Flexible option is best of both worlds

Deciding whether to have your baby within the NHS or to go private, calls for careful consideration, as Lilian Anekwe discovers

Within the NHS, expectant couples are likely to choose a hospital which is the most conveniently located – no one wants to make the nervous, often fraught, journey to the labour ward any longer than it needs to be. But, if you are considering a private birth, there are many more options to choose from.

Couples who want to go private can approach an obstetrician or hospital that offers private maternity services. Only one, the Portland Hospital in London, operates as an entirely private hospital; others make use of private units housed within NHS hospitals.

In some cases this may be in a separate ward or wing, or may use beds located in NHS wards, but with fully dedicated staff overseeing the mum-to-be’s labour. The staffing ratios in private maternity units are superior to those in the NHS. Often a private obstetrician or midwife can offer one-to-one care.

Con Kelleher, consultant obstetrician and gynaecologist at Guy’s and St Thomas’ Hospital, says one of the key things private maternity services offer is continuity of care from pregnancy to labour, birth and beyond.

The revenue generated from private maternity services can also be reinvested back into providing a better NHS service, he points out.

“Public care is really good, but it’s a different model. It would be very nice if you could have the same staffing ratios [on public wards as on private], but we just can’t afford that. Private maternity services generate huge resources for hospitals because the money goes back into the NHS hospitals in which they are housed. For the NHS, it’s a great way of making resources available,” says Mr Kelleher.

“Working privately, midwives still oversee births, but consultants are involved as well. I look after people in exactly the same way. But privately there’s more continuity as you see the same person all the time. In labour, things can go very quickly from normal to abnormal and having more contact points with women makes a difference as, if things go wrong, the last thing they want is to see a brand new face.”

For most people, the decision whether to use private maternity will be largely an issue of cost and safety

The flexibility of private maternity allows couples to choose the package of care that suits them best. For example, couples can have private antenatal care, such as scans and diagnostic tests, which are not routinely offered by the NHS. Or couples can have a private birth, vaginally or by caesarean section, with a dedicated private midwife, consultant obstetrician and surgeon working together during a labour to deliver the baby.

Dr Karl Murphy, an obstetrician at the London Maternity Centre and consultant obstetrician at St Mary’s Hospital, London, says: “Private maternity offers a very integrated service. It looks like a hotel, but it has the rigour of an NHS hospital.”

Paying for a personalised maternity service in this way means doctors and midwives are available throughout a pregnancy, along with the support of a full team of healthcare professionals and consultants at no extra cost if there is an emergency.

“If you look at the facilities you need to run a safe obstetric service, it’s very difficult to have it in a small unit. You need back-up – all the non-fluffy things that you hope you won’t need,” Mr Kelleher says.

Dr Kate Langford, consultant obstetrician and clinical director of women’s services at Guy’s and St Thomas’, one of the biggest labour units in the capital, says: “In general, bigger units will be in higher-level hospitals, where there are more anaesthesiologists, paediatricians and intensive care doctors, if that becomes necessary, and will be better equipped to deal with more complex cases.”

Using private maternity services doesn’t preclude couples from also seeing an NHS midwife or doctor, and attending the routine NHS appointments and scans. Couples can also have their baby on the NHS, but arrange for aftercare – a birth debriefing, breastfeeding support and home visits – with an independent midwife.

For most people, the decision whether to use private maternity will be largely an issue of cost and safety.

Dr Donald Gibb, independent obstetrician and director of The Birth Company, says: “People can sometimes be unrealistic about the costs. I saw a couple today and explained that they were looking at total costs in the region on £18,000 – £5,000 to £8,000 for a consultant, plus hospital fees from £4,000 a night. Then there are scans, blood tests and so on.

“The man thought it was too high, but then I asked him how much his car cost and it was far more expensive. Personally, I think £18,000 for a satisfying, safe and enjoyable birth is worth it for the peace of mind and the better outcomes.”

Private clinics may offer couples payment plans to spread the cost on an interest-free basis over a period of several months or years, allowing couples to budget. Some costs can be recouped from UK private health insurers, but this varies widely and so it’s worth contacting your insurer and checking with clinics to find out in advance what and how much your policy covers.

Concerning safety, Dr Murphy says the private maternity industry is tightly regulated. “We are regulated by the Care Quality Commission and we have exactly the same safety standards, audit trails, and rules and regulations that the NHS has. If anything, in the private sector I err on the side of safety.”

While Mr Kelleher says the private sector benefits greatly from the expertise of its clinical staff. “Generally consultants working in the private sector have been working a lot longer, are more experienced and I think probably do a better job than more junior doctors in the NHS,” he says.

“It’s not that the NHS does anything badly, people just want more choice. In obstetrics there’s so much that can go wrong. It’s complicated and, when things go wrong, they can go disastrously wrong. I would go private because I like choice, but I would want to be in the right place – somewhere I felt confident and comfortable should anything go wrong.”