How can a cash injection best improve on my last experience? (long, sorry...)

[scaredsecondtimer]

I am pregnant (woo hoo!). I had a fairly grim time with my daughter's birth, and am quite scared. My parents have offered to pay for me to go private this time if it would help, and so I have been scanning the archives here for opinions on private options. I'm in north London (N8) and my local hospital would be the Whittington. I'm wondering about St John's & St Elizabeth's but am a bit anxious as to whether it would really make a difference to the things I'm worried about.

Last time round I think there were a couple of things that happened that I would like to avoid. Firstly I was booked into the lovely midwife-led birth unit at the Royal Free and thought their midwives were great. But by the time I was in the birthing pool there was a change of shift and the only available midwife was from the labour ward and was not qualified to deliver in water so I was told I had to get out. She was pretty awful - lots of shouting at me and later when things went pear-shaped I had to really argue with her not to give me more oxytocin as I had just heard the doctor say I shouldn't be given more. Also when I was finally holding my baby I asked her to help me breastfeed as I had no idea what to do, and she said she was too busy doing paperwork to help me. So I just didn't feed for hours as I was so exhausted and clueless.

The other thing that I was upset about was that, having been given an episiotomy I tore really badly and lost so much blood that I passed out and had to be given transfusions. I was stitched up by the doctor who did such a bad job that I couldn't have sex afterwards and had to go back for corrective surgery several months later.

I am rather confused as to the best way to help avoid this kind of situation. I would like in an ideal world to have a natural birth in dimmed light and with water as pain relief, but I definitely want to be somewhere with medical backup on hand after my previous experience.

I really want to avoid having a midwife like the one who was so vile during my previous labour. I will never really know how much difference she made to things, but until her arrival I was labouring with no pain relief and after her arrival I ended up with an epidural and an episiotomy and a ventouse delivery.

I also want to make sure that the emergency medical backup is more competent than the (very nice & friendly) woman who mucked up the stitches so badly.

Can anyone advise me? I wonder whether John & Lizzies is the right place? Or whether perhaps just having an independent midwife in an NHS hospital would solve most of the problms? Is that possible? Or what about private care in an NHS hospital? I saw someone mention that on another thread and they were suggesting that you could get one-to-one consultant AND midwife care. Is that right? And is it available anywhere or only at certain hospitals?

Sorry this is so long but I am desperate to get it right this time.

John and Lizzies-my sister in law had a lovely experience of the 'holistic' kind there but less emergency care back up. another friend had her baby at the Lindo wing St Marys but with her own doula which worked for her. Sadly no personal experience NHS all the way for me!

An Independant midwife would probably help you, the only problem is that they can not normally deliver in hospitals as the hospitals are reluctant to give them honorary contracts. You can normally meet them and have a session to see if you get on with them for about £50 though. It sounds to me like continuity of carer with someone who you get on with and like will really help you.

What about a doula, SST? Then at least if you do end up with an unhelpful midwife, you have someone else on your side?

Any chance of a smaller midwife led unit? I had my first in one and it was great. There was a small team of midwives, so I knew them all from ante natal appointments. Personally I found having a supportive midwife the single most important factor in having a good birth experience. This way, you wouldnt need to pay for the birth either.
Big hospitals can be awful - I had to have my ds in one (he was a VBAC) and i had what I believe was a very mismanaged birth, partly due to the constant shift changes/lack of continuity.
The other thing I would do in your situation is write a birth plan. No way should you have ended up with an epidural if you didnt want one (I guess you must have consented, but what I mean is, it sounds as though you went against your better judgement) and as you found, this makes other interventions more likely.

I don't mean that as The Soln, btw, but a step in the right direction

scaredsecondtimer - so sorry to read your harrowing account. how are you now?

in an NHS hospital an independent midwife would not be allowed to deliver or participate hands on. simply because they are not employed by that NHS Trust, not insured by the NHS,not their employee, MW is essentially self employed

Hundreds of midwives will be forced to quit or work illegally because of new rules governing births at home.

The chief nursing officer has sent a letter to all independent midwives saying that if they do not obtain professional indemnity insurance within the next 12 to 18 months they must stop practising.

The 200 or so independent midwives say they have an excellent safety record but because of high NHS payouts where things have gone tragically wrong in childbirth - usually in hospital - they are unable to get insurance cover.

Until 1994 the Royal College of Midwives insured independent midwives. It withdrew cover when premiums soared.

The crisis in independent midwifery follows serious NHS shortages. The Royal College of Midwives has put the shortfall at about 10,000. While the government has tried to encourage more women to go into midwifery - or return to it - numbers increased by 2,423 between 1997 and 2005, but that only translates to 900 full time equivalents, as most work part time.

Independent midwives have often left the NHS because of disenchantment with the protocols of hospital labour wards. Many women come to them because of trauma over a first hospital birth - and midwives say that some women will end up giving birth alone if they are not allowed to continue practising.

Mavis Kirkham, professor of midwifery at the University of Sheffield and an independent midwife, says the move will deprive women of the choice the government says it wants them to have in childbirth. "It looks as though I can't practise if they are requiring this and there is no leeway, because there is no insurance. It is not just that we can't afford it - although when it was last offered it was more than a midwife's annual income. There is no company offering it at the moment."

There is talk of schemes to contract the midwives' services to the NHS but, she said, they would inevitably be bound by NHS rules.

Thanks all.

That's an interesting idea LadyG - having it at the Lindo wing but with a doula. I'd kind of written off the Lindo wing as being consultant-led, but maybe a doula would counterbalance that?

I'm worried about going to a small midwife led unit in case things go wrong. Just to clarify what happened with the epidural - I was pushing (though think I may have been desperately trying to rush myself to stay in the water as long as poss) for ages and then had exam which revealed a lip of cervix and was told I must not push as I was cutting off baby's oxygen. So I needed an epidural at that point in order to prevent me from pushing as I could not stop by then.

What does a doula actually do? And is there a risk of causing tension with the midwives?

luluMama is a doula i think MarsLady is too
British doulas home page

ooh, thanks v much scottishmummy. Reading now....

(and thanks for asking - I'm fine now though a bit sad about my never-the-same-again bits! luckily dd was a champion feeder so the midwife's attitude didn't actually do any lasting damage there)

hope everything works out

what about an independent midwife who could deliver you at home if all goes swimmingly or accompany you to hospital and act as an overqualified doula if need be?

There are quite a few in the N8 area I believe...

Reading the doulas home page, I'm not convinced that a doula will solve it for me. I was actually very calm during my first labour and managed the pain well. Dh was a wonderful birth partner.

So if a private midwife in an NHS hospital is a non-starter then does that just leave me with private consultant in an NHS hospital versus private hospital like J&L's or private wing like Lindo? Or is there any way of ensuring continuity of midwife care in an NHS hospital?

scared - I worried about the 'what if things go wrong' factor, and for a long time I wavered over where to book my birth. However, at antenatal classes this aspect was talked through thoroughly. A midwife led unit will not let you book if you're high risk. So for a start, you know the chances are everything will be fine. If necessary, you can be transferred to a hospital - but this isnt usually the case. Midwife units are very very safe. they wouldnt be allowed to function if they werent. I honestly would, in your situation, consider it carefully. I had a CS with dc 2 and then wasnt allowed the midwife unit for dc3 as it was a VBAC. My first birth was definitely the best.

youngvisiter - I'm wayyyy too scared to attempt a home birth after last time!

but, alfiesbabe, I was booked into a midwife led unit last time, and things went wrong which was why I was transferred to the more medicalised labour ward. In that sense I got the best of both worlds as I was able to be wheeled straight through from the world of candles and soft music to the world of machines that go beep. Having been wheeled across the divide once already, I would be very worried about being somewhere where that transfer would take longer and be more complicated.

You could go for The Birth Centre which sounds like it's exactly what you want -- the only trouble is that it's the wrong side of London for you. It's a practice of experienced independent midwives in a private birth centre, but it's effectively in the back garden of St. George's Hospital in Tooting so you are literally a trolley ride away from full NHS medical backup if there's any cause for concern.

What is it exactly you're scared of? From your OP, you sound very like I was with my first labour. You were doing ok and in control, and would probably have been absolutely fine if you'd had continuity of care with a supportive midwife who enabled you to feel empowered. I got to the point with my labour when I just felt I couldnt go on, and it was the midwife who kept me going, calmly telling me that I could do it. I managed a fairly big baby on just gas and air and although it was very painful, I didnt feel I'd had a 'bad' birth.
I honestly believe that in a large hospital, it's going to be very difficult to establish that relationship with the midwife that you want. When I had ds, there were so many people coming and going, I didnt know who was in the room half the time and it made me feel stressed out. I felt disempowered and badly treated. I was also shouted at (by a female doctor, not a midwife!) for screaming too loudly!!!! FGS if you cant scream when giving birth when can you!
Sorry this is going on a bit, but from what you describe, the thing you need most is to feel in control - and I honestly would if I was in your situation choose a home birth or midwife unit.

well, a private MW in an NHS hospital isn't necessarily a total non-starter - it's just that they're not generally allowed to act as full midwives as they're not insured. At the least it would mean that you have a qualified MW at your side throughout the whole thing, giving you continuity of care (which was my main issue with the Whittington - I had 5 midwives during a 7 hour labour).

I've never used a private MW but I believe in hospital they have to get a hospital MW there to actually "catch" the baby - however they can stay with you, explain your options, give you continuity of care, advise you on optimal positioning etc just as a "normal" mw would.

sorry crossed post. What exactly went wrong? Your OP suggests that you would have been fine if you'd been left to labour in water with support? Was the medical bit and the epidural really necessary? I had to stop pushing for a while during my first labour, and although it was hard, my midwife talked me through it. No epidural was necessary (though wasnt available anyway in unit)

don't rule out the doula just yet, there are a few on here who might be able to give you more insight into how their role could be helpful but I know for sure my doula wouldn't have let anyone shout at me in labour which is an awful thing for someone to do. a doula is like an advocate so they can do all the arguing for you while you get on with the more important birthing stuff.
I would be wary of going private/consultant led for several reasons, not least being I would be suspicious of more interventions not less. but no doubt there would be stats to see if that suspicion is baseless or not

Just imagining trying to get from Crouch End to Tooting while in labour [curled up in the back seat squealing in a traffic jam emoticon]

I agree morocco - dont know the stats, but anecdotally, most people I know who've gone down the consultant route have ended up with very medicalised births, often instrumental.

alfiesbabe - I suppose the thing is that I'm not certain I would have been fine if I'd had a supportive midwife.

It was a bit of a weird labour - my contractions never regularised really and it took three and a half days. My waters were eventually broken by a midwife from the birthing unit which moved things up a notch intensity-wise, but I was already 9cm dilated and the midwife thought I couldn't possibly be as I was still so lucid. After she'd broken my waters I needed to get into the pool for pain relief, and after they told me I needed to get out I began to push and am still not sure whether I really needed to or whether I would have left it longer without the threat of being made to get out.

But perhaps it made no difference, in which case the whole business with the lip of cervix was unavoidable and hence the transfer to labour ward was unavoidable. And even when fully dilated with the help of oxytocin & epidural I pushed for I think an hour and a half before they discovered that dd had the cord wrapped around her neck and needed disentangling. And even then she wouldn't come out without the ventouse.

So while I would really like to try again for a completely natural birth, I absolutely don't have the confidence that all I will need is a good midwife. I really hope so, and I am sure that it would give me the best possible chance, but I also want to know that if that fails I can easily be rescued medically! I am not at all sure what would have happened to me if I had lost that much blood in a small midwifery unit.

my thought exactly specialmagic!

I wonder if it might be helpful to talk through your previous birth with someone at the hospital to try and work out why things went as they did and if it is likely to happen again or not. there is a lot of info on the net about cervical lips (I had one with dd but it resolved with some change of position stuff) for example but I don't know enough to tell anyone else about it.