advice pls: spend money on private birth or night nurse / nannies

[whampsteadgirl]

Hello, I need to make a decision about where to spend the budget I've set aside for having my first baby, and I'd appreciate some advice.

I'm an American living in London and am 19 weeks pregnant with my first baby (after 3 years of trying to conceive and 3 rounds of IVF.)I have always planned to have a private birth, because it's closer to what I'm familiar with in the States: mainly that I would have a doctor rather than a midwife, I would get continuity of care, and I wouldn't be placed in a ward for recovery with my husband limited to visiting hours. however, as I'm away from home, and I'm sure the first few weeks with a new baby will be stressful to say the least, I would also really value having after-birth support to help teach me about parenthood and help me get the baby onto a schedule.

as my funds aren't unlimited, I can't really afford both options. for those of you who have looked at similar options, what would you recommend? Which is more valuable - peace of mind during the end of pregnancy and childbirth, or support afterwards?

Thanks for your thoughts!

This is a difficult one to answer because you are not comparing like with like. Also, you don't know in advance what sort of birth you will have - if it is a really quick and easy natural birth, there is not much point (IMO) spending a lot of money on private medical care and you would be better off getting help after the birth.

Which hospital are you booked into? Have you visited it, and how happy are you with the NHS standard care?

Is there a halfway house, like hiring a doula who could be with you for the birth and help you with the baby for a few weeks afterwards? That would give you continuity of care. They are not medically trained but can be a big emotional support during the birth. I hired a post-birth doula and would really recommend one if you can afford it.

Forgot to say, we paid £12 per hour for the doula, but that was 2 years ago. She would do anything except cleaning: so looking after the baby, helping with breastfeeding, cooking us meals, ironing... We had her for the first 4 weeks and it was a big help.

I would have NHS birth and help afterwards.

I agree - a doula would be a good compromise. Then you would get support during the birth and also support after. A doula would be excellent for teaching you about parenthood.

Look around your local hospital and ask questions - you may be able to buy a private room for a notional fee (about £25) for post-birth. With a bit of luck, you will be in and out in a day or two anyway.

Alternatively, what about spending the money on a cleaner/gardener/washing services which will help buy you time to bond with your baby?

Getting newborns onto schedules is a rather old-fashioned notion. See this recent article by Dr. Miriam Stoppard. It's rather nice: "the best kind of mother is one who hugs her child when she feels the child needs a hug, who lifts her child when she thinks that her child wants to be picked up and who puts her down when she thinks her baby is ready for sleep. The same mother will feed her baby when he's hungry (and not clock watch) and let him sleep when she senses he's tired."

When I was pg the 1st time round, I had the same thoughts as you and decided to go down the nhs birth/post natal help road, which worked well for me. The second time round, I decided to do the same, but found the pregnancy much more difficult (was dreading labour after the 1st time round, had ante natal depression, etc), and found a noticeable drop in standards at nhs ante natal level. Completely dreaded it. So jumped ship to private care for 3rd trimester. Loved the continuity of care, knowing who was going to deliver my baby and having my concerns actually listened to and addressed. If I was ever to do it again, I would now go for private care over post natal help. Agree with tuttifrutti, if you are happy with the care you are getting now, go for the post natal help and if you can get someone good, it is a bit of a life saver. If you do decide to go down the private birth route, you had better find yourself a consultant pretty soon, as they get booked up v quickly....

I would have NHS birth and help afterwards too, as long as you are happy with your local hospital. Ours gave me the choice of a doctor rather than a midwife and the standard of care was fantastic on the delivery suite.

There are some great doula's on MN - start a thread asking for their advice too, to learn more about what they can offer you and their rates.

(perhaps you could stretch to a private midwife for ante natal continuity of care, plus some post natal help as well?)

p.s. BIG CONGRATULATIONS on your pregnancy!

Another compromise would be to go for midwife-led care at a private hospital. Obviously this is only available for vaginal births but there would be increased continuity of care, you'd get your own room etc and they would refer you to a consultant if the need arises. Midwife led care tends to be a few thousand pounds cheaper than consultant led care, which is money you could spend on post-natal help. I know it is not the system you are used to but a good midwife is an expert in normal childbirth and is the person I would want looking after me if I was planning a vaginal delivery.

And if you have insurance this should cover an emergency section in a private hospital if one is needed.

Hi WHG,
Whilst u decide which way to go dont miss the option for the routine screening tests & scans.I am assuming u have had ur NT scan & have ur anomaly scan booked.
If u r nr Hampstead / Belsize Park do consider the Royal Free we are keen to welcome all maternity referrals and are actively improving provision of continuity of care for our mums!

If I were you I would go for midwife led care at private hospital (as explained my MrsHappy) or an independent midwife for a homebirth.

Hi, I'm an American living in the UK as well, and have had both my children here. It is a very different system from the US, mostly in that experiences are so incredibly varied.

The big advantage that you will have with private care is that you can easily tailor your treatment to meet your needs and wishes. The normal British approach seems to be one-size-fits-all and it is simply not done to kick up a fuss if something is not to your liking. (Unlike the American Way.)

We were fortunate with dc1 in that our midwife found us highly amusing to work with, "refreshing" as she would say, so we had a great experience within the system, ending in a waterbirth at the local maternity centre.

Dc2 was very different. We'd moved to another city, and our assigned midwife could not think out of the box and was constantly having to refer our requests to someone higher up, and it would take weeks to get answers, and we never talked to an actual decision maker until we had a meeting with a consultant. She was great, but still by-the-rules. We also only saw our assigned midwife only three times, as there seemed to be some weird rotation going on. We saw about six different midwives over the course of the pregnancy.

I have heard countless horror stories of hospital births here that would have been straightforward malpractice cases in the US. Truly horrific stories.

My MIL came for the first three weeks, and it was idyllic. She is particuarly good at caretaking, but I had three whole weeks to lounge about in bed with meals delivered, bonding with baby. The only downside was my clothes changed colours due to mixed laundry loads, but well worth it.)

Don't have an answer for you, just sharing the experiences.

I went for both a private delivery and maternity nurse as had no nearby family and got rid of the maternity nurse after a couple of days as I was so well and rested after my CS at the Portland, you are really looked after post natally. There is a great midwife led service there which is a lot cheaper and if you need a CS you should be covered by insurance. You could also have someone from an agency called Night Nannies for a couple of nights just so you can catch up on some shut eye. Thats what I will be doing next time, private birth and occassional night nanny.

Hi everyone, thanks so much for your advice and sharing your stories. Luckily, I've been registered with a private doctor at Chelsea & Westminster so far, so should I choose to continue that route, I'm already on her books. I like the doula and or private midwife ideas as well. I've now got more research to do - thanks for helping me think this through.

Personally, I would spend the money on help after the birth but thinking about what made my DD's birth so special I am thinking maybe it would be worth having a midwife you knew well in attendance.

I can't imagine my story is that rare but it is a lovely one so I will share it with you - I had my child in a NHS hospital, after hearing countless horror stories but would you believe my experience was an amazing one that I don't think could have been bettered in a private hospital.

My Aunt was the Midwife on duty and my Mom, a Matron, was assisting so I was not only in safe hands but it was a familiar and calm environment as you can imagine

It is a shame you cannot do both because having someone, in my case my Mom, on hand for the first 4wks after giving birth, was a God-send and helped me keep it together.

Won't help after birth be a lot cheaper than a private delivery?

Personally I'd go for the private birth given the stretched state of NHS maternity services in London

I had a private midwife for DS2 and would really recommend it, partly for the flexibility of care during pregancy, but mainly to labour with someone you trust and whom DH has met, even if he doesn't know them as well as you.

I would also recommend a private room after birth if you have a c/section. NHS wards are pretty grim, and if you are there for 4 or 5 days it's not much fun. For an unplanned section this is a bit hit and miss - after DS1 we asked at the hospital every day if there was a private room, and didn't get one. After DS2 there was a private room free which was such a difference. This might blow your maternity nanny budget, but in those circumstances I would have the private room rather than the maternity nanny.

Well done with the pregnancy! DS1 was IVF too so DS2 took us rather by surprise.

I had my DS at the Portland and didn't have care afterwards (though I did look into it)

Personally, I'm very happy with that - several of my friends found maternity nurses and PN doulas more of a hassle (I did have a doula for the birth)

I'm due to have my second baby shortly and will do the same again.

For me, care IMMEDIATELY after the birth (private room / Paediatric checks etc) are more important.

my SIL recently gave birth and was sent home from the NHS hospital 3 HOURS after giving birth. She was offered a bath after the birth and the bath still had the blood from previous patients in it.... I'd go private any day.

I had a C section though (elective)

Hi.

I had both my DD's in an NHS hospital and wasnt very impressed with the care they provided. I did however as for a private room with both of them and it was lovely and I didnt get charged!

I know many people who have had maternity nurses/ nannies at the beginning. We have always said if we had DC number 3 we would pay to have a private birth, but not sure where we would go around here as we are in essex. I have looked at the Portland but it's quite far for us.

I think I would pay the money for a private birth and aftercare.

Hope thats helps.

npg - bit of an aside, but private care is really only available in London and a few larger cities around the UK.

I'm in Herts and there is nowhere closer to me that offers AN services. something to do with insurance, I've been told...

Would recommend the Portland to anyone who is looking to go private.

Thank you. I have put up another post about this.

Honestly, as an American - I would spend your money on the private birth. You will get more like the standard of care, cleanliness and staffing levels that I suspect you are used to back in the US.
All the Americans I know have gone private and none has regretted it!!
I had both my children at the Kensington wing and was very happy with it.
You can spend a bit of money on Night Nannies as someone else mentioned afterward if you get desperate. I am lucky as I have a very hands-on mum but (while I have help with cleaning/laundry etc) I've preferred to care for the new baby with my husband and my mum's help.
Spend the money on good care. You will get that where you're going.

How much support will you have afterwards?

Will your OH be taking full paternity leave - or pat leave plus some - or none?

Presumably you don't have family around?

If your DH isn't able to take much/any time off and you have no-one else around I think support after would be lovely.

If you already have support in place for after then a private delivery would be great...

Doula sounds like a good compromise as well.

All the best with your pregnancy

We've come up with a good idea here.

Private birth and a housekeeper 2 hours per day afterwards... It works out much cheaper than childcare and (if the OP is anything like me!) handing over a new born is easier said than done...

But, you can get a cleaning agency to come each day and do all the chores that get you down - just the basic stuff but the stuff that keeps you feeling sane and calm, and means you can sit down at the end of the day when the DC are asleep and not start the endless tasks of washing and cleaning and ironing.

That might be something for the OP to consider.

FWIW, a nanny will cost £80-100 per day (plus you have to be the employer and pay tax etc on top) whereas a cleaner for 2 hours per day is closer to £25-30 per day.

For me, this is a great solution as I love playing with my DS but hate hoovering and cleaning

I can't offer any advice about private delivery or aftercare help or doulas but what stood out to me was the 'get the baby onto a schedule' so I second what morningpaper said wholeheartedly