post natal care

[snowqueen]

I have a friend who wants to have private care but she can't afford an independent midwife. She was thinking of booking in at a private hospital but is not sure she can afford that either as someone has said that costs even more.

The main reason why she wants an independent midwife is that she had difficulty breastfeeding last time and instead of encouraging her the community midwife just told her to bottle feed as the baby couldn't latch on and at four days had not fed.

She thought an independent midwife would have more time to help with feeding. Is it possible to give birth in a hospital under NHS or privately and then have an independent midwife just for post-natal care or do you have to see them for the whole of the pregnancy and birth too?

My aunt had an idependent midwife and that costs around £4000 as their insurance cost so much. There are hospitals that are Approved Baby Friendly, which is about encouraging breast feeding.

www.babyfriendly.org.uk/

will give you more info, and has a list of hospitals which are approved.

I'm booked at Queen Charlottes in London and they are applying for the baby friendly status, they won't LET you bottle feed for the first 24 hours in the hospital unless you have medical reasons.

So she may not have to go private!

BTW when a hospital is applying for the award they are given a Certificate of Commitment. So perhaps your friend can try one that has the award or the certificate?

Thanks pie, but she wanted to come out of hospital the next day anyway and she is worried about struggling the next few days so would really like private post-natal care

Has she thought of a doula?

es she has considered a doula and will go for this option if necessary but ideally she wants an independenyt midwife to look after her and the baby post-natally

Some hospitals discharge after 6 hours after the birth if there are no complications.

You can have an independent midwife no matter what but she would not be able to deliver the baby in a hospital unless she worked for that hospital. It has to do with liability and insurance. As I said my aunt used an independent midwife, 4 times actually. As far as I am aware you plan to have the baby at home and they do all you antenatal care. Any tests you have will have to be paid for. You can notify your local hospital so if there is an emergency they know who you are.

This is what I learnt from my Aunt's experience, though of course there are probably alot of variations. There is an independent midwives association which is probably the best place to start.

www.ima-acceptance.org.uk/index.php

Says that they can accompany mother to hospital, but role depends on the arrangement, nothing about only providing post natal care though...

Get her to talk to an independent midwife or post her question to UKMidwifery email list . The list has many independent midwives as well as midwives working in the NHS and is open to midwives, mothers, anyone interested in pregnancy and birth.

From what I have seen/heard through being on that list, being involved with NCT and having friends who have used independent midwives, the usual cost is around £2000 to cover antenatal, labour and postnatal care. A number of midwives are flexible in their payment schemes; others may not be. It is unlikely she would find an independent midwife who was not even prepared to talk to her about options.

HTH

She can find an independent midwife in her area here

Some independant midwives can accompany you into hospital and continue as your midwife whilst you are there - it depends on the particular Trust and the relationship the midwife has been able to build up with them. SO it is very individual and should be discussed with the midwife in question, rather than assuming that she can/can't do it.

Thanks for your replies, it really is just for the postnatal care that she wants a midwife; do you think she will need to pay the full amount even if she only has the midwife for the 28 dyas after the birth?

One more thing I forgot to say, she isn't registered witha doctor and she doesn't want to be either! Do you have to be registered witha GP to get NHS maternity care?

Really the thing to do would be to ask any local independant midwives if they would be happy to do this, and how much they would charge.

About accessing NHS care with no GP - I think it would be tricky. I'm fairly sure that most (if not all) areas operate a policy of attaching community midwives to GP surgerys (odd picture, that!) and you see the midwife who belongs to your surgery for antenatal care. Not sure how you would access a/n care otherwise - she could try phoning the hospital to see if she can have all her a/n care at their clinic?

Certainly during labour if you turn up at a hospital and say "I have no GP" they are not going to send you away. Does she have an NHS number?

postnatally - has she spoken to the La Leche League? There are breastfeeding counsellors in most areas who specialise in helping women through these problems. LLL woukld probably be able to advise. the alternatives are either a Douls or Maternity nurse - which could bepricey too.

Hope this helps.

snowqueen - does the same community midwife still work in her area? I was saddened to read of her experience - as a community midwife myself I would do all I could (as would my colleagues) to help a woman b/f if that is what she wants to do. Would never dream of suggesting a change to bottle feeding. It would also be worth your friend contacting the NCT b/f counsellor for her area to ask for her input - she may be able to chat to your friend ante natally to help a little, then visit once the baby is born.
If the midwife is still the same, your friend could request to be seen by a different midwife. She could request this at time of discharge from hospital, and her care would be handed over to another midwife. Just thinking that if she cannot afford the cost of P/N care from an independent midwife (and I'm not sure about the cost of p/n care alone - usually its the whole package), this may be an alternative.
Another possibility would be to employ a maternity nurse for a couple of weeks, tho' these are usually live in. Lots of maternity nurses have loads of breast feeding experience - usually mature women - who could also provide the support she needs. A shame tho', that your friend should have to resort to paying for a service that should be hers by right.

Tell your friend to try contacting the National Childbirth Trust for assistance in finding a specialist breastfeeding counsellor nearby. My friend did this (as she had similar problems with her first, ie no bf support after the birth) and she was put in touch with local organisations who could help. They sent someone round who chatted to her for 2 hrs about her concerns, and gave her videos and info, and she will visit again after the baby is born (any time now). The counsellor my friend saw is a volunteer and there is no charge for her services.

Also I would suggest chatting to the midwife she has now about what happened last time, and to find out exactly what bf support there is on offer at the hospital she is currently planning to attend. Eg my local hospital has antenatal bf advice groups and postnatal bf support, both while you are recovering from birth and various workshops etc afterwards. You can often arrange for a bf counsellor to visit you in hospital; although apparently it can cause problems with some midwives who feel like they are having their toes trodden on, it provides one-on-one support for the new mum, which may make all the difference.

HTH.

Snowqueen - a lot of doulas have a strong knowledge in breastfeeding... I am a bf counsellor and a doula and I knw quite a few who are.... Where is your friend located?

The pros of a doula would be that it will be cheaper, a lot more flexible (schedule wise) and they are "mother" focused.... she needs to find someone who she will relate to.

pupuce, she is in Birmingham