Do you have any choice of which NHS hospital you give birth in? Does it make a difference which midwife service you sign up to in the beginning?

[AstroKitten]

I am 5 weeks along and I know that I need to make an appointment with a midwife. My local midwife services is at our local hospital.

I've been looking at their page and the maternity services at our local hospital are rated "Requires improvement" very recently by the care quality commission.

I. Am. Terrified.

My Mum nearly died and became permanently disabled at this hospital a few years ago.

There's another much smaller hospital about 10 - 15 miles away that is rated good.

Do I have any say in where I go? Does it make any difference which midwife service I register with in the first place?

This is my first post, I hope it's in the right place. Please let me know where to go if it isn't.

Yes you can choose where to register for maternity services. I registered at a hospital out of my borough (level 3 hospital that knew my complex medical history well).

You can choose wherever you want. There is a risk they may decide you are too far away and reject your application (not sure if this ever happens, I’ve just seen it on a hospital’s website) but the hospital is your choice.

You can also swap during your pregnancy if needed. I moved when I was 6 months pregnant and so changed my hospital with no bother.

The only thing I would advise is to think about the logistics for whichever hospital you choose, in that how easy is it to get there, and how bad can the traffic get.

Congratulations!

I was given a couple options (London). But the closer one was often very busy and apparently you were more likely to be bumped to another hospital, so my GP recommended the one slightly further away. I don't recall seeing any ratings as such. And I think I had all my appointments at my GPs until I developed diabetes (around 33 weeks - I'm type 1). Only then did I go to the hospital.

Does the smaller hospital have all of the same services? I am close to two hospitals. One is the main one for most of the surrounding towns and has a large number of departments. They had a birthing centre and a maternity ward. The other hospital didn’t so giving birth there wasn’t really an option. I could choose the birthing centre or maternity ward though.

You can go where you like….have you read the cqc report in full? Many trusts that have an overall ‘require improvement’ will be for failings in leadership etc….but the actual ‘care’ element will be recorded as ‘good’

You shouldn't use a CQC rating for a whole hospital to decide about one department- the rating for Maternity could be completely different.

Does the small hospital have the same level of service as the large hospital- Critical care, neonates in particular?

Agree with this. My local was rated as requires improvement but once I read the report it was nothing to do with care but more about admin.

You usually have a choice about which hospital, if there's more than one hospital offering maternity care. But are you sure you have a choice about midwifery services?

For my second pregnancy I tried to register with the midwifery services that had looked after me and DC so brilliantly first time around. But I had moved house in the meantime and although both houses were 0.6 miles away from the midwifery service base they refused to register me as they had strict catchment areas and I was now over the borderline and had to use a different service. This was over a decade ago so things may have changed of course.

You can choose any hospital to give birth in and the midwife services will usually be attached to that hospital, even if they see you in the community. All the info will be on their maternity pages.

A few things to think about though:

Does the smaller hospital offer the full range of services? Including things like NICU care? Or would baby have to be moved to another hospital if they were ill. When DD1 was born, she needed the NICU and there were a few babies in there as well, who had been moved from other hospitals to ours.

How long ago was the smaller hospital inspected? If it was a long time, it may not be reflective of current practice and the smaller hospital may also be having issues due to the massive crisis in midwifery staffing.

Have you spoken to the big hospital about their report? I recently gave birth to DD2 in a big London hospital that is the lowest CQC rating for maternity. I asked what they were doing to address the issues, spoke to a senior midwife about it etc. They talked me through everything and provided some reassurance. Apart from a couple of little hiccoughs, i had an excellent experience.

That's interesting. I was out of catchment for the hospital i gave birth in, but the only difference it made to midwife services, was that i had to go to the hospital for my appointments, rather than being seen in one of the community clinics.

Sounds like it varies everywhere. I was also out of catchment for the hospital I registered at and I was still seen at their community clinic. Once baby was born I was then transferred to my local community midwife.

In addition to what everyone else has said, I would add that if a maternity unit rather than the whole hospital has been rated requires improvement, it will be receiving significant support from the regional team and also from the hospital trust leadership and there will be multiple improvements being put in place right now because they will be under a lot of scrutiny. So if the rating is older than a few months, it is likely that there is a lot of excellent work going on and that the reality now is quite different. I would suggest you visit all of the units you are interested in birthing at and get a feel for them and go with the one that feels right to you.

Yes. My nearest hospital was Boston at the time. It’s well know for not being a good place, though people do say the maternity care is good. I chose to have my baby at Peterborough. It did mean I had to travel to Stamford for certain maternity tests that could have been done in my local town instead but I don’t regret choosing it.

It's good to hear it sounds like there is a choice about which hospital you go to.

The bad rating for the closest hospital is really recent, March of this year. It's an interesting idea they might be under more scrutiny. I wonder how long for?

I've been trying to find out more information about the smaller hospital. They are named a 'birthing centre.' They offer maternity, gynaecology, obstetrics services, as well as audiology and some skin related stuff.

It says on Facebook they are a 'low risk birth centre', which it doesn't say on the NHS website. One the NHS website for the big hospital is also says 'low risk birth centre'. I'm really curious how risk is assessed. Does age have anything to do with it?

The small hospital doesn't have a NICU. The big hospital has a neonatal care unit. Talking to my husband, this is really important to him. Thanks for pointing that out.

I guess I need to just make a midwife appointment and accept I will hopefully have a choice and can talk about options. There's a lot of get my had around, but I just keep finding new questions I don't know the answer to.

It seems like midwife services here are hyper local. It seems to be broken down into the tiniest suburbs of the city.

I've already had an appointment with my GP a week and a half ago, she was not at all helpful. She didn't refer me to a midwife service, or check anything other than my blood pressure.

Is the normal way to call them directly to register? Or is there some way I can do it online? I thought I saw a form online last week, but I can't find it for the life of me now!

Your first midwife appointment with the hospital will tell you if your low risk or high risk. It can change during pregnancy.

I was high risk with both pregnancies due to being underweight