Delay booking with NHS until 3rd trimester

[AlexandraN]

Hi all,

I am pregnant with #2 at the moment, should be about 6 weeks (my son is 4 m.o., this is a surprise pregnancy).

I work full time, back to the office when my son was 3 weeks. The job (financial, in the City) is challenging enough now even without the need to ask for time off for the antenatal visits and annoy the boss even more. Also, I must admit I saw absolutely no value added by the midwife appointments during my 1st pregnancy.

It may sound like heresy, but with the new pregnancy I am very tempted to delay booking with the midwife until halfway through my 3rd trimester. Educated enough not to drink, smoke or use street drugs during my pregnancy, not in the risk group for sickle cell disease etc., able to check my blood pressure with the home monitor, have a doppler at home so can check the baby's heartbeat whenever I like. Of course will do all the scans & bloodwork privately (at convenient time, without three-hour queues). Presumably, it will also help the NHS overstretched budget.

Am I missing something obvious with my decision?

Boudicca actually no, she is following current NICE guidance - it's just that many MWs disregard this and listen anyway.

This is the NICE document: www.nice.org.uk/nicemedia/pdf/CG6_ANC_NICEguideline.pdf

And this is the relevant paragraph:

'Auscultation of the fetal heart may confirm that the fetus is alive but is unlikely to have any predictive value and routine listening is therefore not recommended. However, when requested by the mother, auscultation of the fetal heart may provide reassurance.'

frymious ahh fair enough and thank you, I'll just leave her to it then. I'm now going to a GP for most of my care as I don't trust my MW anymore :(

I did see on another thread that 'booking in' after 20 weeks means you automatically get referred to social services not sure if this is true (although it was a mw who said it..) I think you need to have your bump measured from 28 weeks to make sure your baby is growing properly or book in for regular private scans to keep everything under check. You and baby are more important than work.

Congratulations on your pregnancy!
I was abroad for quite a lot of this pregnancy (number 2) as we had a 3 month trip planned. I booked scans privately, one at 8 weeks, one at 13, one at 16 and then returned to the UK at 20 weeks so had another at 22 weeks with the hospital. Also booked another private scan which I had today to check growth (DD1 was macrosomia and hospital refused to check growth) all was fine, but as suspected another big baby.
The hospital were (as usual) not very useful. I am now 33 weeks and have been twice, both times pretty pointless really besides the usual blood pressure, fundal measurement poke prod (which IMO is renowned for being incredibly antiquated and inaccurate), BP, pee test etc. which it seems like you have covered those bases. The only thing I would say is, usually you will have a gestational diabetes check at around 28 weeks- well I did for both. Might be worth looking into. As the PP's have suggested, perhaps a private MW/OB is for you?

PenguinsEatSpinach, I am not a glamorous high-visibility earner, somewhere around 120K after bonus at the moment. My employment issue is that I am on a work permit in the UK, so there is no need to formally dismiss me - they can just recall my visa sponsorship and I will be required to leave myself. I was warned this is exactly what will happen if I claim anything in excess of my holiday allowance. It's a long story, management has changed overnight and the new guy is really, really not easy to deal with, so all previous agreements went out of the window.
Maybe I should just go private for the full package.

Eek. In your shoes I'd go private, not opt out altogether, though I sympathise with your reasons for wanting to do so.

I think private care is your best option. Another thread requesting recommendations in your work or home location with care outside working hours might be prudent.

What will they be like about maternity leave? Or are you postponing the inevitable?

It's quite a lot cheaper to go with a blended solution than fully private - you can book in with the NHS to get into the system (in case it's needed later for emergency) then self-refer all care to private: private standard scans, private (or GP) blood tests and private midwife, then give birth in hospital (NHS) or at home. A private mw can act as a doula in hospital. Private obstetric care for the birth is punitively expensive, although if you have health insurance that will cover any non-routine pregnancy issues.

I also echo going private so that you can get other things monitored like urine samples etc, as mentioned above for things like gestational diabetes. I know someone who very sadly suffered a loss through gestational diabetes, as it was undetected due to not going for MW appointments (not a blame game here, just a tragic series of events). So if you can, it would be good to make sure you get the full medical checks that one would normally receive during pregnancy just to make sure that you and the baby are both well, whether that be privately or on the NHS. The 12 and 20 week scans will also be useful for dating the baby and determining any possible abnormalities, which would be another reason for organising something similar if not through the NHS.

If you plan on giving birth in an NHS hospital then I would just recommend making yourself 'known' to them and sharing the results of your private appointments so that they're up to date before the birth, and so that you can indicate to them what you want for the birth/the birth plan. The reason I mention this is purely practical, so that you don't come as a surprise to them and they have everything they need on you; when I was pg with my first my GP at the time worked in maternity services at the local hospital, it caused no end of problems for them in terms of treating mothers who went into labour but for whom they had no records as they had to assume that they could all be high risk having no background info on them.

Best of luck to you, it frustrates me to read how you are in a position like this where your work can hang in the balance due to having a child. But again, sadly I know of that experience through relatives who work in the City and have lost their jobs through pregnancy. I really do hope everything goes very well for you and your baby

I agree with the previous poster about going private for most of the pregnancy and then changing to all nhs care for the last few weeks (if cost is prohibitive to do the whole thing privately).

I would be worried about not booking in resulting in referral to ss as I've heard this also. Also I think you do need to go to the routine appointments, as not all pregnancies are the same and I seem to recall there can be issues with having such a small age gap.

So for peace of mind find out about this option.

Concealed pregnancy can trigger a social services referral (yeah, we have rights but it can be a real hassle defending them). Probably best to go private.

Hi Alexandra, congrats on your pregnancy BTW. I work in the city too. When I was pg with dc1 my boss berated me in front of the team for taking time off for antenatal appts. 'I was taking the piss' apparently. Anyway I told my NHS midwife and asked if i could not have anymore until i went on leave, she told me if I missed an appointment she would have to inform social services. This was 2012. Anyway 3 days after I returned to work after 6 months I found out I was pg again! In my annual review 2 months later my boss told me not to get pg again, I told him I already was. Thankfully law was on my side and each time I complained to HR, and he soon changed his tune. I realise you don't have this luxury.

I tried very hard to take minimum time off but got very bad morning sickness, and owing to a few small bleeds and being rh neg I ended up having lots of scans, and wasting hours at hospital for anti-d. Plus I had developed strange lft results and had to have weekly blood tests for last 2 months.

The private midwife plan sounds good in theory but try thinking up a plan B just in case your pg is not as straightforward as your first.

My first was a walk in the park, my second a nightmare!

If it helps my boss has got his head around it now. Even let me change my working hours to fit around nursery which I just wasn't expecting. I've accepted my career is on hold for next 10 years, but on plus side no one has asked me, 'so when you having the next one?' Its like they were all waiting for the inevitable 2nd pg, as most usually have 2. I've already noticed a difference, I genuinely don't think they expect me to go have a 3rd, and we won't for some time if at all.

I wish you luck.

BTW I was told by my gp and many midwives a small age gap is not considered a risk if your first pg resulted in a normal delivery with no issues. Both my pg were planned and we checked this out first. If you had a csection you will need to see a consultant, my friend was in that situation, they induced her at 38 weeks as didn't want her scar to stretch too far.

The fact you had pre eclamptic
Fit would be the decider for me!

Private care perhaps is better option

Hi Alexandra, congrats on the pregnancy and sorry re your predicament. I work in the City too and totally see where you are coming from. Is your employer relatively small and your boss sufficiently senior/bossy HR warnings won't touch him?

Health-wise, invest in private care or go blended as suggested above, don't do DIY. Last pregnancy was not uneventful and you need proper care at times to suit.
It can happen. I almost always saw my obstetrician around 7.30pm on weekdays or Sat am; if you go to Thomas's private section it is 10 mins from Bank so v easy to reach.
Remember health insurance should pick up private bills for medical complications, which some of what you need after your first pregnancy might well be.
Also, look at the long term. Jobs and bosses come and go, children stay. Don't let short-term concerns have long-term consequences-invest in private care and think about stress levels. A colleague had unexpected emergency delivery at 29 weeks following eclampsia; she was in the office having a blazing row about a deal with a senior colleague 12 hours before delivery. Baby was in hospital for 3 months. She always said no client was worth the stress. Not in the least suggesting this will happen to you, but it is an example of what we see as important (this was a v high profile transaction for a major client)fades into insignificance when real life calls.

Good luck!

Bypassing the reasons and whys...

I am in total shock that a company could even have a chance to penalise/ remove your visa due to pregnancy! !
That is quite frankly hideous! !

I'm so sorry that this is the situation you are in but surely there must be some loophole? ???

Surely maternity leave which I believe there is a compulsory 2 weeks off in any job is an out of holiday absence? how would you get around this?
Congrats on your pregnancy anyway.

I would do what someone else recommended and book into NHS but tell them all scans and appointments will be booked privately. With your history, a regular checkup is going to be extremely important. I can't imagine SS will be bothered as long as you actually do have antenatal care whether free or paid for. You do need a midwife in addition to scans though.

Congratulations on your pregnancy.

I did look into the possibility of not booking until very late in my current pregnancy (for a different reason, history of late loss & got tired of them chasing me up for antenatal appointments after the baby had died)

I found out it is definitely true that a post 20 week booking in does trigger a referral to SS in London- it just pops up on their screen when they enter how many weeks you are and then they would be negligent if they don't action it, so do so, even though half the time they know it is ridiculous.

I would say to avoid this I would go to the GP, tell them you are pregnant and will be using private midwives & get them to see you at the weekends. This means that technically you have not concealed the pregnancy. You can also get the GP to send off your urine for asymptomatic infection and iron levels at this appointment.

You can get the strips to test urine on ebay, the NHS ones they use in my area are 'Combur 7 Test'

The 4 things they will be monitoring are
Glucose
Protein (these 2 suggest possible diabetes)
Leucocytes
Nitrogen (these 2 suggest possible infection)

FWIW though, I would imagine your history with your first pregnancy means you might need consultant oversight in this pregnancy? I don't know if you had any discussion at the time about whether it was likely to recur in a future pregnancy, but I would imagine your booking in would flag this as a reason for consultant review, whether privately or nhs, so I don't know if a private consultant appointment is something you would want to pay for.

Thanks all for the replies. My previous pregnancy would have been somewhere around 30k private. Guess I should start looking into the financing options soon.
I am thinking to conceal my pregnancy as long as possible this time, which unfortunately rules out NHS. I will qualify for indefinite leave to remain around 30 weeks into pregnancy, having spent 5 years working in the UK. Then I can go on maternity leave safely. The problem is, my boss is also very aware of this, and he is the most unpleasant person I have ever met. I was told that I reproduce like a rabbit (I am in my 30s and this was my first baby), that he will talk to me from now on with a heavy Russian accent to help me to get used to the "new master" before I go back home (I am Ukrainian, and he actually keeps his promise), that I am a health tourist (with masters and a phd from a top UK university), a mail order bride that trades her [euphemism for female genitalia] for residency, and many more. He probably thinks he is a funny and eccentric truth-teller, but I just want to hit him in the face. There is no hr in the company unfortunately, it is a small consultancy. Sorry for this long rant!

Omg Alexandra! That is shocking! I have worked in some pretty shocking work environments (investment banking) where the men are chauvinistic pigs... But I have never heard such out right sexism, racism, prejudiced...egotistical crap!!!! I don't know how you would be able to not slap him!

That's appalling behaviour on the part of your employer, even without HR you'd definitely have a grievance policy surely? Congratulations on the pregnancy by the way, and good luck with two under two. I imagine that you have help at home, considering the first LO is only just at weaning age?

Going private is probably the best way forward to get personalised care, not that the NHS isn't a fantastic service although it is geared more towards reactive rather than proactive action.

Definitely think about getting a private midwife. Although it may seem as though the midwifery appointments are completely without purpose, as a RN myself, in an acute speciality (alas, not the 120k without bonuses had I stuck with humanities and business rather than biology ;) more the 22k with bonuses and 16hr days) I often come across midwife referrals who have foetal SVT, or pre-eclampsia, or reduced movements, or congenital defects only picked up via the midwife appointments. Either way, you'll have to book in at some point in your pregnancy for the birth itself - even if you go private! Most midwives are pretty flexible and can give advice over the phone if that's more appropriate.

Mostly though, midwife appointments allow you the chance to talk for support (which it seems like you need with such a dinosaur employer. Job role aside, working for someone like that doesn't seem all that enriching a life). Anyways, good luck but possibly seek out some legal advice for the degrading way he's talking to you!! x

he sounds horrible! You poor thing having to work with him

If you qualify for indefinite leave to remain at 30 weeks can't you change over to the nhs then? That way you'll save money in private care.

Goodluck and I hope you have a healthy and uneven trial pregnancy

Uneventful!^^

They can't recall your visa on the basis that you took time off for antenatal care. This type of absence us automatically protected and is wholly separate to holiday allowance.

He sounds like a nasty piece of work. If I were you I'd get myself a dictaphone and start recording the bastard. You might as well. You'll find it useful as I'd sue him anyway. This type of behaviour is wholly unacceptable and I feel so angry on your behalf.

Do you ever say anything back to him?