What exactly is a doula or a case-loading midwife I hear you say? Do I have the right to an elective caesarean, or a home birth? If I wasnt to choose the private route, can I choose my consultant; can I mix and max private and NHS maternity services?
As with most medical care, the options aren't uniform across London, so talk to your GP to find out about options in your area.
Case Loading Midwives
First off, I'd like to share my best tip. If you are expecting a straightforward delivery and are deemed low risk then try to get on the books of a case-loading midwifery team - it is the gold standard of midwifery care. Centred round the pregnant woman, a midwife or pair of midwives are responsible for the care of a set number of women, managing their antenatal appointments, delivery at home or at hospital as well as postnatal appointments. This woman-centred apporach means that you can build a relationship with your midwives and I was lucky enough to have the same fantastic midwife give antenatal and postnatal care and delivery two of my babies.
Independent midwives are qualified midwives, who are registered with the Nursing and Midwifery Council. The midwife will support you through pregnancy, birth and the early weeks as a new mum. Importantly, if you choose to have an independent midwife, you do not have to opt out of the NHS and you are entitled to full NHS maternity services from blood tests and scans to consultant appointments. A complete package of care covering antenatal, birth and postnatal care costs between £2000 and £4500.
A doula supports you during your pregnancy and birth and helps you to settle into life at home with your newborn baby. Whilst tey are trained in childbirth, their role is not medical. A doula birth package ranges between £350 and £900 and post natal doulas charge from £10 per hour.
Although most NHS Trusts have targets to reduce the number of caesareans they perform, you can now opt for an elective caesarean, especially if this is after a difficult previous birth. You can book a private room after the caesarean in most hospitals if you want more comfort and privacy while you recover.
Birth units are also know as midwife-led units or birth centres and are usually separate from the labour ward. The units are staffed entirely by midwives and provide a relaxed home-from-home environment. They are suitable if you are expecting a low risk birth and want an active labour. Birth units do not offer epidurals or caesareans and you may need to be transferred to a labour ward if your labour does not progress as expected.
At 7% of all births, Kings College Hospital has the highest home birth rate in London. If you book a home birth through your GP or midwife, you are likely to be looked after by a team of community midwives, who will give you antenatal care at home or at a clinic and come to you at home when you are in Labour. the NCT says that a first-time mother has a 70% chance of achieving a home birth and not transferring to hospital and, for women who have already had a baby, the chance is between 88 and 99%.
Private or NHS
Actually it doesn't have to be a case of private or NHS. Of course booking privately will give you more freedom to choose where you give birth and choose your obstetrician and it will also mean that a birth pool will be available and that your stay is more comfortable and that you can stay as long as you want. You can pick and mix to a certain extent to keep the bill down. If you are worried about not knowing your midwife, you can book a private midwife to come with you when you go to hospital or doula if you want a little extra support. The full private package can cost up to £10,000
FOR MORE INFORMATION SEE THE A&U PREGNANCY & BABY DIRECTORY.
Illustration by Emily Faccini