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Being comfortable with safety and emergency care

Childbirth is still one of the most risky times in any woman’s lifetime, even in countries such as the UK where maternal mortality is very low. So how can you be assured of care that is as safe as it is comfortable?

It comes down to continuity of care, says Tiong Teoh, consultant obstetrician and gynaecologist, a specialist in maternal and fetal medicine, and newly appointed director of women’s and children services for Imperial College Healthcare NHS Trust. While every mum will get that through the use of multidisciplinary teams in the NHS, when you step into the private wing of an NHS hospital, you get a different sort of continuity.

“Our mothers will see the same consultant for every appointment, from booking in to delivery,” Mr Teoh explains. “So there is a real sense of familiarity during the pregnancy. You get used to your doctor, you trust them and have faith so, if there are any antenatal complications or problems in labour, such as the baby lying breech, our mothers are more relaxed about treatment because they are managed by someone they have developed a relationship with.”

He adds: “Of course it would be nice if that was true for all mothers, but in the NHS we don’t have enough money or doctors to enable it to happen.”

When you step into the private wing of an NHS hospital, you get a different sort of continuity

So what sort of mum-to-be chooses private care for safety concerns? Timothy Watts is a consultant neonatologist at Guy’s and St Thomas’ NHS Foundation Trust, and works in its private Westminster Maternity Suite. “We see all sorts of families, but some mothers definitely choose to go privately if they have had a traumatic first birth or difficult pregnancy as it offers more certainty.

“On an NHS ward the newborn check-up will be carried out by a midwife, nurse specialist or junior doctor within 72 hours, but your private package will include a thorough assessment by a consultant like me. We’ll examine the baby and talk to the parents.”

At Chelsea and Westminster, maternity services include what they call “the highest level of neonatal intensive care” with a neonatal intensive care unit which, like others elsewhere, is fully staffed 24 hours a day by a team of specialist nurses and doctors. The team includes seven neonatal consultants who are all fully accredited with specialist qualifications. And patients on the private wing also have access to other specialists, including a team of paediatric surgical consultants on-site and cardiac specialists from the nearby Royal Brompton Hospital.

Wherever you choose, every newborn’s check-up follows the NHS Newborn and Infant Physical Examination Screening Programme, so babies are checked for general wellness, signs of jaundice, infection, heart and eye problems, including cataracts, cleft palate and congenital abnormalities, which may not have shown up on an antenatal scan. “We particularly check hips for sign of dislocation,” says Mr Watts, “and a special team will check the baby’s hearing.”

All babies born in the UK to parents with NHS rights are entitled to free NHS care, even if born on a private ward

In addition, if parents approve, every baby will get an injection of vitamin K at birth, and be given the heel prick test (blood spot screening) by the midwife, which looks for serious conditions, including phenylketonuria, congenital hypothyroidism, sickle cell disease and cystic fibrosis.

If anything is found during the screening, depending on whether your maternity care is covered by insurance or not, and whether you are a UK resident, your baby will usually be taken into NHS care.

“All babies born in the UK to parents with NHS rights are entitled to free NHS care, even if born on a private ward. You are an NHS baby when you are born,” says Mr Teoh.

But what happens when there is a more dramatic emergency? Co-located private maternity units, like the Lindo Wing at St Mary’s Paddington, are reassuringly close to the best in trauma medicine if a baby arrives prematurely or a mother suffers intense uterine bleeding due to conditions such as placenta previa, when the placenta breaks off from the side of the womb.

“If a mother requires extra care, we have doctors skilled in all sorts of surgery here who can come to her immediately – such as cardiologists,” Mr Teoh counsels. “Don’t forget, St Mary’s is the major trauma facility for west London.”

Moreover, he adds, there is access to interventional radiology, a relatively new specialism. “These consultants can do extraordinary things,” he says. “If you suffer arterial uterine bleeding, a rupture which cannot be stopped by simply tying off – ligation – of the arteries and which previously might have demanded a hysterectomy or removal of the uterus, as it can be life-threatening, we now call in the radiology team. They can place pellets into the femoral artery and guide them to the rupture to plug it.”

So for mothers, the advantages are clear – you get the reassurance of continuity of care, as well as access to the best in acute-care medicine, plus a midwife ratio of one for every two to three patients.

How does private care help newborns in emergencies? Mr Watts explains that a private standalone hospital like the Portland will have a neonatal unit which can handle standard early care. But if babies at Guy’s and St Thomas’s need emergency neonatal care they will be taken to the NHS intensive care unit, and from there to the high-dependency and special care units in turn, just as any NHS baby would.

“Women don’t envisage their new baby will be unwell when they plan the birth, but if the baby is premature or born with a serious heart defect or illness, say, you could not be in better hands – or a safer place. These are consultant-led units and offer the finest care for every baby.”

“If you are entitled to NHS care, there will be no additional cost, although mothers from overseas, with no entitlement, will later be sent a bill.” If you can afford it and it is your preference, Mr Watts says, co-located units offer “the best of all worlds”.

And the consultants like it too. “For me,” says Mr Teoh, “there is the thrill of delivering a healthy baby, who I have known throughout pregnancy, and whose mother I have looked after for eight months and developed a relationship with. When I get woken up at 3am to deliver that child, it’s a real buzz, every time.”