NHS v private

[eurochick]

If you were in the position of being able to chose, how did you decide which to opt for? We had fertility treatment to achieve this pregnancy and money set aside for more, which means that we could, if we wanted to, afford private care.

When I began ttc I always thought that I would opt for an independent midwife, but it has taken so long that the option has effectively been removed! So I think that leaves me with the option of NHS care (hopefully midwife-led, all being well) or private care, most of which seems to be consultant led (although I think the Portland does a midwife-led option). Are there options I don't know about?

Many thanks in advance for your thoughts.

If I had the money I'd go private

I think it depends where you live. I had a wonderful time at the local MLU. One midwife (the same one I had seen throughout pg), water birth, own clean room with clean ensuite, lovely food, friendly staff who were always available, I chose to stay for 4 nights, etc.

I don't see what the private sector could've offered me.

I couldn't have hoped for a better experience during my three pregnancies and births in NHS hospitals. I really wanted natural drug free births and was lucky that was how they went. The staff were all amazing.

It would depend entirely where you live in the country and what your needs in pregnancy are. One NHS hospital can be just as far removed from the next as private wards are. I don't think its as straightforward as saying NHS and private for that reason. It very possible that a certain NHS hospital might have a speciality for a certain thing whereas a private one might not but then neither might any other NHS hospital.

ALL hospitals have their pros and cons. You might be paying for a private room or 1 to 1 care or higher staffing levels or facilities that also your partner to stay with you or many other things that might be available at some hospitals in the NHS.

I think you are wise to look beyond just whether you pay or not.

I'm in London.

I'm also not very good with hospitals but I suspect as an oldie (38 if this works out) first timer I am not going to manage a homebirth (plus the idea freaks out my husband as a friend of his ended up with a brain damaged baby after a home birth went wrong). A "naice" MLU would be my preference, whether that be NHS or private.

Most London hospitals seem to be pretty vile, tbh. I ended up in one when I had a bleed and needed the EPU. The staff were lovely but the surroundings and clientele were not.

I think if I was in London I would be very tempted by private if I'm honest. Staff ratios on NHS are poorer than elsewhere and that would be a real concern to me.

From what I understand is choice of hospitals is often limited because there is so much demand so you can end up in a situation of no choice at all anyway despite the principle that you should be allowed to choose.

That said if you are thinking of going private, I would be making the decision quick too as again, by all accounts, private fills up pretty quick too.

We could have had private care, in that we could afford it comfortably, but it is something I would not seriously consider for my pregnancies and deliveries. It does help to know the NHS so well (I'm a GP), so I feel very confident about the service, and know my way around it, but I have also worked as a junior doctor in the past in private maternity services, and that experience certainly put me off ever using them myself.

My first pregnancy was complicated and we had excellent NHS care throughout (prem growth-restricted baby requiring 8 weeks SCBU). Second time was straightforward, midwife-led, with some consultant input and a full-term baby. This time I am old (40) but otherwise straightforward, and so far (29 weeks) all is well.

It is very much personal choice, as with all private medicine. Personally I believe I am safer with the NHS, but others would disagree with me. The NHS is certainly short of midwives, and in certain areas that is having an impact on safety and quality.

To answer your question, though, your choices largely depend on how complex or otherwise your pregnancy turns out to be. All being well you can have a private midwife/ doula and home delivery if you want, but the more complex things become, the fewer safe choices are available. In terms of private v NHS decide what is important to you personally. If you want a quiet, private room, great hotel services and comfort, consider private care.

And congratulations, BTW!

NHS. Easy access to an Intensive Care Unit and SCBU if required (hopefully not but I'm also a doctor so err on the side of caution).
I worked for a year in an NHS maternity unit and have no qualms about giving birth in one myself.
Lots of NHS hospitals now give the option of paying for a side room post natally if you want- not guaranteed though.

Thanks for the thoughts. There's a lot to consider. And I see that there are now some insured independent midwives available again, so that option is back on the table. Lots to think about.

I'd question what MrsM said about ICU and SCBU because most private wings are in NHS hospitals anyway so that makes no difference at all.

The only one that there is concern over is the Portland and I've heard mixed information over that anyway (apparently there is SCBU but you have to pay for in whereas if you are in private wing of an NHS hospital you don't pay).

If you had ivf you may find you are consultant led on nhs anyway as the pg for some reason I now fail to remember is classed as higher risk.

Living in London, I would (and have) go to the Fetal Medicine Centre on Harley Street for 12 week and 20 week scans. They are going to be the very best you will get in the world, pretty much, as they're one of the leading fetal medicine research clinics.

For routine midwife/consultant appointments, NHS care is usually good but can be variable - however, unless you end up high risk in a properly scary way, then it won't really matter.

Then when it comes to delivery, possibly private, but most likely NHS delivery and pay for a private suite afterwards (look into Lindo Wing at St Marys, Kensington at Chelsea and Westminster, Landsell at St Thomases and the Knutsford at Watford.. think there are others too). If you have a private delivery remember most private consultants are also NHS doctors anyway - the only advantage paying them a small fortune gives you is consistency of care and perhaps a guarantee of a doctor delivering you that you like.

Just having a "birth only" package and using the NHS/FMC for the rest would save you a lot of money and you would get all the important advantages of going private.

The Kensington wing at chelsea Westminster has a midwife led unit privately and is attached to nhs should anything go wrong.

(am afraid in my post I only referred to private doctors as I know nothing about private midwives/birthing units etc due to being high risk all the time!!)

I have previously considered private care, then considered private midwife then doula. It seems nhs services are incredibly variable from one hospital to another.

I'm in London and if we had the money would have gone private in an NHS hospital. Because the mat units are under so much pressure and often under staffed I was too afraid to try for VBAC as I would want to
be fairly certain of 1-1 care in labour, so had ELCS with DC2. But it depends where you are and how much pressure your local hospitals are under. Also recommend FMC in London where we went for early scans and 12 week scan with Harmony test.

My cousin had hers at the Kensington wing. Very positive about it.

FMC is amazing, can't say enough positive things. Perhaps book in there for scans and then ask if they have any private recommendations, while you chat? They are wonderful and very practical.

Why is the option of a private midwife removed for you?
That's the way I'd go if I had the money. I am paying for a Doula and we love her but she's not medically trained, thus not able to answer many of the questions I've had.

Private if I lived in London.

There isn't the option of private health care where I live.

My mum's a midwife and, back when she was working (I appreciate it could have changed), said she'd seen far better care in NHS hospitals. Not in terms of staff numbers, obviously, but women were far less likely to end up with unnecessary procedures and interventions. I had the same experience with my first, who was born overseas - consultant care and his c-section rate was something like 70%. He wanted to scan me every visit, had every mod con going but probably only touched my belly once. I'm sure it depends on the hospital but definitely worth researching the ones near you. Congratulations!

Slippers I agree; I think a private wing of an NHS hospital is the ideal, really. You get the same care but more of it, in a more comfortable setting. And you're guaranteed not to be shipped to another hospital if your chosen one is too full - happens in the Rosie in Cambridge's MLU, which if you're lucky enough to get in is IMO as good as private since their refurb.

The Fetal Medicine Centre is basically the private wing of Kings College Hospital's fetal medicine unit. It's just how you can access that NHS world leading care if you're not in the area.

NHS care is wonderful, it's just over-subscribed at the moment in London, I think?

Julietee I thought the private midwife option was removed because when I last looked at this when I was pregnant last year (mc) there were effectively no private midwifery services left because they could not get insurance. Having looked again last night, I found an insured private midwifery service, so I am going to investigate that more. I'm also going to have a look at the midwife-led private options mentioned on this thread.

The FMC is a given for my scans. i've heard great things about it. We have already decided to have the Harmony+scan there anyway.

Thanks everyone for your thoughts so far.

Just to say, Euro, I had the Harmony and nuchal done at the FMC right before Christmas (following a positive screen for Down's with my NHS test). The scanning was excellent, used a lot more markers to assess than the NHS do and the detail was almost as much as you would expect for a 20 week anomaly scan on the NHS. The nuchal results right away dropped from 1 in 95 to 1in 300 due to having more evidence to look at. The Harmony was great as well as I would really have agonised over a CVS as have a history of previous miscarriage. So good to have that non-invasive alternative (and that came back normal!).

On the NHS vs Private question I am outside London in a fairly affluent area so difficult to compare but I have had very good care with the NHS generally. If you didn't use the money to go private would you be thinking about future IVF for possible siblings? I think that would be at the forefront of my mind as well (having a friend who had first by IVF, she would love more but there is just no money to pay for it).

Because of my age and the hell we have had to go through to get this far, I very much doubt that future IVF is on the cards, but thank you for the thought, and it's great to have another good report of FMC.