - I've left umpteen messages on the answer phone - nothing. What's more the last two friends who've given birth there had terrible experiences - shortage of midwives, rude midwives, drunk midwives (I kid you not) and just downright incompetent midwives that put their babies at risk. My other choices are the Whittington and the Royal Free which from what I hear are no better - at least UCH has a great SPU (as I know from experience). I certainly don't want to go private (even if I could afford it) as I've no faith in these places in case of emergency, so an IMW seems like a good plan but what Motherofone says about their lack of any powers in hospitals is a worry. Anyone know of any good IMWs in the Highbury area?

A friend with moderate placenta praevia, booked into her local (Chelsea and Westminster, and very happy about it) ended up at the Whittington and had a very positive experience, Robbie. She said like most inner-city London hospitals the decor was a bit grim, but that the staff were quite simply brilliant. And she is a sensitive, fastidious sort of person, who was under a lot of stress at the time. I know so much depends on the personnel on shift, but I hope that helps.
Sorry to hear UCH is proving so elusive - a person from my NCT class (downtown SE London) actually chose to go there. She was a doctor and felt it was the best NHS hospital in London for maternity services...

Robbie
I investigated the Birth Centre in SW London (next to St Georges hospital in Tooting) for my birth. It is run by Caroline Flint (well known midwife - on TV etc). My sister used them and raved about them. You get 2 IMVs dedicated to you and they will go where you want to go (not sure how far afield though - e.g. north London) - home, hospital, their birth centre. While I was very tempted I found it hard to justify the cost (from about 3000-4000 pounds upwards for all ante-natal care, the birth and post-natal visits for some weeks after) and decided to wait to see how my pregnancy progressed. In the end everything went so smoothly that, with the encouragement of my NHS community midwives, I decided to have a home birth and the NHS midwife that came to my flat at 8am and stayed through to 6pm was just great (baby born at 1pm). I'm now glad that I didn't pay out for the IMV but my sister says it was the best money she ever spent (she ended up at St Thomas' with an epi and forceps delivery).
The Birth Centre offer a free visit to the centre where you can have a look round and discuss options with them - no obligations.
I should also say I found the NCT classes very reassuring so that both me and my husband felt much more empowered about what to expect, what to ask for, what we had a right to say no to etc.

Robbie, the emergency services vary from hospital to hospital. I'm sure that UCH has the top level NICU facility, so most hospitals private or NHS won't match that. Eg, if you had a super premie (say 25-28 weeks) at Whittington, the baby still might have to be transferred to a higher level facility. (I'm not sure if they do the "level" system here. It's what they use in the US. My little sis had a baby at 25 weeks at a level II facilitiy, able to cope with a later premie but not a baby that early, and she was transferred to a level III facility many miles away via ambulance.*) If you're worried about that sort of thing, you should ask about the particular facilities at each hospital, NHS or otherwise.

That having been said, the Portland does have a NICU and emergency services available to its inpatients and admitting doctors. My friend had an emergency C-section there and it went smoothly and left her loving the hospital and doctors. I've given birth there and it was wonderful. My 4 1/2 yo son has been admitted there as an emergency case when he was sick with scarlet fever and the care was swift and effective.

Just wanted to point out that there are private hospitals that can handle most emergencies, in the same way that most NHS hospitals can handle most emergencies. The Portland does have a midwife-led service available also, if you don't want to have a consultant. The only thing I'd do is book with someone now as places fill up quickly.

*My sister's little girl is almost 4 now and ahead in most things for her age (not height and weight, but that's all!). In Illinois (in the US), all premies are given speech, occupational and physical therapy from the day they leave the hospital (or thereabouts) until they are 3. This is a state funded program and costs the parents nothing. There is a choice of doctors available, so if there is a personality conflict with one, it's easy to switch. It might not be obvious, but there are no waiting lists, no hassle finding someone and it's very open, so the course of therapy is dictated by the best interests of the child.

Interesting what you say about the Portland Jj. I'm sure the ante/ post care is great (couldn't be worse than NHS) but i'm still not convinced in cases of emergency. My consultant last time round worked a day a week there and he said he'd never go there.
I think for the moment I've decided to brave out the frustrations of UCH - has anyone got a good UCH birth experience for me?

robbie - if you live anywhere in north london i recommend the edgware birth centre. Its run by midwives. Not a doctor in sight. The best thing I did was book out of hospital and into there (at 38 weeks - left it a bit late!)

Robbie, I had my DD at the Whittington last year. The antenatal and post natal wards are a bit grim (but being refurbished I think and you can get a private "amenity room", if one is available, at a reasonable cost), but the labour ward is fine. Two rooms have birthing pools. The midwives are fantastic - very supportive and keen to let you make your own decisions. I ended up with an epidural and then a ventouse to turn DD who'd got stuck - the registrar was wonderful - clear about my choices and willing to have a go at turning DD with the ventouse and letting me carry on pushing rather than whipping us straight into theatre.
IMO the surroundings are not important (providing they are clean), it is the care that matters.
I'm hoping to be back there next year!

Robbie, what were your consultants concerns about the Portland? It's interesting that he recommended against it and still practices there. I have heard criticisms and have decided against using some consultants there, but still think it's a good place. In total, I know 5 babies who have been born there (ok, ok, to 3 mothers.. ) but have heard absolutely no complaints. One incident which sums up my stay is my night midwife (I was induced with a gel and stayed in hospital until labour started and then, of course, until the baby was born; this was before actual labour) coming in to tell me she was taking a 15 minute break and introducing me to her replacement while she was gone. I definitely felt cared for and looked after. My consultant was great and very hands off. All interventions in the labour and delivery were instigated by me.
Anyway, I am curious. There are criticisms that seem quite correct to me, but as a consumer and independent patient. The guys (and yes, it does usually seem to be guys) there are sort of an incestuous bunch and it's hard to referred out and they do have a reputation for being a bit quick to intervene. Having said that, it was my OB who suggested a second opinion out for my son's (the already born son) hearing difficulties. Also, my sons' paediatrician is there and has been wonderful for both boys. I'm certain that he's helped me avoid some serious problems with the baby (we've got the whole allergy thing going).

Oh darn, that should read "consultant's concerns". And I proofread, too!

My consultant (top woman in her field, in private pratice) also told me not to go to the Portland. I had placenta praevia, which was covered by my work medical insurance so I could have gone there but she strongly implied it wasn't safe enough for emergency cases so I ended up in horrible but much safer Kings. Must say, I rather fancied celeb spotting, living it up in posh room and drinking house champagne, but ended up spending ages in a hideous rather dirty room, then four days in a noisy private wing afterwards. But the baby and I were fantastically well, which is the main thing. The cases of the women who died at the Portland due to lack of care sent shivers down my spine. I felt lucky not to have gone there after that.

Wasn't the Portland recently critised following the deaths of two women due to lack of PN care?

Oops, sorry, Aloha, just seen that you've nentioned it already.

The latest tragic case has been referred to a jury inquest. The best consultant on the planet is no use if he is tucked up in St John's Wood and you are hidden away in a private room and not receiving basic postnatal care and obs. If I had the money to go private, Robbie (sound of hollow laughter) I'd go to St John and St Elizabeth.

I had my first at St.Mary's in Paddington and had the most horrific NHS nightmare. (a bit like what robbie is experiencing at uch). I am booked to have my second at Queen Charlottes which is a newly renovated hospital, but still, like much of the nhs, understaffed and underfunded. For a minute I had decided to have her at the Portland as my parents had offered to pay, but when I finally went to visit it last week, I was horrified at the state of the place. The decor and equipment were as antiquated/ugly as St.Mary's and not much cleaner. Certainly not the "posh" room that I had anticipated. I decided that the £10,000 would be better spent on new furniture for our new house.

Though, I'm not sure that the criticisms of the portland in terms of medical care are entirely fair. In the case of the woman who died after a c-section, I understood the complaint to be that her blood pressure wasn't checked every 15 minutes. I had a c-section in what was supposed to be the best nhs hospital in london and don't remember my blood pressure being checked more than once or twice a day....

After all major surgery - which having a C/S is - vital signs ( blood pressure and pulse) are recoreded frequently throughout the procedure. In recovery ( or observation unit) vital signs should be checked every 15 mins for at least the first hour, then 1/2 hourly, hourly and when they are stable 4 hourly for about 48 hours.
After an operation there in the danger of haemorrhage, especially after a caesarean. This is standard procedure and hospitals who do not perform regular blood pressure and pulse recordings immediately post operatively are giving substandard care.
Every 3 years The Confidential Inquiry into Maternal Deaths is published - often the cause is substandard care due things such as treatment by inappropriate junior staff and non adherence to proper procedure.
Glad you did not suffer as a consequece SofiaAmes

Robbie - Are you by any chance going to Kings' College ? If so - go to the Albany practice... they are absolutely fabulous. They are NHS but are on a pilot project where MW are actually managing to deliver their women. This means that each mother gets a team of 2 midwives and there is 95% chance that one of the 2 will be there for you. They have been in the media in the past and a good friend is working with them and says that their work is really TOP OF THE RANGE !

What about a doula otherwise ???? Let me kow if you want more info !

P.S. Congrats on the pregnancy !

Robbie - have a look at this :www.independent.co.uk/story.jsp?story=134286

Robbie that independent story is interesting but do choose a practice that is insured, chances are everthing will be fine but you really cant be too careful