Comparisons between NHS and private care during the different stages of pregnancy, birth and beyond shed light on the choices for expectant couples, writes Maria Anguita
Antenatal care during pregnancy is community-based and led by a midwife. All antenatal appointments will be with a midwife during normal working hours. All parts of the UK have introduced policies for maternity services based on female-centred care, choice and continuity. A woman should be able to choose whether to give birth in hospital, a midwife-run birth centre or at home and the same midwife should look after her throughout the pregnancy. However, the reality is that chronic staff shortages and high service demand means the mum-to-be is likely to see more than one practitioner during her pregnancy.
Throughout pregnancy, the woman’s pressure, urine and growing bump will be monitored. She will also be given information about folic acid, vitamin D supplements, nutrition, smoking, drinking alcohol, drug use and keeping healthy. Routine blood tests will be carried out and she will be referred to a consultant for further tests if there is a problem. Two scans are available on the NHS – one at eight to fourteen weeks to screen for Down’s syndrome and to confirm the due date, and a second one at 18 to 20 weeks to check on the physical development of the baby. Some hospitals may offer extra scans if there is a clinical need. Policy on whether to tell the parents the sex of the baby varies between hospitals.
If the woman develops complications and has to go into hospital, she will be accommodated in four, six or eight-bed wards. Private rooms are available in rare exceptions. Common pregnancy complications are diabetes and pre-eclampsia (pregnancy-induced hypertension). Free parenting classes are available.
One-to-one care is provided by an obstetrician or midwife of the woman’s choice, and this will continue throughout pregnancy and labour. A woman choosing to give birth privately can book antenatal care at a private hospital through a private clinic, at a private wing within an NHS hospital, or she can opt for a home birth with an independent midwife.
While most private maternity clinics are clustered in the London area, private midwives operate nationally.
Private hospitals and units offer a choice of consultant or midwife-led care. A typical private package will consist of nine to twelve appointments with their consultant or midwife of choice and of further appointments for scans and blood tests. Patients usually have direct access to their consultant or midwife throughout the pregnancy and can contact them if they have any concerns. Most clinics offer appointments outside normal working hours and at the weekend.
A woman opting to give birth privately will receive the same routine checks and blood tests as her NHS counterparts, but she will be able to request other screening blood tests not currently available on the NHS. A minimum of four scans at different stages of the pregnancy will be offered, including 4D scans and video recordings. Some clinics offer a scan at each appointment. Most private clinics offer a 24-hour telephone support line, access to complementary therapies, such as acupuncture and reflexology. From hypnobirthing to yoga, the chances are there is private therapy and support available nearby, including lactation consultants, for private breastfeeding tutorials, and maternity nurses, who will help the expectant mother pack and prepare the nursery for her precious arrival.
The NHS offers women a choice on where to give birth – at home, a midwifery unit, birth centre or in hospital. A water birth is an option in some units or, if the mum-to-be is having a home birth, she can buy or hire a birthing pool. Guidance from NICE (the National Institute for Health and Care Excellence) emphasises that a woman should come to a decision on where and how she gives birth after discussion with the healthcare provider. However, choice will depend on whether the pregnancy is high-risk and, to a certain extent, where the woman lives.
During labour the woman will be supported mainly by the midwives on duty. If there are complications, doctors will be available to help and, if the woman is labouring at home and develops complications, she will be transferred to hospital. Midwifery units and birth centres are more comfortable and homely than hospital maternity units, but bathroom facilities are shared and wards may be unfamiliar.
Since 2010, £68 million has been provided to make NHS hospitals cleaner, and earlier this year the Department of Health announced a £25-million investment to improve NHS maternity units and increase the number of en-suite rooms. Delivery rooms will have a bed and an easy chair, and some will have bean bags and mats, as well as a bath or shower.
Some units will have a birthing pool for water births, but they are assigned on a first-come first-served basis. If a delivery room is not immediately available, the woman will have to be in a ward with up to six other women until one becomes available.
Labour will be overseen by the obstetrician or midwife who the woman chose earlier during her pregnancy and who has seen her throughout. If the patient chooses a consultant-led birth, then the consultant will be available and on call for the birth, and would deliver the baby. In most private units, the woman would also have a dedicated midwife during labour and birth.
According to Independent Midwives UK, the number of women paying up to £4,000 for a private midwife for a guaranteed home delivery or water birth at home, if medically feasible, is steadily increasing. The other option is to hire a private midwife who will accompany the woman throughout labour in an NHS unit. This means there is always going to be a known person with her.
Clinical standards of care in a private hospital will be largely the same as in the NHS, and the expectant mother will have the same range of pain relief to choose from. The main difference is that care will be delivered one-to-one throughout by a selected team. If she has booked a water birth, and as long as there have been no medical complications, she will be guaranteed availability of a birthing pool.
After delivery she will recover in her own en-suite, soft-furnished room, and can expect hotel-like facilities, as well as peace and quiet, and access to complementary therapies.
Private hospitals are well equipped to deal with medical emergencies. Very sick babies and women with serious health problems, will need to be transferred to specialist NHS units and the private clinic will make arrangements for this.
Following national guidance, the baby will be kept with the mother at all times and she will be encouraged to breastfeed. Paediatricians will be on hand to check on the baby. After an uncomplicated pregnancy, mother and baby can expect to be allowed to go home within 24 hours.
A midwife and health visitor will make home visits to weigh the baby and check the woman is physically and emotionally recovering from the birth. After this, she will be encouraged to attend baby-weighing sessions in the community.
Common problems during this recovery period include perineal infection, urine and bowel problems, and backache. More unusual, but of greater concern, are depression, haemorrhage and the formation of blood clots.
The baby blues – emotional instability brought on by hormonal changes – usually starts three to ten days after giving birth and lasts only a few days. According to the charity Mind, it affects around 85 per cent of new mothers and is so common that it is considered “normal”. New fathers may also feel it. More serious postnatal depression usually develops within six weeks of giving birth and can be gradual or sudden. It can range in severity, and it is important that women are properly assessed and receive appropriate support.
NHS postnatal care has come under fire for being generally sub-standard and for providing inadequate breastfeeding support. A survey by the National Childbirth Trust of more than 1,000 mothers highlighted a serious shortfall in the physical and emotional help they received.
Immediately after delivery and while she recovers in hospital or at home, the woman can expect the same level of one-to-one care and information that she will have received throughout pregnancy and labour. The obstetrician and paediatrician will check the woman and baby before and after they go home. The hospital or clinic should make arrangements for her to be discharged into the care of the community NHS midwife, who will visit at home the following day.
Some women choose to supplement NHS care and receive their postnatal care in the comfort of their homes, enlisting a private midwife or maternity nurse to check they are recovering from the labour and that the baby is doing well, and to offer advice and support.
Private carers will come to the woman’s home as often as she wishes, and telephone assistance will be available around the clock. There is a huge range of private help available and, if she is happy to pay for it, a woman can tailor her care to suit her exact needs. During those first few weeks, it is possible to hire the services of a night nanny, who will look after the baby while the woman sleeps, and somebody to come in and help around the house.
Postnatal classes for new parents and newborns are also seeing a boom. Typical topics on offer, in the weeks immediately following the birth, are parenting and how to adjust to the new arrival, baby massage, and baby calming workshops. For women, there are private postnatal fitness classes to help get back into shape.