First baby after IVF, low placenta,NHS vs Private...very confused !

[mehro]

Hi all,
I am thoroughly confused and hope you all can be of some help.I am 24 weeks pregnant with our first child following ivf.We are keen to have the baby in London (presently in pakistan visiting family). We are entitled to NHS treatment and my first choice would be st mary's. However at my 20 week scan my placenta was "low lying not reaching os". The ultrasonographer was 80% confident it will move up in 6-8 weeks time, but my dr told me yesterday if by 30 weeks it is still low lying, she is going to book me in for a c-sect at term and not even try a trial of labour (risk of fetal distress). She also said if i wanted to give birth in the UK i should definitely go private, as being an ICSI baby and with a low placenta going NHS way is "asking for trouble!" Even if i went private it would be in an NHS hospital but the cost is exorbitant !
Any advice? Do you think i can get myself registered with a mid wife and then asked to be referred to a consultant? Atleast i would save something that way am i right?

It depends what kind of birth you want tbh. Private consultants are intevention-happy.

I think many women have c-sections on the NHS and as far as I know it has been fine. Certainly my friends who have had them have not reported any major problems! What exactly did your dr mean??

I had a low lying placenta at 21 weeks, a few weeks later it had moved which it does in a lot of cases. Don't panic yet, you still have time.

Your placenta is low now but it may move up. My understanding is that they can also move up after 30 weeks so a scan then may not be late enough to make a final decision that a c.section is the way to go.

I know that some people who have babies by IVF feel that they prefer the control of having a planned c.section but if that is not the way you feel then you could wait and see what happens nearer the time. Even if you do decide to go for a planned section you can get perfectly good care on the NHS. Many of those private consultants also do NHS work.

As for your doctor's comments re the NHS and delivering an ICSI baby, I really don't get it. They do it all the time. Of course, if your placenta was not adequately far away from the os you would not be allowed to go into labour but that is the same on the NHS and privately. Personally (because of the facilities available in the big teaching hospitals) I feel pretty safe in an NHS hospital in London - probably safer than I would in a private hospital.

I agree that you need to get yourself booked in with a hospital. You see your GP about this, and I would do it sooner rather than later since some hospitals do get booked up. Is Mary's your nearest one? If not, you might want to consider Queen Charlottes (a specialist maternity hospital) or UCH (which has a good birth centre, a brand new building and seems to have a lot of satisfied customers).

Thanks for all the info guys. She meant to say that bcz its an assisted conception its a precious pregnancy, and she would much rather that i went private (in an nhs hospital) rather than entirely the NHS way (even though i understand that in case of complications a consultant is always involved even if your care is NHS?)

The only issue is money. Good hospitals charge atleast 5000 for delivery alone and then the consultants charge another 5k...so that makes it 10k atleast ! Whereas on the NHS I pay nothing...but do i get the same level of care??

An IVF baby is not any different from a naturally conceived baby in terms of birthing so I find that an odd comment. Where is this consultant based?
If the placenta moves, then you can have a normal birth. You need to book in asap though whatever your decision.

Personally, I would choose an NHS delivery over a private one even if I had the money, but I would hire a doula.

Decisions in both the NHS and in private care are made based on money and resources (and imo to the detriment of your care, experience and health), but a doula can make sure the decisions are in your best interests.

mehro, I have an IVF baby and he was delivered by the NHS - the care was exemplary. I have many friends and acquaintances who have IVF babies (through IVF forums I belong to) and all of them, without exception, have had NHS deliveries.

All babies are precious and I don't think the parents of naturally conceived babies have any different concerns about the delivery of their little ones. FWIW I think the obstetric care in an NHS hospital is often better, esp in an emergency.

I would save your money and find an NHS hospital you are happy with.

Best wishes x

I have worked in maternity care in London for some years, and my honest advice is that this: NHS care is hurried, undignified, lacks privacy and often cleanliness. Postnatal care is at best barely adequate. BUT in terms of clinical care, especially delivery and birth, you are way better off in the NHS. Quality control in the private sector is very hit and miss - there's some really inexperienced obstetricians working there and it's a complete misunderstanding that they are the 'best'. Private care is 'best' at providing private rooms, clean bedding, good food (none of which is to be sniffed at). When it comes to higher risk births (and I don't think you should count yourself in that category yet) you are far better off in the NHS: you will have access to clinical expertise and emergency facilities that the private sector cannot match. Bear in mind that the private sector sends most of its obstetric emergencies to the NHS.

In short, then, it depends what is most important to you. If you are not at high risk, and you want to buy a little comfort and privacy, the Lindo Wing at St Mary's or the Portland could be just the thing. If you want to prioritise a safe labour and delivery, and you can cope with the experience being a bit rough and ready, you should go for the NHS.

Sorry to rant on, but I think your doctor is misinformed and scare-mongering.

Oh, and don't worry! Bottom line is that you and your baby will be be fine whatever you choose!

Completely agree with Hester.When I had my DD I found there was a lack of the "softer" aspects of care in the NHS and also a lack of continuity. BUT when something went wrong in my pregnancy and the doctors had to get involved/medical decisions needed to be made they were brilliant.

I looked at all of the options quite recently and decided that this time I would have an NHS birth but the support of a private midwife to provide continuity. So far it is working well. Maybe it is something for you to consider?

If you can afford it, go private in the private wing of an NHS hospital (eg the Lindo) and you will absolutely get the best of both worlds.
The consultants who cared for me privately at Chelsea & Westminster were not in the slightest "intervention-happy" - in fact I had two natural births, the first with gas and air and the second with nothing at all. What they believed in is the woman's choice. As mine said to me "it's your body and your baby".
I had all of my scans and antenatal appointments with my consultant obstetrician whom I knew well by the time I delivered my baby in clean, safe and private surroundings.
Why would opting for NHS care have prioritised a safe delivery? I know plenty of people who had a decent experience on the NHS, but there are always some who don't, and end up with junior obstetric staff making decisions and calling shots when things go wrong and the consultants have gone home or with the "more urgent" case.
If I had a high risk pregnancy I know I would opt for the experienced consultant to be on side, on call throughout but the costs are indeed very high. If you can afford it I would - one option would be to see a private obstetrician (eg at the Lindo wing at St Mary's) for separate appointments as a second opinion if you are concerned at the decisions/advice you are getting throughout your pregnancy, rather than opting for the full antenatal care - my normal delivery cost £9K all in so if you needed a longer stay it would cost more in hospital fees (though the obstetrician's fees were the same however I delivered).
Everyone has very different views but I found it enormously reassuring to have a highly experienced consultant at the end of the phone or whom I could pop in for a check whenever I needed it.

Agree with Hester.

Yes, the food on the NHS leaves a fair amount to be desired. But I would definitely opt for NHS care with perhaps private room after if that is a priority.

I think that your doctor's comments regarding a precious pregnancy is perhaps tainting my general opinion of his/her other comments. Whether or not you need a c-section I don't think that needing one should exclude having an NHS delivery. I have lots of friends who have had NHS c-sections with entirely positive outcomes. Including ones who have had problematic pregnancies and who had medical needs that were not straightforward. In fact a couple who had private care in the pregnancy and then an NHS delivery by c-section when things went wrong (not as a result of the private ante-natal care, just one of those things).