C section or Natural? Private or NHS?

[jeaux90]

Hi there,

I'm 37, 15 weeks pregnant and its my first and unplanned but I'm very happy albeit rather shocked. (OMG I'm petrified)

I have a massive aversion to giving birth naturally and hate the NHS.

I would be happy to be pursuaded otherwise though or get any helpful tips on using the NHS but paying for extras that are really worth it.

Another thing is, I work full time and really can't afford to be sitting for several hours in a clinic...is there a way round that?

Thanks all

If money is not an issue, i would get an independent midwife. Think you need to get it sorted quite soon though. They will meet with you regularly for each ante natal appointment and be with you during the birth. Think they cost around £3000 (which includes a private room at the hospital)

Thanks, I think that I will be assigned to Queen Charlottes so is that a service that they all offer do you know?

You need to find out which hospital you will be going to, and only then can you investigate which private services you want from them. All hospitals are different, some have private wings and some don't.

At my hospital (Royal Surrey in Guildford), I went NHS but paid extra for a private room. This is a good compromise because you get the privacy which ensures a good night's sleep, but you are not paying megabucks. Still get the same medical treatment (which was excellent, actually) and food (not so good) though.

What do you mean when you say you work full time so can't afford to sit in a clinic for hours? Are you self-employed? If not, any employer has a legal obligation to allow you paid time off to attend antenatal appointments.

As to the "massive aversion to giving birth naturally"... I'm sure this thread will kick off soon with hundreds of outraged women telling you how misguided you are!

I had 2 c-sections and am generally pro them where someone has had a difficult first birth, but for a first-timer with no medical reasons for c-section, I think you should try for a vaginal birth because you might be one of those lucky women who gives birth easily.

"I think you should try for a vaginal birth because you might be one of those lucky women who gives birth easily." I would second that, having had two sections myself. I mean, your section WILL be fine but a natural birth is a far healthier experience IMHO.
Also you will probably recover to some sort of functional fitness quite quickly but if you are at all sporty you will find it takes a long time to get back to full fitness. I couldn't do a single sit up when I started fitness classes again [blush.] It does take a long time to feel completely 'well' again, especially if you lose alot of blood, not to mention the sickness from morphine, and the prospect of additional surgery if you have more children. I face a third section in the summer and I am not looking forward to it (need it for medical reasons tho.)
Anyway I doubt anything I say will change your mind, so good luck with it.

I think statistically if you're going to have surgery the NHS is still considered a very safe place to be (see other threads about maternal deaths at The Portland). I had to have a section (NHS hosp) with my first dd and the only thing I wish I'd had was a private room afterwards, for a bit of peace and privacy, and I think in most NHS hospitals these can be arranged.

Because I had a section last time I have no option but to have another section this time (expecting twins in january). As it took me 6 weeks to get back to normal - not limping around in my jimjams - after my section I'm not looking forward to that. I had a wound infection, so was on antibiotics and very strong pain meds for about 4 weeks. But not all women have this, some recovery very quickly, you can't guess beforehand.

Have you thought about hiring an independent midwife or doula? This can make (so I'm told!) a huge amount of difference to your birth, if you decide to go for a vaginal delivery.

I've had an elective section (problematic twin pregnancy), a normal vaginal delivery, and then an emergency section. The normal vaginal delivery was by far the least painful experience of the three (despite being by far the biggest baby - 9 lbs 10 oz), and a much easier recovery. The emergency section was by far the worst in every respect, unsurprisingly.

The first section was somewhere in the middle of the two in terms of pain and the aftereffects - I was shocked at the state of my body after the first section, from the point of view of my muscles/back/pelvic floor etc. I was shockingly naive as to what a cs involved (not that I had a choice in how I gave birth), and never imagined the effects it would have on me until it happened.

Please don't think I'm being judgmental - this is entirely your choice - when you say a massive aversion, have you thought of having counselling? I had it due to the trauma of my first birth (section) and it was wonderfully helpful. Motherhood dredges up all sorts of feelings positive and negative about how you feel about yourself! If you're cool with how you feel then fine, but if not then I would recommend it.

Wishing you all the best.

I think you should talk through your aversion with a counsellor and a good consultant (you may have to go private to get the level of attention you want) before you make any decisions. I am about to have my second section and to be honest, I would much rather be giving birth vaginally.

Huge yawns about the reference to maternal deaths at the Portland... Years ago. What about Northwick Park? Or recent babies lost at St Mary's new showpiece birth centre where the resus equipment wasn't working? I had excellent care in the private wing of Chelsea + Westminster. Saw same obstetrician throughout,plenty of midwives aplenty, great food and care. Not cheap but it is worth every penny if not a huge stretch. I'd pick a consultant and like twinkle says, work out a careful birth plan - you never know you could be lucky like me with fast easy births. But if complications are likely you can demand a swift move to a section during labour. I think only private care will allow you this flexibility and freedom of choice.

Had homebirth with an independent midwife and would strongly recommend. I don't know anyone who's had an IM who resents the money they paid. Mine was great - she was on the end of the phone whenever I wanted her throughout the pregnancy and came to my home for antenatal appoinments. Homebirth is a hugely, hugely popular choice (I mean popular in the sense that almost everyone who does it comes away from the experience a complete homebirth convert - you really can't say the same for hospital births). And women who've had a homebirth and a hospital birth overwhelmingly prefer giving birth at home - even if they end up transfering during labour!

I know you don't want to give birth vaginally, but if you change your mind and decide to go for a natural birth I would seriously recommend you don't have an obstetrician as the lead professional at your birth or give birth in an obstetric unit. Not unless you like having loads of painful interventions.

On the other hand you might come round to the idea of a vaginal birth with an epidural from early on. It's the norm in places like Spain and France. In which case you'd need to be on an obstetric ward. And if you'd opted for regional anaesthesia you probably won't be put off by the idea of monitoring/catheters/spending your labour in bed anyway.

I had my twins at Queen Charlottes and was in the private ward. It costs around £10k to have a c section privately in an NHS hospital so it isn't cheap and not much cheaper than the Porland, which comes in at around the same amount.

I can't say I'd rate a c section but mine was a particularly grim experience (twins, emergency, lots went wrong and I had healing issues afterwards). However, if you had a strong psychological fear of vaginal childbirth then I would imagine that a c section would be a very good option for delivery. It's no picnic and a straightforward vaginal delivery is MUCH easier to recover from than a c section, but it's your choice. I would definitely echo the others in suggesting some counselling though as even if you still decide to go for a caesarean it could be very helpful in resolving any issues and fears that you have surrounding birth and which might overlap into your caesarean delivery. The latter is highly medicalised but the aftermath can be very debilitating, undignified and, as with all women post-childbirth, messy. It came as a total shock to me how incapacitated I was after mine - to the extent that I had to rely on my husband to take me to the loo, wipe me down and change all my pads, etc. It was humbling but strangely bonding.

I don't know how doulas or independent midwives would work at Queen Charlotte's so it might be worth calling their ante natal department and ask to be transferred to someone who can talk you through your options. The private ward is excellent but it is expensive. They do have 'amenity room's on the NHS post natal ward (about six if I remember correctly from my wanderings about) but they are allocated on a first-come/first-served/higher needs basis (caesareans, complications, twins, etc.) and you have no guarantee of getting one as it all depends on how busy they are and how many other caesareans/twins are born that day. They cost about £150 per night I think. The only way to ensure that you have a private room is to be a private patient and go on the separate private ward.

If you want to ask any other questions about Queen C's then feel free. In spite of all my problems and dramas I rate it very, very highly and also highly recommend my consultant who was a bit of a genius and got my twins to me safely, when that wasn't always a given. He also gave me a tiny section scar, which was an added bonus. His name is Mr. Kumar and he is very gentle and would, I think, be very sympathetic to any concerns you might have.

Best of luck with chosing. My only advice is to do your research on all your options and then go with YOUR gut instinct as to what is the best thing for you and your baby. The right birth for YOU is a great start to motherhood in my opinion.
Kx

My personal opinion is that you need to try and work out what it is about a natural birth that your aversion is about. I was afraid of birth itself, but I was terified of being put in a situation outside my control - of being expected to labour to a timeline dictated by hospital policy, having random people I didn't know (not) supporting me, of being expected to make decisions about interventions in a stressful environment with incomplete information and of hearing other women screaming. For me, a home birth with independent midwives was a brilliant solution - I'd had time to get to know and trust my midwives and felt I would be allowed to get on an birth my baby however it felt appropriate at the time. And that's pretty well what happened - DD arrived after a 7 hour labour, weighing 9lb 12 with no chemical pain relief required.

Due to issues around insurance and employment, for an IM to act as a midwife within a hospital both sides need to have done a lot of paper work - there are relatively few MW/hospital combinations where this has happened, which is why IMs tend to only do homebirth. One of my MWs also pointed out that she felt she couldn't do a good job as a MW if she didn't know the hospital well - in that circumstance she felt more valuable as an advocate. A lot of IMs will be happy to support a hospital birth, but will only be able to do so in the capacity of a doula/advocate rather than a MW.

You may be assigned to Queen Charlotte's but that doesn't necessarily mean you have to go there - you may well have a choice over where you give birth. I had a choice of 3 hospitals (although I was pushed towards one of them quite strongly). I think that does depend on exactly where you live and how your GP fits into local PCTs. You'd need to do some digging locally and see whether you had any other options and, if so, which hospital was the best for you.

Good luck making a decision - as kitstwins says there's no right or wrong way to do this, just the right way for YOU

I had a chat to Queen Charlotte's, as it's got a private wing in an NHS hospital you can either go private, or attend as an NHS and pay for a private room afterwards? IT's got a good rep.

I know at Kingston where they also have a private wing that you can even attend as an NHS patient and then pay a smallish amount to book a particular consultant to deliver your baby / do a C/S. If they can't be around you get one of their colleagues and it costs about £550 compared to just under 8k for full private care, and can be a good option for someone with a straightforward pregnancy. Maybe ask at Charlotte's if their consultants also do this?

The old chestnut about maternal deaths at the portland is such a classic. it gets trotted at every opportunity. That was AGES ago.

Anyway, I too have an aversion to vaginal delivery. Not that I had a choice with my DS as he was breeched. so i had a section at the portland. the consultant was great, service tops. however, recovery is definitely slower than most vaginal births. having said that, i have quite a few friends who were left to labour for too long and ended up with tearing and took quite a few weeks to heal anyway. Plus the bits down there were never the same - thats what they told me.

Bottom line is there is no easy way to get out a baby. I have about 15 fellow mums that I regular chat with and only a couple had what I would call a fairly easy vaginal delivery.

Once your baby is out and you have him/her in your arms, you will realise that the birthing part is only a fraction of the whole picture. DS is now 4 yrs old and I am expecting #2 in a couple of months time! i have chosen to have another section at the portland.

Good Luck with your decision

Hi I have had 2 sections experienced both NHS and privately at the Portland. My experience on the NHS was excellent care for the op but the aftercare was extreemly poor. I left the hospital feeling dreadful and found bonding with my baby hard.

Second time round I opted to go to the portland. I cannot fault anything the consultant Mr Braithwaite was fantastic the midwifes, nursery staff were excellent. The food is of excellent quality, just what you need when you've had a major op. I stayed for 4 nights and came home feeling refreshed and a million dollars. This time round I didn't suffer with any depression, my baby is extreemly contented. If you can afford private, I would recommend it. There shouldn't be two levels of care, but unfortunatly there is and if you have the money go for it. If you call the portland they will show you around and you can make your own decision.

Should I be fortunate enough to have another child, I will be back at the portland like a shot.

Hi DA3, so glad to read your post because I feel the same way about my experience at the portland. the staff were so supportive, the food tops and the nursery staff great

I would go for a pre-booked mobile (low dose) epidural. Best of both worlds. I had this and it took most of the pain away, I delivered normally and was up and about within hours, even able to go jogging gently 2-3 weeks after the birth. Haven't had a CS but would hate to be cut open unless it was really needed.

If I lived in the UK I would probably go for a private birth at St John and St Elizabeth.

just a thought on one of your other comments

"I work full time and really can't afford to be sitting for several hours in a clinic...is there a way round that?"

1stly no! If you make sure you book the first appointment of the day it usually helps though - I always have many more delays at the midwife later on in the day. Scans are also the same - it took nearly half a day to get a 12 week scan of my current DS as he was asleep in a strange position and wouldn't move to be measured.

2ndly - I think you have to think about what it's going to be like AFTER you have this baby,,, I know it's very unreal at the moment but realistically you aren't going to be working the same hours as you are now....

I was a full time career woman before and ended up packing in my city job and starting my own company - I can be home with my son but working (I still am very ambitious) but couldn't reconcile being out of the house for long hours with his needs. i do have full time child care but am there when he needs me!

Plus although pregnancy isn't an illness there are issues and complications. You will need to slow down, I am only posting on here now as I have a day in bed due to the fact have just been to the hospital for monitoring at 31 weeks, nothing serious fortunately, but when you notice something you do have to drop everything and get it looked at which does often mean waiting for hours whether it is by midwife hospital or doctor.

ref the birth - you need to do some serious reading and make a decision whats best for you - I had a reasonably easy vaginal birth and so did most of my friends - (5/7 had no problems, 1 had a planned cs for breach, 1 em cs as went into labour b4 planned cs) I had a far far easier recovery than the em cs and the planned cs.... however if your fear of vaginal birth is that bad then go for a CS.

Hi there,

I am due number 2 soon (38 weeks + 2 days and counting) and I must say that I share your views/concerns on vaginal delivery. I am petrified!

I had a c-sec (at Portland as well) with dd1 and whilst it is a scary experience, the care and support was faultless.

I am going to try for natural if possible but ONLY because my dd is 2 and very clingy and cuddly and I know it will be harder to look after her if I have another section.

I have been begging my hub to break the bank and pay for a natural delivery at portland as I am petrified of needing an emergency c- section and being in a ward with poor aftercare...My hub has not accepted

A lot of people cannot accept that c-sec is a viable option if not strictly on medical basis (mine was though)and will try to talk you out of it. I have not experienced a natural delivery (yet) to give a qualified view of which I prefer.

If money if not a worry though, I would absolutely recommend going private where in my experience, you DO get better care and the royal treatment. Sad huh!

That said, my friend had her baby in an NHS hospital in Liverpool and said that it was better than any private hospital she ever attended including Portland.

If someone can point to an NHS hospital in London and say the same, please tell me about it quickly!

Good luck whatever you decide.

Hello!

When I read your post I thought: yeap, that was me a few months ago! Terrified of childbirth, did not trust the NHS, no family around so wasn't sure how I would cope... All of this was made worse by the fact that I have a mild disability which could put me at a higher risk of complications (and because it is fairly rare, no one seemed to know much about what could happen).

And I am not joking re: fear of childbirth. It got so bad that I started having panic attacks, and was referred to a psychiatrist as an urgent case. Counselling was a great help, although I suppose the fear never goes completely (which is completely normal, btw). I have a stressful job in the city when I am not on mat leave, so in general I am hardly a shrinking violet.

The NHS was pretty good actually, but I did have an independent midwife who came to see me monthly at a time which suited me (evenings or weekend), chased the NHS when needed, came with me to consultant appts, asked all the right questions on my behalf, and fought my corner every time it was needed. I would highly recommend an NHS birth aided by an IM actually - for me it was a right balance of having the NHS safety net in case of complications due to my disability, but I had someone who knew the system inside out to support me when I needed it.

At the end of the day, you have to do what feels right for you - for every woman that tells you that her c-sec was great you will find another who is evangelical about vaginal birth. Equally, some people will be enthusiastic re: their hospital while others will hate it and explain to you how bad/dirty it all was.
Just make sure you explore all of the options carefully and weigh pros and cons (from homebirth to elective c-section at the Portland and every shade in between), so that you can make an informed choice, whatever that is.

Good luck and enjoy the pregnancy!

PS: As it happened, childbirth for me was a piece of cake: I had no pain relief because I did not need it, and dd was out in two pushes, no tears or anything. I was discharged 12 hrs later and we walked home from the hospital as I felt fine. Down there is as before (I am 31, so not exactly mega-young or anything) if not actually better due to all pelvic exercises I did in pregnancy .

also think about private birth centres as a good happy medium - I went to look at the birth centre in Tooting next to St Georges - would be my choice for first baby and money no issue if you wanted best chance of a good natural birth.

My first was NHS, natural and hell. In hindsight would have gone to birth centre or private. Second time around just went to local NHS as didnt seem much point forking out second time and it was fine.

'Tis a lottery and, at the end of the day, it is one day out of an extraordinary year - don't stress too much, do what feels right to you (hard I know). Paying for an NHS private room is also something I would do if I had my time again - another good happy medium.

Reallt depends on your financial circumstances - as with everything, if you have money to throw at it you will get a more pleasant experience for you but from the baby/birth perspective i don't think it makes a huge amaount of difference.