Transfer to NHS for late pregnancy from USA

[mlhp]

Hi! We're relocating to London mid Oct when I'll 32-33wks!
Looking for all your advice and insight into transferring antenatal care to GP, NHS hospital, booking c-sec, etc.
I'll be relocating as a dependent on my husband's work visa.
Thanks in advance! Look forward to anything I can learn from you all

Whereabouts in London?

North Finchley thereabouts :)

I've read that the closest GP's in the area are Torrington Park Group Practice (low rating) and The Speedwell Practice (med rating). However, not sure - do I directly contact them and send them my medical records and request a transfer to their practice? Will they accept such a late transfer? Can I book a c-section ahead of time at a NHS hospital? So many questions! 😵

You will find the NHS very different to the US system and C Sections are not on demand unless for medical or psychological reasons. I would book into the Portland for americanised type care but it is expensive unless you have insurance that will cover it. I had both my dc there it was brilliant.

OP are you from the USA? Are you expecting hospital charges in the UK? Or will you count as permanently resident here? Maternity action have a good fact sheet on when you are eligible for free NHS care - https://maternityaction.org.uk/advice/nhs-maternity-care-for-women-from-abroad-in-england/

In terms of registering with a GP, when we moved we chose our local GP and had to provide ID and proof of address and fill out a form in their offices (but we were entitled to NHS care).

In UK hospitals You can request a c-section, but you may not be allocated a consultant (unless there is medical need). Either way - when I transferred my care from the UK to the EU previously - I brought all of my printed notes, attended the hospital I wanted, and asked for a late registration appointment. They then gave me a time slot (that day) to return (for context I was 37 weeks, travelled legally as I needed to be close to family to support a NICU baby).

In the UK c-sections are typically booked for c.39 weeks, all London hospitals could provide them. Average stay after a section is in a shared ward, and typically one overnight, before discharge home. Even elective dates can be moved, to make space for emergencies.

In my experience of transferring care to a new healthcare system - they will want to complete much of the tests again. I had new scans, bloodwork, urine etc. and then they were used to inform my care. So be prepared that it may not be as straightforward as “this is what I was told…” Have you read the threads on mumsnet on requesting a maternal preference section?

I’m a bit surprised that your relocation package doesn’t include private healthcare in the UK?

I came back to the UK from Canada when I was 36 weeks. I temporarily registered with GP. I was buying a house and staying with family. GP referred to midwife who got me a consultant appointment at local hospital. Scheduled an induction for 40 weeks.

It was all very straightforward. NHS maternity care is a conveyer belt which is easy to get on to. It's not fabulous and the care you get post birth is shit but it's easy to organise rather than ringing around to find available midwives.

Thanks for all the responses! Yes we are currently located in the USA where i had my first child by c-sec (emergency) June 2022. Due to short-interval pregnancy (current birth due is 28 Nov), US obgyn request to do repeat scheduled c-section. I wonder if they would just automatically allow you try for vbac in the UK?

My husband's job is under clergy therefore it does not have budget for relocation :)

Yes I did read the link about maternity care in the NHS website. I believe that I should be eligible for NHS care since we will be under skilled worker visa?

My obgyn here was planning a scheduled c-sec on 20 Nov (38wks 6days). Since we are relocating 2-3wk of Oct, I'm just wondering if that gives us enough time to register with a GP then get transferred to a hospital as this is my understanding that I have to go through a GP first? Or did I misunderstand that and can go directly to a hospital to register, undergo whatever repeat testing required, and schedule the c-section or discuss vbac?

Thanks, ladies, you are helping me a great deal! I'm going to try to go into this experience with an open mind and expecting some challenges with the late transfer of care.

however different the NHS is... I certainly would not reccommend going private for maternity care in this country. I am really glad @User2346 that you had a great experience but out of hours cover in private hospitals is not as robust and additionally if things go badly wrong they basically will have to call an ambulance as they don't have higher levels of care. even though for example the portland says it has NICU facilities (one of very few in the UK to do so), the number of beds is ridiculously small. the NHS, however much it is breaking down is safer. @mlhp just pop to one of your local GPs and they will help you. definitely do some research on the docs at the practice though and also local hospitals. if you are in North finchley, the Whittington hospital and the Royal Free are not too far from you. I would personally reccommend Whittington, it's really good. I trained there. I also worked at the Royal free, it's very good too. but Whittington maternity is better. Barnet would be a no for me. don't even think about Northwick Park, they have a really bad rep.

Hi OP,

you usually refer directly to the hospital of your choosing, they will arrange a booking/transfer appointment with a midwife asap. They will go through all your medical and obstetric history, and likely want to repeat blood tests etc.
As you have had a previous EMCS, they will refer you to a consultant who will council you through your choices for this birth. You will be able to opt for an ELCS which they will want to do in your 39th week of pregnancy.

I would recommend also registering with a local Gp too.

Congratulations on your pregnancy! You don't give a ton of information on your post, so I thought I would mention a couple of things although likely you have thought about them I'm sure.

I see you are coming from the USA, bear in mind that you need to register the birth with the US Embassy, assuming you (and your husband) are both US citizens. I don't believe you have an ability to claim UK citizenship on behalf of your child unless you have what is called leave to remain. You need to think further down the line as to whether or not you are staying in the UK for many years or just a short period of time and please bear in mind passports will take much longer especiallyif you want to go back the USA after the birth.

Secondly in order to qualify for NHS free care you need to show you are ordinarily resident or you need to pay. Europeans have slightly more bridging options than Americans so please make sure your residency is iron-clad or you have sufficient funds to cover the worst case scenario of a difficult birth before moving. You are unlikely to be accepted by airlines after 34 weeks to return to the USA to give birth in the event that you aren't covered or you change your mind about where to give birth.

Finally, the UK is different, they definitely take the view that vaginal birth is safer than an c-section in most cases and is not offered without some consideration as an elective option. Most births are midwife, not OBGYN led, I didn't see a OBGYN at all throughout my pregancies. The care in the UK is for most part really good, but you may find yourself in a confusing world where you are on a steep learning curve about how things work and it may be brilliant but equally you might be really unsettled when coupled with the difficulty of an international move. You are taking on a lot. I would seriously consider staying with what and who you know, can you delay the move by six months. It depends so much on what you are coming from so a little more information would be great.

It's worth contacting the gp for wherever you are moving to for some guidance. In some places you self refer direct to midwives/ hospital but where I am you have an initial gp appointment and they refer you to the midwives.

I don’t want to detract from the thread but what you are saying about the Portland is not true and interesting that these myths still exist. There is level 3 scbu and you are not blue lighted to the NHS. I had complicated pregnancies and births and felt a lot safer under the care of a consultant. There was also very robust night cover with for the first couple of nights 1 to 1 midwife care in a lovely clean room.
A huge proportion of parents opt for the Portland after horrific NHS experiences.
Good luck OP.

Just to mention in London you often don't get a big choice of GP practice as they cover very specific streets in the area. So you if you know your specific address now then I'd contact the GP surgeries or check their website to see which one will cover your address. It may only be one or two.
Maternity care tends to be midwife team led so your GP will put you under a midwife team who will do most of the appointments checking etc and support your birth plan and do post natal checks too. If you are not complicated then you may never see a consultant Dr.

You will need to first register with a GP. Really easy in theory once you have an address and are resident. Then ask the GP reception how you refer to see a midwife - in most areas that means filling in an online form or making a phone call.

You can have an NHS c section for maternal choice. The Dr does have to get your informed choice so they do have to explain the risks. Like a PP says an elective c section can be bumped to another date if they have lots of emergencies.

Definitely check you’re entitled to free care or you will end up with a large bill.

You won't be entitled to free healthcare here from experience.

Try private or stay in the US to have the baby.

Seems a very bad time to be moving. It can take weeks just to get a regular GP appointment here nowadays so I would worry you wouldn't get everything sorted in time. Might be best to stay on in the US and travel on afterwards. Good luck with the birth!

Yes OP, as you and your husband will have paid the Immigration Health Surcharge as part of your visa you will be eligible to use the NHS.

Hi OP, I moved back to the UK at 34 weeks pregnant and it was all very straightforward. Although I think I was still registered with a GP at the time.

I had a midwife appointment at the GP surgery within days of being back. She referred me to consultant at the hospital. At that appointment I had a scan and was booked in for a c-section (DS was breach). All very straightforward.

Good luck with the move.

Doesn't OP/her partner pay the big NHS charge when moving here, or maybe her partner's employer pays it. That way they would be entitled to NHS care.

In North London you self refer for antenatal care.
The GP contract has not included antenatal care for years.
Google "self refer antenatal NCL" and it'll take you to the right place.

Thank you everyone for your input! Yes, we will be paying the healthcare surcharge as part of the visa process. I hope this ensures a smooth transition into NHS.

Based on all the info provided (Thanks for the NCL self-referral info!), I'm assuming that upon arrival, I would register my entire family (husband, self, 1-yr old) at a GP that serves my postcode. Simultaneously, I will self-refer to a hospital such as Whittington (thanks for the recommendation :) and indicate the GP I registered with (although at that point I may not necessarily have had an appointment with them yet?).

I would not classify my pregnancy as low-risk per se, as I've a history of GD, Pre-e, and oligohydramnios with first pregnancy. Currently, I've just been prescribed meds for hypertension as the drs are seeing some high numbers. I'm not sure if in the UK they would consider it dangerous to attempt vbac with my recent(ish) c-section? Any experience with this? I would like to go into the conversation with the medical team in the UK without arguing off assumptions based on the protocol used in the States.

Due to my husband's job here ending and the job start date in UK, I don't think it's possible financially for us to remain in the US without a salary until baby is born.... although this would of course be my preference for obvious reasons.
Also, yes, we will register baby's birth at the embassy as someone mentioned.

A huge thanks again to each person who contributed insight to this convo! xx

@mlhp we wouldn't offer elcs straight off based on the risk factors mentioned. but you will see the obstetricians and they will discuss options with you. one of the things I would recommend if you go down the labour route is an early epidural (provided your platelets are fine) so that your BP will be better managed and if emergency section is needed, it'll be less faff. fingers crossed all will go well :-)

This isn't what you asked but with that kind of high risk history, will you even be cleared for a long haul flight at that stage of the pregnancy? Just something to keep in mind as you will need to certified "fit to fly".

@LolaJ87 yes I am going to talk to the doctor today about it! Fingers crossed this pregnancy stays "normal" without repeat issues :)