Moving to London 26 Weeks Pregnant - Need Advice

[gaby0422]

My husband recently accepted a job offer in London and we will be relocating from the US in 2 1/2 months. I will be 26 weeks pregnant and need advice on how the NHS works.

• How do I find a doctor/midwife that is likely to accept me into their practice being so far along in my pregnancy?
• In the US you are seen by your doctor every 2 weeks during the last trimester... is this also typical in the UK?
• Will I likely have to wait a long time before being seen by a doctor/midwife once I am able to make an appointment?

I know I am not the only pregnant woman to relocate to the UK, but I get a little anxious at the thought of not knowing anything about the healthcare system there and not knowing where to start looking for a doctor or midwife. I am sad to leave my wonderful doctor here in Boston since I have had a very good experience with her so far but I'm sure I can find just as good care in London.

I appreciate any advice you have for someone in my position. Thank you!

NHS care eligibility : www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcategoryid=162

Just to say I also had no problem getting an epidural at Homerton. But agree OP should look into private as well as NHS if she is used to US system. It will be much cheaper than the US and employer may agree to cover as part of relocation.
GP service is very variable. Mine is great (often given a same day appointment even for non urgent), but I know some people in other areas who struggle to get a timely appointment for non urgent problems.

*As it happened, the NHS teaching hospital I went to to have my baby (nearest one) was also the location of one of the world authorities on my particular condition, so I got the kind of care that money just couldn't have bought. And indeed I didn't have to buy it - everything was free at the point of demand.

dreamingbohemian I'm really surprised about what you say re epidurals. I got offered choice at every stage of my pregnancy, by consultants who explained everything in detail, and that included epidurals*

This has also been my experience, in London, NHS, not in leafy suburbia but London proper.

PS. Have had mixed care (i.e. chunks of it are with low risk women and MW) - this has also been excellent and if anything better than the medicalised care.
I am going to pay from a private room after birth, (not private care, just the room) because a ward full of babies and sleep-deprived women will be pretty grim mid-summer!

Many many women here have had problems getting epidurals. There was a whole long thread about it once:

www.mumsnet.com/Talk/childbirth/1147361-Anyone-else-tricked-out-of-epidural/AllOnOnePage

I gave birth at St Thomas, considered one of the better hospitals. We were told not to count on getting an epidural. When I first started thinking about having one, the wait was quite a while, but luckily by the time I really needed one I didn't have to wait too long (I think about an hour).

my NCT instructor this weekend said that she has absolutely seen midwives lie and say they've sent for an epidural but haven't as they feel that the mother is stressed during transition and wouldn't really want it!! I found this appalling. totally goes against the idea of a woman being in charge of her own body. I hope that she was exaggerating.

The trouble is that there is a lot of anti-epidural feeling out there (ironically the NCT are a big part of this) leading to threads like this:
www.mumsnet.com/Talk/childbirth/a2094600-Epidural-why-wouldnt-you
...and a general culture of fear pre-birth that hospitals will force an epidural etc' needlessly onto women, that MLUs and home births are 'safer' for this etc'. You get women on the childbirth thread talking about being ashamed of having one.

This is aside from clinical issues: the culture around birth in the UK (particularly in middle class areas of London) has a certain attitude to them- VERY different to the USA (or France etc'). They are equated with needless intervention and recovery.
As do many HCP (I have been told "No!! Never have one!" to by a friend who is a nurse for example - they used to work sometimes in a labour ward, but have very firm and out of date views) - many MW are the same.

Add that to a system where the patient isn't a 'customer' in the financial sense and often it's "doctor knows best" (or MW) but the reverse of in America -they're trying to go for 'natural' because their stats depend on it.

Go on the birth board and ask how to choose a hospital and someone will suggest checking epidural rates and finding somewhere with low ones.

Jesus. Any midwife that does that should be struck off, pronto.

There is just such a cultural difference IMO ... for example VB is very, very important to many British women, but from what I understand in the USA it's less of a big deal (e.g. this thread, hands-off VB of a breech baby ... not sure if that would be allowed in the USA but here it's very openly discussed www.mumsnet.com/Talk/childbirth/2102454-Anyone-any-experience-of-a-Mary-Cronk-style-hands-off-breech-vaginal-delivery ).

...So even hiring an independent midwife or going private it might still be a bit of a culture shock for the OP?

As an American who'd lived in the UK for quite some time before falling pregnant, I found he quality of prenatal care with the NHS to be fantastic. My hospital was located in Central London and I didn't feel at all that they were strapped or overburdened. Everyone was very helpful and thorough. So don't worry - I am sure you will be fine.

I've actually just moved back to the US in 3rd trimester and while the care in the US is good as well, I do miss the rapport I had with the NHS midwives and more generally, the British approach to labour and delivery.

They have massively clamped down on who gets NHS treatment in the last few years especially in London and at each of my antenatal appointments I have witnessed women being turned away at booking appointments because they haven't brought proof of UK residence for over a year with them. It seems there is no bending of the rules anymore so you should insist on private healthcare cover as part of your relocation package - at least for the first year

I live in London and also have private healthcare. It's quite unusual to find a insurance company who will cover maternity care here in the UK.

With that said, there are some excellent private maternity options roughly costing between £5k-£15 depending whether you opt to go consultant or midwife led. Also how complex your birth will be, what kind of suite you go for and any procedures that have to be done.

Personally around here that isn't a lot of money, but London is a funny place where the recession hasn't ever seemed to hit.

That said, the NHS care is OK. Much less choice but they do try and make sure everything is safe. It's a mixed bag though because you could end up with a midwife who has only just started their career, or someone who's been doing it for many years. In that situation I'm sure everyone would want an experienced midwife, although I'm not saying someone who has just started wouldn't be adequate but just trying to highlight that the NHS doesn't allow you to pick unlike the US and private UK.

So all in, I would consider whether you what you can afford and what your expectations are. If you can't afford private healthcare then it's all about adapting to the new way of the NHS and appreciating the lack of big bills at then end of it all.

Personally around here that isn't a lot of money, but London is a funny place where the recession hasn't ever seemed to hit.

£15 "isn't a lot of money"?
!!!!!!!!!!!!!!!!!!!
/signed, a Londoner.

...that's £15k.

(Even I can afford £15.)

Lol yes alright typo on the second number it was missing a K at the end, of course you know that what it meant since I started with £5k. But then naturally you've clung to that comment for obvious reasons.

Moved to the laptop so I can actually type :D

I noticed you highlighted the top number of around £15k, that would be if you wanted only consultant led care, the best suite and lots of procedures also the amount of days you spend at the hospital. It can be very affordable, it's just you need to be aware that you can't always control the cost as obviously the baby dictates how complex it will be and how long you might need to stay. That range is a good estimate however to take onboard and I don't know whether the OP is in the position to consider private healthcare but It's worth noting given the direction of this thread so far.

Private maternity care is something that certainly in London is seen as affordable to a much larger portion of the population here than other cities in the UK. London is such a big city with very high house/rent prices compared to the rest of the UK, the professional opportunities and many other reasons attract those on higher than average wages. Even if you need to save up for it, when you consider that a two week holiday away long haul can cost that for two? It's a different life I'll admit and I'm sorry if it's not your life (if that's what bothers you, if not then forget the above sentence) but for many here it's very popular. I don't see why I should limit my responses to bare minimum spend options and with regards to the affordability being higher in London, it's logical if you think about it?

£15k?

I'm a manager with a 3 bed house etc' in West London (so hardly breadline - I would probably be seen as prime Bugaboo bait by some) and I couldn't conjour that up! Not sure many of my peers could either. Certainly not the norm - the only people I know who have gone private ( which costs more than elsewhere FWIW, so higher wages are offset ) are not English but working over here. They chose to because they are deeply suspicious of MW led care (hence all my posts about culture shock) and wanted something more akin to their homeland.
My nearest private hospital (leafy suburban one in NW London) has had recent issues with hygiene and care on their postnatal wards too (similar to private schools in London, shopping around needs to be done, all are not equal!) so if I did go private I would go for a big name in the centre of town (e.g. Lindo Wing etc'). Just private wouldn't be worth the cost to me FWIW: I would need significant proof of quality.

It all depends on your income I suppose, this is a really interesting website which gives you an idea of where you fit in with the population percentages (totally off topic but if your interested in these things)

www.ifs.org.uk/wheredoyoufitin/

Bugaboo bait :D I love it. The pricing I've quoted is taken from Portland and also the Lindo Wing you mention. I'm intrigued though, which NW private hospital is so bad? Worth knowing to avoid!

I'm an expat, OP, and I've been very impressed by my experiences of NHS care so far. I wouldn't be deterred if I were you until I'd at least tried it.

What is a bigger concern, IMO, is as Fred pointed out, there has been a big crack down on the use of NHS hospital services for foreigners resident in the UK. It is much more tightly controlled than registering with a GP is. Having said that, my hospital lets you self-certify that you are either permanently settled in the UK and on a path to settlement or have been resident a year. Some make you prove it. Read the link Observer gives above and think about whether your circumstances will look like you're permanently settled. Tier 2 is a path to settlement, I believe, as after two visas at Tier 2 you're forced to apply for indefinite leave to remain or to leave. For example, have you sold your house in Boston or are you renting it out? The second would indicate that you're not permanently settled, and therefore not entitled to NHS hospital services until after you've lived here for a year.

Like I said, I wouldn't go private unless I were forced to by ineligibility. Others have said that private insurance doesn't cover maternity. I don't know as I don't have private healthcare insurance here. However, don't completely despair, as healthcare is cheaper here. Most of my friends in big metropolitan areas in the States pay at least $5k out of pocket for prenatal care and childbirth, even with insurance. (I believe that average cost after insurance in the States is about $3,500.) I think the average cost for a vaginal delivery in the States without insurance is $30k. So although we certainly couldn't afford £15k, Squizita (or £5k very happily) it is cheaper than a much less swish uninsured birth experience would be in the States!

One named after a Prime Minister's wife. Not very clean from what I hear.

It's also worth mentioning that my financial care tightwadness is I am the breadwinner so our household income will halve for almost a year when I have maternity - which needs consideration. This also seems to be more 'normal' in big cities I guess because there are more opportunities, and dare I say it attitudes to who-you-marry/the dating scene is slightly different (purely based on F&F from more rural areas who place a man who can 'take care of them' quite high, and seem to have DHs who are slightly older and almost always earns more).

Hard to believe that I still have anything to say after that essay, but I'd take any assurances from your partner's employer about eligibility for services with a grain of salt and a lengthy search through government websites. It is a moving target, and IME (at a big university that employs lots of people on tier 2 visas) HR often have outdated information.

I'm an expat, OP, and I've been very impressed by my experiences of NHS care so far. I wouldn't be deterred if I were you until I'd at least tried it.

What is a bigger concern, IMO, is as Fred pointed out, there has been a big crack down on the use of NHS hospital services for foreigners resident in the UK. It is much more tightly controlled than registering with a GP is. Having said that, my hospital lets you self-certify that you are either permanently settled in the UK and on a path to settlement or have been resident a year. Some make you prove it. Read the link Observer gives above and think about whether your circumstances will look like you're permanently settled. Tier 2 is a path to settlement, I believe, as after two visas at Tier 2 you're forced to apply for indefinite leave to remain or to leave. For example, have you sold your house in Boston or are you renting it out? The second would indicate that you're not permanently settled, and therefore not entitled to NHS hospital services until after you've lived here for a year.

Like I said, I wouldn't go private unless I were forced to by ineligibility. Others have said that private insurance doesn't cover maternity. I don't know as I don't have private healthcare insurance here. However, don't completely despair, as healthcare is cheaper here. Most of my friends in big metropolitan areas in the States pay at least $5k out of pocket for prenatal care and childbirth, even with insurance. (I believe that average cost after insurance in the States is about $3,500.) I think the average cost for a vaginal delivery in the States without insurance is $30k. So although we certainly couldn't afford £15k, Squizita (or £5k very happily) it is cheaper than a much less swish uninsured birth experience would be in the States!

OP I hope we haven't scared you away!

I found this explanation on the NHS website:

^If you move to England permanently or return to live in England permanently, you're entitled to free NHS hospital treatment. Like other UK residents, you'll have to pay some NHS charges (for example, for prescriptions), unless you are exempt from these.

If you move to the UK, you will not be charged for NHS hospital treatment from the date that you arrive as long as:

you intend to live permanently in the UK, and
you have the right to live permanently in the UK or have a "route to settlement" that will allow permanent residence in due course

You'll be expected to prove that you meet these requirements.

Your spouse or civil partner and children under the age of 16 (under 19 if in full-time education) are also exempt from these charges if they live with you permanently.

If you're not entitled to live in the UK permanently but you've applied to the Home Office to enter or stay, you'll be charged for hospital treatment until:
your application is granted, or
you have 12 months' lawful residence in the UK^

I think what you need to check is whether the Tier 2 visa is still automatically considered a 'route to settlement' visa -- it used to be, but I believe they have made some changes to it in recent years which means you can only apply for permanent residence after some years if you also have a certain minimum salary.

(Siarie, I was referring to my typo, not yours.)

Just to clarify about health insurance. It's impossible (as far as I know) to buy local insurance that covers a normal pregnancy, however insurance purchased overseas may cover it.

Local insurance generally only covers specific complications, rather than standard pre-natal care. I'm mixing both as I have complex health conditions, but most of my care is NHS, and is excellent.

I'd also say I'm 'off the right' of that chart you posted Siarie and I would baulk at paying £15k! It would be nice to live in a world where £15k is just something you spend on a two weeks holiday.