1st baby - midwife led or hospital?

[roarfeckingroar]

Hi everyone,

I'm early on with my first pregnancy. I'm 31, no health conditions or high risk factors, healthy weight and exercise (new to this - apologies if it isn't relevant but I've seen lots of mentions of BMI).

I've been advised to self refer and the options seem to be the hospital or the birthing centre. Where I am, the nearest two are next door so I assume if something went wrong I could be moved to the hospital from the birthing unit? On the flip side, I always thought I would opt for a Caesarian because there seems to be such a prevalence of tearing then poor after care for women in the UK.

Any advice would be hugely welcomed.

Apologies for silly questions - all seems a bit surreal

I thought a private birth was about £25,000 or did I imagine this ?

I had my first in the birth centre and jt was a a water birth it was lovely to have my baby in the baby and I'm now on my second pregnancy and I hope I can have another water birth and the midwives were great xx congratulations

Private will be around an 15-25k depending on where

"Bol87
Sections are also a lot more costly to the NHS, so they don’t just hand them out! "

• that is incorrect . They don't cost that much more if you look at the recent research that was done on this ( probably by Birthrights) it's been shared a lot on some of the c section threads

£15-25k

A private midwife or doula will cost much less and will improve the experience.

I’ve had one in hospital, and two at home.

I hated everything about my hospital birth. The birth itself wasn’t really anything to shout about: Quick, uncomplicated, unmedicated, very minor tear that required a handful of stitches. But the way I was treated both during labour and during my 24hr stay on postnatal (I was induced so had to stay to have baby’s obs done every 4 hours) were literal hell. There’s an active thread at the moment about people’s experiences on postnatal.
My two home births were the exact opposite experience. The births themselves were still uncomplicated, quick and relatively easy (as childbirth goes anyway!). But the way I was cared for by the midwives was in stark contrast to my hospital experience. I had 2 midwives who were solely focussed on me. There was no “conveyor belt” feeling because once they showed up at my house, that was that. I was 100% their priority.
I was able to have a bath in my own bathroom, snuggle up in my own bed with my baby, my other DCs didn’t have to wait to meet their new sibling, my mum brought me a cup of tea in my favourite mug while I fed my baby and waited for the placenta to come, and the best part: my dad delivered fish and chips to me a few hours after DC2 was born

An increasing number of women are choosing to buy supplementary care from private midwives or doulas alongside their NHS care. It really comes down to working out what you want & make sure that you focus any spending on that & get the right person with the right skills. For example, you can get one-off sessions with a private midwife if you want to talk through an issue of concern or talk through choices and then employ them to for specific parts of your care. A doula can be brilliant if you want additional support too.

@HelloViroids I'm in SW London so looking at Chelsea and Westminster / Chelsea birthing unit.

Does anyone have specifics about these?

Re private - thank you for some excellent points. I want a private room for post natal care after hearing some horror stories on here and from friends. I would also like one to one continuous midwife care if possible.

@HelloViroids I would love to be your buddy I'm the first of my friends to do this! Where are you based?

@BecauseReasons I've read that book. I remember the horrific scene that led to him leaving medicine but don't remember the private / NHS aspect.

@TillyTheTiger I've looked into PBC and I'm 100% going to do this - thank you. Cannot wait to get my delightful Yorkshire rugby playing partner involved in the hypno stuff

I've read that book. I remember the horrific scene that led to him leaving medicine but don't remember the private / NHS aspect.

It's in the middle of the book. He does private practice on the side for a bit but discovers that a lot of the private practice doctors he meets are actually very junior in NHS terms. He also finds that, because generally private deliveries are only one doctor teams, if something goes wrong they've got to switch you to NHS pronto and having been private in the first place can slow that process down. There's also one instance where, working on his NHS rounds, he finds a fetus with a worrying trace and informs the woman's private doctor, who says he'll be there in a minute and under no circumstances is he to deliver the baby before the private doctor gets there. Anyway, the NHS doctor delivers the baby and the private one actually apologises when he sees how touch and go it was. Had he waited for the private doctor the baby could have died.

That's the gist anyway, i can't remember all the details. Maybe flick through the book again, OP.

@memberofseven i keep hearing good home birth stories. I was wondering what if home birth happens at night and what would the neighbors think (we are in a terraced house). Is it loud?

@Viletta my neighbours had no idea either of my home births had happened!!
With DC2, we went out to the car with baby in the car seat when he was a few days old, and my next door neighbour came bounding over with a huge smile on her face saying “Omg you kept that quiet!! I’ve been secretly watching to see if the car leaves and you come back with a baby, but the car never left!”

@Viletta but I guess it all depends on the person too!
I’m generally a pretty quieter birther! I usually start grunting and mooing like a cow towards the end according to DH, but that’s when he knows baby is inbound and to get his catching hands ready

Not read the thread but I was 30 when I had my first, same background as you in terms of BMI, low risk etc and I picked a MLU within a hospital so I could move across to labour ward in case I felt I could not cope with pain. I wanted have baby in the MLU without pain relief purely because I wanted to avoid the postnatal ward and go straight home from there having experienced the postnatal ward as a doctor working on it.

I was extremely lucky, had a very long but straightforward labour, did most of it at home and went into hospital for final 7 hours, delivered in the MLU and didn't need to set foot on labour ward.

I then had my next at a standalone MLU as I felt confident I would not need epidural and wanted to get home to my eldest asap.

If you want to try do it without drugs, I recommend MLU that is in a hospital so you can change your mind if you feel you need to. Even though plan is MLU, they still ask when you call to say you're in labour where you would like to go so can change your mind whenever suits.

In terms of tearing and aftercare, it is more luck than anything else. Certainly listen to the midwife when they tell you when to push etc to minimise damage but if you need episiotomy, it is completely out of your control. Personally I felt risk of tearing or episiotomy was preferred to a guaranteed c-section and associated recovery

Just read some more of the thread. I am a paediatrician, don't work on NICU any more but have rotated through when training.

Personally, I don't think private care is worth it at all. The majority who have private care have employers paying or are exceptionally wealthy. Very very few who have saved up just for it as the NHS is generally outstanding in care. Many in outer London pay for private room on a postnatal ward for privacy and space but this is extremely costly in the inner city hospitals like you are considering.

I have read some awful experiences on here of dismissive midwives and those not listening but luckily I have not experienced anything that bad professionally or personally. I did encounter a couple that were short or where I don't like their bedside manner but certainly not downright incompetent. Personally , would advise private midwife or doula if you feel you want someone there to advocate for you. Much better value for money

I checked the book, OP. Two thirds of the way down page 137, beginning, 'My opinion of private medicine changed...'

Definitely think you would benefit from a private midwife and / or doula for continuity of care. Then choose MLU as this will be a private post natal room I imagine. or if you choose hospital, simply pay for s private roomat the NNS hospital. Private midwifie costs about £5k, doula costs about £1200, private room at hospital maybe £200 per night?
Even if you did all of that - much less than wasting your savings on a private hospital

@IslayBrigid good advice. I think I'm going to pay for a doula and a private room. I've already contacted a couple of doulas in SW London for initial chat.

Thanks again to everyone, this has been really helpful.

@roarfeckingroar do be aware that prices for private midwives and doulas vary widely depending and it is really worth specifying what you want. If you go directly to a midwife rather than through an umbrella organisation, you want a couple of meetings before birth, one to one care in labour and a couple of follow up visits a midwife can be a lot less that IslayBrigid suggests - nearer £2k. PM me if you want any pointers

Depending on where you are in SW London it is worth also investigating whether you are in the catchment for an NHS caseloading team. They are the absolute gold standard of NHS care, giving you a named midwife for continuity of care from the first antenatal appointment, to the birth, and to the postnatal period. I was under the care of one based in King's College Hospital for my first child. I know that there are several based in Guy's & Thomas's which cover some SW postcodes.

Good plan OP, I am also getting a doula :)

Thank you @Sussexmidwife I will do if that's ok.

@YippieKayakOtherBuckets I hadn't heard of caseloading teams. My nearest hospital is Chelsea & Westminster. How would I find this out? Thank you for advice.

www.chelwest.nhs.uk/about-us/news/news-archive/2018/maternity-care-blossoms-with-new-daisy-and-sunflower-teams

This might be a starting point? I don’t have any direct knowledge of C&W but you may be able to self-refer if you can find a phone number. Local parents’ networks and NCT teachers can also be goldmines for this kind of info.

FWIW, we can only request private rooms at our hospital- no guarantee of availability. Also, at our midwife led unit, all birthing suites are private- it's only for after the birth you need to request a private room.