Baby no 2 - deciding between NHS and private

[RebeccaJM]

Hi lovely people,

I (36F) would love some advice from anyone who has given birth recently / is currently a patient at UCLH (NHS or private) or at the Portland Hospital.

I had DD in 2019 at UCLH, delivered naturally in the Birthing Centre without interventions or issue. The midwife at my birth was outstanding. However, it could easily have been a different story. I arrived at the hospital at 10.30am on the day of the birth, having been in labour for 36 hours. After waiting for almost an hour to be seen, at triage I was sent home pretty brusquely. Not long after getting home, my waters broke and my contractions began coming every 30 seconds. We rushed back to hospital - a taxi ride that was by far the worst experience of my labour, with an overwhelming need to push coupled with panic that I was not somewhere safe when baby was clearly coming right now. My hospital notes show that I was admitted at about 1.30pm and my baby was born at 2.15pm.

I don't mean this at all as a "poor me" story, I had a fantastic first pregnancy and an "easy" birth overall with a healthy baby, and I know how lucky I am for that. But reflecting on the experience now that I am (at last!) pregnant again with no 2 (yay!) I find myself wondering what would have happened if there had been any danger or problems with DD given I had no medical care or monitoring right up until I was actually giving birth to her. I would have been better off having a planned home birth.

So, even though all turned out well at UCLH, I'm feeling some misgivings about going back. I feel like the individual medical staff are all excellent and doing their best, but the shortfalls in care I experienced were due to understaffing. And by all reports things have only got worse in the NHS in the past 4 years. My baby is also due just before Christmas, and I'm worried about the further impact that holidays plus seasonal illnesses might have on staffing levels.

I'm currently exploring going private (through a combo of insurance and self-paying, if I can make the numbers work). I'm looking at the midwife led package at the Portland Hospital, as I am within the criteria and would ideally (all being well) have another natural delivery. I also like the idea of being able to have the same 1 or 2 midwives for my entire pregnancy as part of the package.

Has anyone got any experience of the Portland Hospital, particularly the midwife led package? The Portland has a NICU and adult medical services in case of an unexpected emergency, and it is only a few minutes down the road from UCLH in the (I hope!) unlikely event that intensive care is needed.

I'm otherwise considering the Fitzrovia Suite at UCLH. It's attractive to be within the overall hospital as if there is an emergency I know the staff there will deal with it, and at the Fitzrovia I would have a one-to-one midwife during delivery. However, it's significantly more expensive than a midwife led package at the Portland as I would have to pay for a consultant on top, and (again, assuming all goes well!) I am hoping that my pregnancy just won't need that level of monitoring.

Sorry for such a long post. Really appreciate anyone reading this far down, and any comments people might have!

Would be lovely to have the continuity of care that private healthcare can offer, but maybe consider a home birth considering how quick your labour was?

You can hire independent midwives to home birth, you would have the continuity of care and avoid any panicked journeys. You can also get in to your own bed after! Priceless.

I would 100% go private if I could afford it. My maternity care was very poor and I’ve found midwives to be very judgmental and I don’t know something about them I don’t like - not all but certainly a large proportion just do not listen to mothers I ended up giving birth in triage with ds3 and on the ward with a lady in the next bed with ds4 because I was not listened too. Many other issues, ds4 was meant to be a homebirth but I went overdue.

i think if you can afford the private care I would go for it.

If your first birth was relatively quick, I’d consider a home birth. (Sounds like from water breaking to baby being born it wasn’t long). If you would rather have medical professionals around, you might want to consider a private wing in an nhs hospital? The “problem” with the Portland, is what happens if something goes wrong? They do not have a NICU (I don’t think they have a SCBU either) so consider how you’ll feel if the baby needs to be moved - 1 in 7 have to. And also if something terrible happens, you are not in an nhs facility. Consider what extra costs would be involved should you deviate from your birth plan (I’m talking emergency c-section, an extra nihht etc). I speak from experience - we decided against the Portland for this reason. Gave birth in an amazing nhs hospital and he needed help immediately which the Portland wouldn’t have been able to deal with - we would have had a tragedy on our hands. He had to be transferred somewhere else because our hospital couldn’t cope with something rare which was happening with him - we always think about the costs and extra panic this would have caused.

Also, out of interest who is your insurance provider? Do you live abroad? It is incredibly rare for medical insurance to cover any sort of antenatal care

I gave birth in March and had a similarish experience. I was induced and the midwives didn’t believe I was in labour until I was fully dilated. I was rushed to the labour ward but I felt, and still feel, very let down as I wanted an early epidural after a bad experience with number 1. In your shoes I would book a home birth (if you’re reasonably close to the hospital).

Thanks everyone for your replies! Much, much appreciated.

@oliveandwell, @Nearlyamumoftwo and @Garethkeenansstapler - I am loving the support for home births! That would absolutely be my preference after last time, for all your reasons. Sadly I've ruled it out because DH is totally opposed to a home birth on risk/safety grounds. We're in London, about 20-30mins from UCLH depending on traffic. He feels that if something went wrong, we'd never be able to live in our house again. (And it would be especially difficult dealing with it as a couple knowing that he'd wanted us to be in a hospital.)

@Shopper727 and @Garethkeenansstapler - just to say I'm really sorry to hear about your bad experiences with the NHS and hope you and your babies are doing well now x

@Nearlyamumoftwo Thanks for the feedback on the Portland! I'm going for a visit there next week so you've given me lots to think and ask about. According to their website they do have a NICU onsite (with 3 days free care if your baby needs it ... though I dread to imagine the £££ after that...). I'm not sure how their NICU compares to the UCLH one though. Their midwife led package also apparently covers all fees for an emergency c-section - but you're right, they charge for extra nights (at an eyewatering rate!).

As for my insurance - it's nothing amazing! I'm in the UK and just have BUPA, it would only cover me for serious post-partum complications. I'd be paying out of pocket for an ordinary birth (or elective c-section) package.

Thanks again everyone for the replies!

I would warn everyone against the Fitzrovia Suite at UCLH - I was booked in for an ELCS there last month and it was the most disorganised shitshow I have ever come across. I had to chase them for everything - a registration appointment, the pre-op assessment etc. then, 2 working days prior to the ELCS date they suddenly decided there was something wrong with my consultant’s contract and cancelled on me. Didn’t even have the courtesy to phone me to tell me, mind, they let the consultant do that instead. God it was stressful.

Also, the Fitzrovia suite only has 4 rooms - it’s tiny and not a priority for the hospital at all. Plus they only started doing normal VBs this year - so all a bit of a trial…

Fortunately I got a last minute slot at the Portland. Aside from some lack of transparency over costs, the care was excellent. The midwives were incredible plus they have all sorts of specialists on hand. I would totally recommend it and I hope to go back for a second child in a couple of years’ time.

re: NICU at Portland, my DS was admitted for observations for 24 hours. The staff there were great and facilities seemed good. They say that for self pay clients you can transfer to NHS care if you can’t afford to stay private after the 3 free days. So the baby would be moved to UCLH if needed.

Forgot to mention - for Portland, if you need extra nights you can downgrade to lodger status. Then it’s £345 per night, as opposed to £1250. It means you lose all midwifery care, and are effectively staying in a B&B. We did it for the night DS was in the NICU as I was already fine to be discharged. I don’t know if they have this option at UCLH.

also UCLH have a hidden cost of £750 for a standby anaesthetist that they don’t mention online anywhere. That really pissed me off as it applies to everyone and they would therefore include it in the overall price.

I can’t understand the appeal of the Portland. I used to work in a level 3 NICU (sickest babies) and we regularly had babies transferred from there. Being transferred down the corridor from the private wing of an NHS hospital is much less risky than travelling with said sick baby via blue light ambulance an hour (or more depending on who has cots, and that may be across counties) across London.

OP, the ‘NICU’ at the Portland is for very mild issues; it’s not for properly sick babies. The on call junior paediatrician who would attend the birth or come to see the baby if they deteriorate is alone and not part of a team. They are most likely doing a PhD and doing the job to supplement their research income, and therefore a bit deskilled since they don’t work in a busy NICU at the current time. The nurses are very likely to be deskilled since they do not deal with very sick babies.

Ask a neonatologist or NICU nurse if they would give birth at the Portland. The answer will invariably be no.

@BxB87 I'm sorry you had such a stressful time of it with Fitzrovia - NOT what you need when you are about to have your baby! Portland sounds like it did brilliantly for you though. Hope you and DS are doing well :) And thanks for the incredibly useful info. That's so reassuring about being able to transfer baby to UCLH if needed, it was a factor worrying me. Also fab to know about the lodger status option!

@nohero thanks very much for the info about the kind of "NICU" offered at the Portland - it's so helpful to hear from someone with your expertise! I completely take your point about a level 3 NICU like the one at UCLH being the right place for a very sick baby.

May I ask you something though (and sorry for my ignorance about this!). Keeping my baby safe during labour is the reason I'm not opting for a home birth, but to what extent can a baby's likely need for a level 3 NICU be predicted during pregnancy? All going well, my pregnancy will hopefully be low risk like my first, but maybe that is giving me a misplaced sense of confidence. Did you sometimes care for babies that were born at full term, where all tests and scans had shown healthy development? Eg because things had gone wrong during labour?

OP, sadly, it can’t always be predicted in pregnancy. That’s why emergency caesareans happen; that’s why forceps and ventouse happen. All manner of problems cannot be predicted. Term babies can be perfectly healthy in utero until they aren’t. We received term and preterm babies from the Portland. The term babies couldn’t be predicted and the preterm only delivered there because it was too late to go elsewhere (i.e. mother arrived with some possible contractions to be checked out and labour happened quickly): it’s always less risky to deliver in the same hospital the baby will be cared for if there are complications. At the Portland, the local expertise for caring for sick babies is lower, plus as well as the transport time itself, you have to wait for the neonatal transport team to arrive and stabilise the baby for transport.

If everything goes well, of course the Portland would be a lovely place to deliver. But I feel about this the way I feel when I see 5 star reviews of insurance companies with the line ‘never had to claim but the staff are friendly!’ You don’t know until things go wrong.

I am definitely not saying the NHS is perfect or things always go well - we all know that’s not true- but if things go badly wrong with a newborn, NHS care is inevitable. And when you are intentionally getting an ambulance ride away from expertise, IMHO you run the risk of putting an unnecessary barrier between your baby and help.

I hope I am not scaring you: you had a good birth before and it’s likely you will have a second good birth. I see the worst case scenarios though so I account for them in my own decision-making.

Good luck with your decision, and with the rest of your pregnancy.

Hi@RebeccaJM respectfully, the NICU at the Portland is not where you will want your baby to be if something happens. What if they need emergency surgery inmediately etc? If your husband doesn’t want a home birth he should want his baby born in an nhs facility for the same reason . You will also not want your baby transferred in an ambulance , it would be better to wheel them down a corridor. It’s not a case of “going to UCLH” it’s a case of “going to UCLH if they have space” then finding somewhere else which will be stressful: If your baby is born at UCLH they will have spaces in SCBU/NICU as maternity units are shut if no beds are available in SCBU/NICU as it’s a condition beds are available for any babies about to be born. Also consider that if you give birth privately and your baby needs to move, Depending on how you’re doing too, you might not be discharged but your baby might have to leave you. This happened to me. My pregnancy was perfect and ended in an emergency c-section - he had to be transferred to another hospital because he had such a rare problem, but the hospital wouldn’t discharge me. I discharged myself in the end, but I was still separated from my child. Appreciate this is rare. I know women who have given birth at the Portland and can’t fault it, but I’m pregnant with my 2nd and wouldn’t dream of giving birth anywhere other than an nhs hospital now.

when I gave birth in 2021, i was informed by several sources that in the south east 1 in 7 children end up on either SCBU/NICU after birth, and mine did.

Your DH sounds adamantly against home birth (a common position for fathers) but would it help at all if you shared some research with him? Statistically it is the safest place for mum and baby if you are having a low risk pregnancy and it's a second baby. In your situation it's a no-brainer to me (either NHS home birth team or private midwives), however a private midwife will also come with you to the hospital in labour if you want to have a hospital birth, as a support person. Perhaps that would give you the confidence to go for NHS again?

Agree with @teezletangler - You need to get DH on the home birth literature and statistics!

You're safer at home for second babies, and certainly in the case of a possible BBA.

Another awful experience at the Fitzrovia at UCLH, you are basically paying a fortune for a worse than nhs experience.
Go to the Portland!

I had a low risk easy first pregnancy, high bp spike as my waters broke as i went into labour but that was it really. VB at 38w with just gas and air. But 12hrs after the birth DD developed sepsis and ended up with 5 days in NICU and another 7 days in SCBU. She was literally pushed by a doctor running through the hospital to get her from postnatal ward to the neonatal unit. You can just never tell.

I have no experience at either of those hospitals so cant comment on that but if your DH is against homebirths on risk / safety grounds, how does he feel about being in a unit that doesn't have a full NICU?

Thanks everyone, really appreciate the input and advice.
@FiloPasty @Nearlyamumoftwo and @Sunnyshoeshine - Thanks for the warnings about how things can go suddenly wrong (and I'm really sorry to hear about both your experiences with your firsts, wishing you a smooth birth this time round @Nearlyamumoftwo ). Definitely a pull factor for UCLH.
And thanks for your points @oliveandwell about @teezletangler about the safety of home births and my main risk probably being a BBA. Especially if the active part of my labour progresses even more rapidly second time around! I really like the idea of going back to the NHS at UCLH, but with the additional support of a private midwife during my pregnancy and labour. That way if my labour ends up going crazy fast again, I'll have a professional caring for me at home and - if it's anything like last time - I bet she'll be telling DH "too bad, there isn't time to get to the hospital"!

Oops my message got a bit garbled somehow! I meant to thank @FiloPasty and @BxB87 for the feedback on Fitzrovia! Doesn't sound like it's worth it over the usual NHS offering / Birth Centre (which, once they let you in, is quite nice) so thank you for helping me save my money on that front! I'd been thinking the consultant-led requirement was overkill anyway.

And to thank @Nohero with Nearly and Sunny for the warnings about what might happen with a sick baby and how transfers would work. Really appreciate the advice.

I had a private birth in London (was lucky my insurance covered the whole thing). It wasn't at the Portland but my experience was also of showing up and being told after triage the baby wasn't nearly here. It was my second and I told them that might be what it looked like but she was coming soon. I wasn't technically in active labour - the NHS would have sent me home. Because they have the space to, in the private hospital I was listened to and given a room. My baby arrived 40 mins later.

So if you can afford it and what you want is to be sure you will be listened to, I'd go to the Portland. No disrespect to the brilliant nhs but they don't have the resources to offer the level of care we'd all like.

@RebeccaJM unfortunately, the information about the safety of home births isn't that reliable, it's based on this study. I'm with your husband. https://www.bmj.com/content/343/bmj.d7400
However, they only included a selection of adverse outcomes for the baby and none for the mother and if you look into the charts more closely, for example if you look at table 2, you can see that the percentage of women transferred after birth at home is significantly higher than in any other setting.
Ob/gyn's do not give birth at home.

I had my second two at the Portland, some time ago, after a poor first birth, but I was obs care rather than midwife care. We've been back to the Portland since for child health, clinical staff are still amazing, but the level of administrative incompetence is unbelievable. The 1 in 7 transfer stat, is one that is bandied about a lot, but it means that eventually 1 in 7 admitted to their high dependency units are moved, but that's cost issues too. It's very expensive and they can be moved when they're stable, so why wouldn't you.

Anyway it's not perfect, but it was eons better than the NHS offering.

I went to the Westminster wing at st Thomas’s and had an excellent experience

when I say 1 in 7 babies end up in SCBU/NICU I don’t mean at the Portland, I mean 1 in 7 in any setting - not sure if that’s what you were referring to

Not sure if this is applicable to London NHS trusts, but you might like to explore the possibility of giving birth in a midwife led unit (MLU) that's attached to a hospital, as a compromise between home birth and hospital birth.

I know some MLUs are stand alone, but that doesn't get round having to be blue lighted if something goes wrong. My husband and I went for the MLU attached to our local hospital, which meant we were only a floor away from delivery suite and all the doctors there if something went wrong. But I don't know if that's a common setup.

Ob/gyn's do not give birth at home.

Not entirely true. Obviously it's rare, but thedoctormummy on Instagram
is an obstetric registrar who had a homebirth.

@RebeccaJM curious to know what you've decided as I too am battling between the two options.