Maternity Care

[chimps123]

I am a mother and a practising midwife. My experience of giving care to new mothers is that it can be frustrating for both the new parents and the midwife, largely due to the changes in funding/cut backs within the service. I am considering starting a company during my time off, offering support to new parents, similar to a doula, but with midwifery aspects. There would be a charge for this service, and whilst I don't necessarily agree in principle to mothers paying for care, if this was in addition to the limited midwifery visits, I wonder if it is something people would be interested in, and willing to pay for it? At the other end of the care spectrum, elderly people with more money do have to pay for additional carers/cleaners they need, is this completely different? I'm just putting this out there, I'd love to hear your views!

Well I understand that these services already exist - so there must be some market for it.
For me personally - the answer is no.
Firstly I am finding my maternity care good - I can see that the midwives are busy but so far have always found that they answer my questions and concerns thoroughly during this pregnancy. Relative to experiences of NHS prior to becoming pregnant I am feeling well looked after - I get phonecalls to follow up my blood/urine tests and I've been able to get through to someone when I've had the random/strange panics that seem to happen to first time mothers.
Secondly, if the answer was no and I was finding my care poor, then I am the sort of person that would be demanding the care and attention I deserve from the NHS by complaining to my GP and the supervisor of midwives and anyone else that was appropriate. The NHS will not get better if people put up with bad service and resort to paying for it. As I've grown older I've become a more confident and assertive and would think I need to do this, because if I don't, then the meek/shy/non assertive people certainly won't and the service will just get worse.
But I get that there are people that will pay for something, particularly if they've had a bad experience in the past or present. Also I'm originally from Yorkshire - so I'm probably too tight to pay for this when it could mean an extra month before I have to return to work. (You can take the girl out of Yorkshire, but you can't take Yorkshire out of the girl!)

What sort of support? I think there are already night-nannies (can't remember what they're actually called, sorry), & mother's helpers. If I had the money then I would possibly be interested. However, having a baby means being on maternity pay and so much stricter budgeting.

But, I would guess it depends on what area you're in and the income/financial state of the people living there.

I don't think I would pay for 'extra care' no, I think the amount of appointments and scans etc is enough and the nhs midwives are always on the other end of the phone if you have any concerns and so are the doctors.

I wouldn't pay. Can't see the requirement sorry

This is my first pregnancy and I had my first appointment (booking appointment) with the midwife this week. I wasn't at all reassured by her lack of eye contact and she spent the appointment filling out her paperwork and dismissing my problems (unable to sleep). Then she threw multiple sheets of paper, leaflets and booklets at me. I understand that pregnancy should be normal, and she was not exactly unprofessional, but was not at all personable. It just looked like I was just another pregnant woman as far as she was concerned, she was in auto-pilot mode and I am not comfortable with my maternity care being with her and her alone. I am also shocked that an obstetrician only sees you when there is a problem and not as a routine. You would not expect to meet your surgeon on the day of the procedure only, so why should childbirth be any different? Due to a minor something in my medical history, I MAY be seen at 24/40 by a registrar (at best, and an SHO at worst). Has anyone else had similar concerns?

Problem is that come September 2013 you won't be able to practice independent midwifery without insurance. And there is no insurance. So you won't be able to.

sksk I'm happy with the nhs care that I've got so far. What's surprises me is that there's no option really for any private consultations. In all other fields of medicine you can opt to be seen privately but not in obstetrics. I understand you can pay for a private midwife & that you are referred to a consultant if necessary but it strikes me as odd.

sksk my midwife didn't make much eye contact with me when asking questions in my booking appointment either. But I'm not surprised, look at the pages of questions they have to trawl through! And yes a lot of the questions were on autopilot as they didn't concern me, but she still has to ask them. And yes it's normal at booking in to be handed a wedge of leaflets for you to read & think about at home, then question at the next appointment (after a scan to make sure pregnancy is progressing/ viable).

And no it's not normal to see an obstetrician, I assume you are under midwife care? I will be under consultant care from 34 weeks, but until then I have no medical need to see him, and am perfectly happy with that.

I suggest you see how your next couple of appointments go, when you are discussing your blood results etc. and shes explaining major descisions that hopefully you wont have to make (if screening isnt normal etc) and if you are still not happy request a different midwife.

Like a private maternity assistant? I know there are a few midwives who used to practice at st. John and St. Elizabeth in London who now do this. I certainly considered it and I think it would work if you could just pay for more thorough and personal check ups in the same way as people often pay extra for private scans on top of the NHS ones. I looked into having a maternity assistant, maternity nurse or postnatal doula for after the birth and have gone with a postnatal doula in the end just because I think what most people need or want is help with daily tasks such as cooking/washing clothes and maybe some advice on breastfeeding etc. along the way. I just can't imagine a midwife doing that stuff. But, overall, there are clearly lots of people who are willing to pay for help before, during and after the birth of their baby. I guess it just differs area to area.

Funnily enough, I'm also a healthcare professional, and like to think I give my patients much more attention than my midwife did. If there is so much paperwork, they should offer longer appointments (and therefore more staff)! Surely it would be better to properly meet and greet the lady, ask her how's it all going, any particular problems etc and THEN proceed to be a robot and fill out forms. Leaflets and booklets are not a substitute for explanation and attention, much the same way as signing a consent form does not constitute consent- it is nothing without the conversation. Not acceptable in my book. And I'm not even sure I have the choice of another midwife at my GP surgery!

sksk my first appointment was exactly the same, to make things worse she didn't have a clue where anything was kept and she didn't know how to book in next appointments on the computer (which suggests this was a new clinic for her or a new way of doing things) but as this was my first appointment for my first (and unexpected) pregnancy which I was already very nervous about with a lot of questions, it didn't make me feel much better about anything! I didn't even get asked how I'd be feeling so far which I thought would have been a basic first question to be asked. I also have a health condition which could complicate pregnancy and this got completely ignored.
She wasn't my assigned midwife as mine was on holiday on that date, as she has been for every other appointment they've given me. I'm 35 weeks now and have seen her twice overall and only recently in my third trimester. Not having continued care from one midwife has made it very difficult with the same confused expressions and questions being asked about particular notes in regards to my health problem which, after so many times has gotten very frustrating! (sorry, rant over!).
I've found the care very poor, particularly when it comes to 4 hour waiting times at hospital appointments, with a severe lack of simple seating and then being sent away and given a new appointment as mistakes have been made overbooking people, and despite complaints/raising concerns they have just been shot down with "we are very understaffed and have too many women to see in the area".
So chimps123 I think I would be interested in a service such as that, but do agree with Rollercoaster that if this type of thing continued and people resorted to paying for better care then these issues would never improve!

To be honest this is a much wider issue. Im sure midwifes came to this profession to give their best but the system and beauracracy of it all makes it very difficult sometimes. In an ideal world it would be great to see 1 midwife thoughout our pregnancy and get their full time and attention.

I think you've all made some valid comments. However, the bureaucracy and lack of midwives doesn't make it ok. Complaints need to be made at higher level- write to the Trust/Hospital/PCT and even CEOs. This is not the care I'd expect in a developed nation! Will definitely try to seek out a different midwife if I can!

flyingsprocket - of course you can see a private obstetrician. It won't be covered on most private health insurance but there's nothing to stop you paying to see one yourself - I looked into it a few weeks ago as I had an issue that I needed to discuss with a Consultant. You can even choose to go to the full extent and have your baby privately eg at the portland.

I personally wouldn't pay but I have a great team of midwives and feel like I am getting excellent care.
I live in Cheshire and private midwives are advertised a lot I think you would need to push the angle that you provide more consistent care and will see the mother from conception to post natal including birth. I see a lot of midwives I am happy with most but then had a stranger at the birth if my DS not a problem but could have been.
If I was wealthy I may consider this option just like I may hire a personal trainer when I already have gym membership.
I would be concerned that a role like this may be very hard on you and your family as you would be expected to take calls at all hours and answer the silly questions most people post on here but don't actually bother the midwives with until someone on mn has said to call. Also they would want hand holding through labour - no shift changes which could be 24 hrs plus of support.
I think in the right area and the right clients you could make a business of this on the plus side you will get very close to your clients/ mothers but this could be difficult as you have to be professional and if the worst happened - infant death or still birth you could be heartbroken and in the firing line.
Good luck with your decision sorry if I have been a bit harsh I have a business and went through all the worst case scenarios before setting up to make sure I was mentally prepared as much as I could be. X

TwitchyTail, thanks for the information. I will look into asking to see a community midwife. Having a rant here is quite helpful, actually! Curiously, the midwife told me she went privately but that was 25 years ago.

I am confident when it comes to acute care with the NHS. It's just that I don't see pregnancy and birth as an acute thing. I expect good clinical care but I also expect the team looking after me to have a human touch. I got more helpful advice and reassurance from my parents who happen to be old school medics. I work within the NHS for a Trust so am au fait with our limitations but I would still argue that I at least am not so mechanical. The problem is, that so far, the surgery has not filled me with confidence, and I feel I don't have a choice because you can't just go elsewhere. A junior doctor might actually offer more care as they haven't been beaten down by the system and become cynical!

I'm actually generally cynical about all the regulation eg CQC etc but I can't wait to see what happens when my practice does register. At least they will tidy up their offices! And maybe the poor patient reviews might shake them up a bit.

I think it's a shame that we have to pay to get anything approaching decent care.

I'm 24 weeks and have not seen the same midwife twice. I have only met one midwife who actually seemed to care. I have put my polite face well and truly in a drawer when having to deal with these people. When I go in to deliver my daughter I will be prepared to fight.

Which is not what I thought I'd feel like six months ago.

I would say overall depending on the cost, I would definitely pay for this. If it was thousands, then no, but otherwise, definitely. Something needs to plug the gap.

The care in my area is so poor that it is almost comical. I'd pay. I envy those of you who have reasonable care, and I'd love to be in a position to complain, but there is no alternative midwife or trust to switch to.

Mutley outside of London private obstetric care is largely unavailable. It's down to insurance - the premiums are too high for consultants to set up practice. I live in the heart of commuter belt nappy valley, and there would be a huge amount of business for a private maternity hospital, but there isn't one.

I've skimmed over the above posts and the varied experience and views is interesting and somewhat alarming. Anyway, I'm expecting our fourth baby and where I am, I think that extra antenatal care is unlikely to be needed. Our first three were born in another city and I think that the antenatal care there wasn't great for second or subsequent babies unless you were having a true emergency. Where we are now, it seems easy to have extra antenatal care if you need it. I'm not convinced about how good the breast feeding support will be or any other postnatal support but I can't comment yet. Something I would have loved after all three previous babies was a night nanny who could offer great breast feeding support. It would have meant that I disturbed DH less and hopefully got a bit more sleep myself. That is definitely worth paying for!

I don't really have anything to say about whether people are likely to pay for maternity type care - there were times when I fancied having a night nanny when DD was little, but she'd have had to be a wet nurse as DD was a bottle refuser and avid night feeder!

But OP, I don't know what area you're in, but you may like to find out more about the One2One service as it might be something you are interested in looking at. It was set up here on the Wirral by a long-experienced midwife (and lovely lady, who was my Hypnobirthing tutor when I had DD) and is offering the sort of care that I imagine may be of interest to you. As far as I know, they contract out their services to the NHS. I am using the service as currently expecting DC2 and I see the same midwife for every appointment, I have scans at a local clinic (not at the hospital) - the only possible issue is that at the moment the midwives are only insured to attend you at a home birth, they cannot deliver your baby in hospital. They will, however, come to you at home and stay with you until you wish to transfer, if you don't want a home birth - and can take you into hospital and bypass triage, which is majorly important to me after last time (classic quick labour, with me quite calm, hence nobody believed anything was happening and they tried to send me home despite me being 9cm and DD being so severely distressed that we ended up in theatre for a crash section minutes after they finally examined me...)

Take a look - it's a pilot scheme at the moment but they're hoping to go nationwide, might be something you would want to work with???

www.onetoonemidwives.org/

worsestershiresauce - I am also outside London but there are three private hospitals in our town and at least one of them has a private obs (I think it was actually two out of three). You can't deliver at the hospitals - and tbh there are so many issues with that anyway as they obviously can't provide the specialist kind of emergency facilities on site particularly for the baby - but you can see a Consultant for pre-natal care.

The care in my area is very poor as well but I think you have to be assertive and know what you want. I had to write my own booking in notes as the appointment was so rushed - it is my 3rd baby so I knew that out of that meeting all I wanted was: scan booked, bloods done, urine checked and consultant referral. I then saw another different midwife at 16 wks for second appointment. There was no way I would bother asking them for any kind of resassurance or advice because I don't trust they know what they are talking about. But I heard the heartbeat, got my urine checked and that was that. During that appointment I found it totally ridiculous that I asked for a clean urine pot (instead of re-using the old one- as instructed by my GP following a UTI in early pregnancy) and the mw was really difficult about it!!

Tbh being under Consultant care does make a big difference - for baby number 2 I always saw my Consultant for appointments after 20 weeks, she scanned me during most visits, and she personally delivered my baby by C-Section - I couldn't have paid for a better service really. It also meant I had a point of call when I felt the delivery suite / midwives weren't giving me the right advice - e.g. when I had bleeding in late pregnancy. Had I not been under Consultant care I would have re-considered my options but probably would not have paid for a Private Midwife as tbh IMO what a midwife can provide is fairly limited anyway so wouldn't feel the need for anything above NHS service.

I would be interested. Particularly as I had problems over the new year and basically got told to 'pad up' by the out of hours gp and mumsnet was my only source of advice and had to wait 4 days for an emergency scan. Plus I am already paying for private NT scan as baby was in wrong position, so I don't see the difference in paying for that and what you are proposing.
emsjy does that onetoone service extend to chester?

I don't know what the geography is Supershiv1 - ring them and ask. In 'FAQs' it has something about contacting them if you're outside the Wirral, but I don't know what your postcode would need to be to access the service - worth looking into though.

So I contacted them, they do cover my area and I met my midwife today - she accompanied me to a repeat NT scan.
They have offered me another free scan as baby was again in the wrong position.
I can't get my head around the fact it's free, but so good to have the reassurance.