Private Care - MW versus Consultant - what's the difference?

[abgto]

I am trying to understand the difference between MW-led versus consultant care. I am deciding between the Kensington Wing and the Portland and I am getting the impression there's a significant price difference to go for the consultant led care (although getting a straight answer out of anyone without commiting to use them is proving to be difficult!). If you are with the MW's, who actually delivers your baby? Do you have any contact with a consultant at all? Particularly if you end up needing a c-section? And if so is it someone who just happens to be on duty with other clients? I have also seen posts where people refer to shared care - is that what the MW care is? I am leaning towards a consultant but I want to make sure I understand what I am getting. Any clarity would be very helpful!

Midwife led care is open to you if you have had a straightforward pregnancy and no problems in a previous pregnancy/delivery.So not a breech baby or twins or previous section that sort of thing. The midwife unit will have birthing pool and use of gas and air and/or pethidine. Midwife delivers baby.

If you or baby are having problems or you are hoping for an epidural then you will need consultant care. In NHS midwife still delivers baby but on-call consultants around if needed.Can be much more clinical, but not all hospitals the same.

You should be able to opt for MW led but ask to change to delivery suite if things get too much for you or baby becomes distressed etc.

This applies to NHS.

In private sector with consultant care your obs. consultant will be informed of your admittance and will visit you and come in later to deliver you. This is how costs mount up as labour can take a very long time.

You could deliver on NHS and then ask for private post natal care. Our hospital charges £700 per night basic then all nursing costs medication and visits are added on to that.

I cant speak for the Kensington but if you opt for midwife led at the Portland you will have a covering consultant who you will meet and who will step in should complications arise before or during birth.

Go for St John & Elizabeth's you stand a much higher chance of a safe and lovely straightforward vaginal delivery with them. The statistics speak for themselves, with a Consultant Obs on hand for those of a nervous disposition!

John and Lizzies is closing down.

I'm at the kensington wing under consultant care and very happy with it (35 weeks though so not done the birth bit yet!)
I think there are restrictions on who can have midwife led care i.e. history of complications or gynacological issues or even age if I remember correctly you have to be less than 37 (a bit weird in my opinion).
The best is to email or call the kensington wing directly and they will send you lots of information or even better you can book a tour and get someone to answer all your questions.

Find out the relevant Caesarean rates. Women under MW care tend to have a higher chance of a straightforward vaginal delivery whereas consultants are usually much more inclined to perform abdominal surgery at any sign of a deviation from their charts (in a normal labour most women show some slight deviations as were not robots).

If you are well and healthy and the pregnancy is progressing normally I would go for MW care, you'll get a much better, more caring service. Obviously if there's any problem with either your health or the baby's health the Consultant Obs will be called in to advise anyway, but otherwise I'd opt for a MW every time.

Would you call an ambulance for a bad cold? No?. Same here, use the appropriate experts. Rely on the experts in labour & birth - Midwives. If there's a need for an expert in problematic pregnancy and birth rest assured they'll be called in when they're needed.

: ( at St Johns & Elizabeths. They were fab.

Also in private care the midwives are very aware that they are the experts of normal and will have no hesitation in getting a consultant involved like they did with me. However there are lovely and personable consultants out there so I would recommend seeing both and then deciding whats best for you.

I disagree that you would get a 'much better and more caring service' with a midwife. This is a really subjective statement and the level and quality of service you receive is more due to the personality of the care giver rather than their title!

So I am the husband of abgto (orginal poster of the question). Are guys allowed on Mumsnet? Hope I am not crashing in but as a husband from overseas learning the system over here, I am pretty lost and feel useless so far helping to make a decision.

At this point, we have no reason to feel that the pregnancy will be complicated in any way. She is uber healthy and fit, early 30's and this is pregnancy #1.

Other than availability risk, what is the downside of going down the midwife route and if any issues subsequently arise to then solicit a consultant obstetrician at that time? It feels rather odd to make a decision at an early stage (6wks).

This is likely a silly question, but if we are on the midwife route and during delivery things get difficult and there is a risk of episiotomy with forceps etc (read some real horror stories on here) can we make an emergency switch to an emergency c-section even if the midwives may not approve and just pay up for it at the time?

Depends on the midwife or hospital and the consultant. I dont think it would have been a problem for me at the Portland but I had to have a CS anyway as DS was breech. Bear in mind though consultants covering midwife services may have a natural or nothing bias. If you go for the portland MLD you will meet your covering consultant at around 37 weeks and you could discuss it then and transfer over to them but you will not have your choice of consultant . I know it sounds weird but you dont want to be too long in booking particularly if you want a popular consultant.

If things are complex in 2nd stage of labour (when the baby is actually being pushed down the birth canal and out) then a Consultant will be summoned anyway. Midwives don't do forceps or ventouse deliveries. If you're paying for private healthcare it would be a Consultant who would perform these.

So if at the point where the decision was being made to deliver 'with assistance' your wife decides she'd rather have a Caesarean operation then she would be able to chose that (medical circumstances allowing) with the agreement of the COnsultant Obstetrician present.

I guess it depends what kind of birth you want - if you're keen for the natural route then go midwife-led, as you are much more likely to get a straightforward natural delivery. If you want an elective section, best go for a consultant! A midwife would never 'not approve' of a c-section if it was deemed necessary, they would only ever do what is in the best interests of the baby and as someone pointed out, a consultant would be called for things like forceps/ventouse etc anyway.

Agree with the comment that you wouldn't call an ambulance if you had a cold - midwives are the experts in straightforward normal births! After having fantastic midwife-led care under the nhs with two pregnancies I have no idea why anyone would voluntarily want to go under consultant care, or go private for that matter, but then maybe I've just been lucky with the nhs care I received.

6 weeks does seem early to have to make the decision though, can't you wait a bit?