Maternity Led Vs Consultant Led for first baby - Kensington Wing

[Battersealiz]

I am 30 and 6.5 weeks pregnant and have decided to go private with the Kensington Wing (rather than Portland or Lindo) due primarily to location as I live 5 minutes from the hospital. I am completely confused as to whether to opt for midwife-led or consultant-led (Mark Johnson, Roshni Patel, Nick Wales). I have read that if this is your first baby and you have no medical history indicating a complicated pregnancy, then you should opt for midwife-led. However being used to private medical care in Australia, I am leaning towards consultant-led however I am aware that there is a huge price difference. Surely there needs to be an appointment at the hospital where you discuss anything in your medical history and then you decide which option is best? However when I spoke to the Kensington wing about midwife-led, they said that your first appointment wouldn't be until 12 weeks and surely by then all the best consultants are booked should they discover something that makes your pregnancy more complicated. I have had a LETZ in 2008 and have a retroverted uterus but have read that this should not affect the pregnancy. Is it unusual or deemed a waste of money to book consultant-led if you this is your first and you have no complications in your medical history? I am so confused as to which option to choose. I am worried that if I book a consultant they will think I am wasting their time. If anyone could please shed some light I would be highly grateful. I am incredibly superstitious and don't want to tell my friends before 12 weeks thus cannot ask them for advice. Thank you!

I cannot speak for private treatment, however, in the NHS when you booked in for pregnancy in view of the LETZ treatment you would be sent to the consultant for an appointment. The consultant would review your treatment and so long as everything was fine would send you back to midwifery led care.

In a normal, low risk pregnancy you have statistically better outcomes if you stay within midwifery led care. You can find the results of the birth place study freely available online, it is this study upon which the NICE guidelines are based in terms of their recommendations. By electing for consultant led care you would be increasing your chances of having an instrumental or operative delivery and increasing your risk of having complications following the delivery. A healthy woman with a healthy pregnancy is best cared for by a midwife within a midwifery led setting. For a first time mother the safest setting according to the study is a stand alone midwifery led unit followed by an alongside midwifery led unit.

I would wait until 12 week appointment to get advice and decide. Even if you opt for one route then, there will still be months ahead to change if your pregnancy becomes more complicated etc. I would read up on the consultant profiles to decide which you prefer if you choose that route. I did have one friend though who was advised to have an expensive caesarian which she paid for privately after she was told her baby was huge, turned out baby was quite small but the hospital and consultant did well financially

I am going for consultant led care at the Kensington wing, mainly for my quite impressive medical history in the past year (ectopic and breast cancer), plus I am 35 and a doctor from a different hospital told me there is no chance I would qualify for a private midwife-led care. Therefore I can't say much for this part, but I believe if you have had any problems at all (sorry I don't know what LETZ is) they will want to evaluate if you can be taken under midwife-led care at all. Keep in mind that midwifes only deal with completely straightforward pregnancies, where they basically can go through a checklist and tick off things. This is how it has been explained to me.

Regarding consultants at the Kensington wing. I did some research and picked 3 docs and called their PAs to check on their availability for my due date when I was about as far along as you. They all had availability and I was offered a free of charge "meet and greet" appointment where you can meet the doc, speak and see how you connect. I went to meet Nick Wales, Keith Duncan and Vasso Terzidou. Liked all 3 but decided to go for Vasso, simply guts feeling and she is a mom of 3 herself so I felt more comfortable asking her all the silly questions (it's my first baby too). NW charges £1000 more than the other two. I was also told that Mark Johnson is the most expensive one of all and even though everyone said he is an excellent doctor, after having read online a few people saying how busy he often is and travelling I took him off my list right away.

Dr Vasso also told me that she works closely with Roshni Patel and they take care of each other's patients when the one of them is away.

Hope this helps, good luck with your pregnancy!

And btw, they hold a place for you with a consultant until you have had your meets & greets with everyone (as long as there is no waiting list that is). I met the docs mid-December and only made my decision around Jan 5th and paid the deposit then. Nobody chased or rushed me, but maybe cause it was holiday season.

Definitely opt for consultant over MW led if you choose the Kensington wing as if you need obstetric advice in labour out of hours under the midwives, you may be dependent on the NHS on call staff who are busy enough! There is quite a group of OBs who cover for each other on weekends/hols, you won't necessarily get a particular one if yours is off, depends who is on the rota. Depends what you call the 'best' consultant as well, some of them have larger practices than others and do a lot of travel so think about what's important to you. I would highly recommend Roshni.

Ps of course they won't think you are a time waster, they are well used to seeing women in their private practices with uncomplicated pregnancies and deliveries who want the absolute security of a consultant on call just in case. It's all about what you think is the best care for you during pregnancy and will help you feel safe and supported in labour.

Yes, agree with Sonoma that you don't need to worry about wasting their time. These are private docs who make good money with us. They take any case first come first serve, and obviously the less complicated you are the easier for them. So really no need to worry about this :). Main thing is you find someone you are comfortable with.

And btw, regarding your concern about when the first appointment is. I was ca. 10 weeks by the time I chose which consultant to go with and paid the deposit. And although my first appointment was only scheduled for 12 wks, I had a food poisoning in week 11 (was vomiting all night and very scared) so texted my consultant at 5 am, hoping she will get back to me sometime in the morning. She called me back IMMEDIATELY and told me what to do. Also offered to see me the next day shall I not feel better in the morning or if I want reassurance that the baby is ok. Also, I came down with a very bad cold 3 days later and I emailed her at around 9 am and she responded an hour later. So the "standard" appointments are not set in stone and if you need more you will be seen. And it was a good feeling to know I have sort of 24h emergency help if I need it.

Please investigate what pain relief options you think you might want. I'm not sure how it would operate in a private hospital, but I found out last week that in our NHS hospital, if you go in the midwife-led unit, you cannot have an epidural at all, only gas and air and pethidine - the only way to get an epidural is to go in the consultant-led unit. This is my first baby and I have no idea what I'll want on the day, but I do know I don't want my options restricted - the idea of being in agony and begging for an epidural only to be told 'well, you should have gone with the other unit then' is not appealing!

Jonty it depends on where your midwife-unit is. Ours is in the hospital (no choice here) and if you need an epidural (and MW did say that a lot of first-timers do) then you move across to the Labour Ward but you can start in the MW unit where you can have water pools etc.

You can have an eidiral on the Kensington wing with a midwife. The consultant anaesthatist does it irrespectve of who you are booked with. The pp is correct that the NHS team of doctors does handle any emergencies in labour. But they are on site as a positive which the consultants are not alwsys esp at night. (Although they do come in quickly and hang around if needed) Your choices of consultant are excellent go with any of them. Mark is very busy but he is very sumpathetic so most of his patients don't mind. If knowing who is delivering you is important just check if the midwives still work as a team as you may not have met the midwife who delivers you. Kensingto wing is a good choice and meet the doctor before you decide.

Sorry that should read, epidural. Lots of typos!! The NHS drs respond to the midwifery led (and support the consultants too when there is an emergency).