London - how did you choose your hospital?

[mummytoonetryingfortwo]

Given the current situation with the NHS, my husband and I are considering going private for our twin pregnancy, I’m currently ten weeks along. I gave birth to my daughter back in 2018 at home in Bristol, so I feel a bit lost when it comes to it all! To those who opted to go private, how did you choose? Or to those who chose NHS, what influenced your decision making? Obviously if the pregnancy becomes more complex, we’ll be following the guidance of our doctors

Where in London are you based?

Duh, would help 🤦🏼‍♀️🤣 we are between Kensington and Westminster, but have a rental in central if needs be

We live near King’s. At the time it offered caseworking midwives so you could develop a personal relationship through pregnancy and they were likely to be with you at your birth. I’m not sure if that service continues as it was under review when I had my last. Kings also has groundbreaking foetal medicine, as a research centre. So it felt like the best of both worlds.

The caseworking midwives sounds amazing - my husband has a lot of anxieties about this pregnancy because it took us a long time to conceive, so I think it would be important to have that ongoing relationship. That’s why I’m looking more towards private care

From where you are I would be looking at the Kensington Wing at Chelsea and Westminster. You have the back up of a full nhs hospital with all the emergency facilities if needed.

We chose that one based on facilities and location. Can’t remember how I picked my obstetrician.

If you can afford it I wouldn’t hesitate to go private. Not sure if it still occasionally happens but my big fear was my chosen hospital closing its doors and having to go somewhere else unfamiliar. Or constantly being sent home or told to wait at home.

The Lindo wing at Charlotte's is consultant led. C&W is midwife led with a big tag for the consultant.

I think it should always be consultant led.

As you are having twins it may be consultant led on the NHS.

I would want dd and dil to have consultant led care.

Actually from where are I think St Mary’s is also a good option location wise with the London Wing.

Not true. There is a private wing at C&W where you can chose midwife or consultant care.

I had home births, which is the real speciality of these caseloading (not caseworking, sorry!) midwives, which meant the same midwife there from booking it to postnatal discharge, including birth. For two children. I had appointments with some of the others in the team throughout and it was chance it was her on each of the big occasions but it was wonderful. The same that people pay privately for tbh.

If this isn’t available on the NHS and you have funds I’d suggest exploring the option of a private midwife alongside NHS care. Speak to some and ask what arrangements they have for supporting deliveries in local hospitals.

Yes, my concern is being turned away in early labour. It happened to me with DD, it was exhausting. Constantly on the phone to ask when we could go in, just to go in and be 9cm and not follow any of my birth plan. I don’t want a repeat

I’m not sure a home birth is possible with twins? It’s always something that’s interested me, the draw of being in your own environment on totally relaxed. Not sure if it’s advisable for me this time around unfortunately

It depends on what's important to you.

With a twin pregnancy, I would be thinking about a place with a high level NICU so the chance of my babies needing to transfer away from the Unit is greatly reduced.

I'd bear in mind that the mortality and morbidity rates as such units can appear higher because they're taking transfers of high risk patients as well as serving their own population. Some statistics adjust for this, others do not.

Personally, if all was well, I'd aim for a vaginal birth with twins, so I'd look at places with a high rate of twin and breech vaginal birth? Why breech? Because one twin is often breech and I wouldn't want that to be a final factor into whether or not they feel they could support me in having one.

I'd look at patient reviews. I'd bear in mind that the people who leave written reviews online are typically very happy or very unhappy. On my unit, we hand everyone the relevant surveys several times through their pregnancy and stay.

I'd look at travel times in an emergency but it doesn't mean I'd take the closest hospital. A colleague is coming to our unit to give birth but she lives 30 odd miles away from it. What she's done is email the maternity team her details at her local hospital in case she needs emergency admission and of course she has her notes anyway. But at least they know about her as a pregnant woman in the area and they'll be her official community team in the postnatal stage anyway.

@Drivingmissrangey please read my post properly before being so abrupt.

@mummytoonetryingfortwo go and see the different facilities and get a feel for them.

Twins can be born at home but things have to be right (good positions, late enough gestation etc) and also you need to feel confident in the choice. As does your partner.

Another plus of either caseloading or private midwives though is that you can labour at home until the point you all decide you want to transfer, with a professional opinion that you are close enough to delivery to be admitted (and an NHS midwife at least will just call the ward and tell them you’re on your way). This may be less reliable if you have a history of quick births!

You can have a homebirth with twins if you want one but your hospital might feel that they can't support it for various reasons. Honestly, If the head of the homebirth team or equivalent midwife says this, believe them.

I'd be less inclined to accept if an OB said it. Depends who they are and their general attitude.

Very, very unlikely to be turned away at any stage of labour with twins

I’m staying with the NHS as low risk singleton pregnancy currently, and my local East London trust have been great with other non-pregnancy treatment I’ve needed + friends have given birth there recently and it’s been fine. It’s close to home which is a big factor and I have a comfort level with it, also DH and his siblings were all born there without incident albeit almost 40 years ago! If I was high risk I’d likely need a planned c-section and would consider a referral to Guys or UCLH where the NHS consultant care is best in class, but only if the consultants in my trust turned out to be rubbish for some reason. The only thing rubbish in NHS care is post natal wards and I don’t think my trust do private rooms anymore, but I can cope with it for a short period before I discharge myself. I would happily pay for a private room in any NHS service but have heard it’s luck if any are free on the day.

My friend went private at Guys as she was high risk with preeclampsia and received poor service from her local trust Homerton - she had a good experience but did say the long drive back home after c-section was agonising. Something to consider as to how quickly you can get to hospital in rush hour if needed. Another friend had an elective c-section at Guys on the NHS and her experience wasn’t any different to the one who went private so am not really sure what value paying for private offers other than a better post natal experience. But following here to read other experiences.

Oh my friend who went private had a private mid wife too - she’s on the spectrum as is her DH so they selected a mid wife who was too to feel
more comfortable throughout. Definitely an option to have a private midwife or doula even if you stay with the nhs for continuity of care.

Definitely go private attached to NHS hospital so you have the full NICU available if needed. See what's closest to you, can't be travelling across London in labour. Then look up the consultants there and see if any specialise in twins / any you like the look of.

As others have said, other option is private midwife or doula and do extra scans at fetal medicine centre (only place that does hospital grade scans)