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Your Birth & Your Choice

Written by Helen Holmes
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Your Birth & Your Choice
Will it be an elective caesarean at the Portland, a birthing pool on the kitchen floor or a standard delivery on the good old NHS? We explore the options for London parents.

The vast majority of us will end up giving birth on the NHS. Even so, there are still choices to be made about the kind of birth you would like. Most NHS maternity units now incorporate a birth centre providing a low tech birth experience for women with uncomplicated labours. You’re entitled to choose a home birth within the NHS, and in many cases, particularly after a previous birth has had complications, you can opt for an elective caesarean.
Even going private doesn’t necessarily mean having to remortgage the house. There are options, for example hiring an independent midwife or a doula, or simply paying for a single room after the birth, that can give you a little bit of extra control without stretching all the way to a private hospital.
So, before you book yourself into the local labour ward, it might be worth spending a little bit of time examining all your options. Although, there is definitely something to be said for proximity – particularly when your waters have broken and your contractions are coming every three minutes.

NHS Hospitals
The advantage of going to a large hospital to give birth is that it will cater for pretty much every eventuality. Epidurals and other pain relief will be available if you need them, as will a caesarean. Specialist doctors will be there to monitor your progress, and there will be facilities for looking after you and your baby if there are any complications after the birth.
“Our second baby developed very high levels of jaundice and was put into special care for a couple of days, then we both went to what they call the transitional ward for about ten days. We had the support of experienced midwives round the clock, and our daughter was seen by a team of paediatric nurses and doctors every day.

She’s fine now, but they kept us in the system for regular check-ups and I thought the follow up care was fantastic. We had probably some of the most advanced medical care in the world - we’re extremely lucky to be able to walk in off the street and get world class medical care for free.”
Most local hospitals now also have a midwife-led unit. In these units the care is provided entirely by midwives. The aim is to provide a more relaxed environment to encourage natural births with as little intervention as possible. An NHS midwife-led unit will generally have at least one birth pool, though it is not usually possible to guarantee that it will be available when you need it. If there are complications during the birth then you will be transferred into the care of a consultant on the labour ward.
The graph below shows what percentage of births at London hospitals involved an induction or a caesarean. This can give you an idea of how interventionist the hospital is, and how likely you are to have a natural childbirth experience there. Be aware, though, that the bigger and better equipped the hospital, the more complicated births, requiring medical intervention, will be transferred to their unit.
There is a midwife shortage in the UK, and NHS hospitals can often be short staffed and forced to rely on agency workers, particularly at night. Anecdotal evidence suggests that in general most mothers are happy with the standard of care that they receive on the NHS during the birth itself, but that post natal care can be haphazard.
Although partners are actively encouraged to be involved in the birth process there are not usually facilities for them to stay overnight at an NHS hospital after the birth, and if you want to have a single room afterwards then you will usually have to pay for it (around £100-£200 per night). As with birth pools, hospitals can’t guarantee that a single room with be available when you request one. 
The best thing to do is to go on a tour of the maternity unit and ask the staff there about the things that are most important to you. Your antenatal midwife should be able to give you details of the times of hospital tours, or you can call the hospital’s main switchboard and ask to speak to the antenatal department. Even if you have already booked yourself in to a particular hospital you can change your mind at any time during your pregnancy.

Chelsea and Westminster Hospital
369 Fulham Road, SW10 9NH
Tel: 020 8746 8000

Homerton Hospital
Homerton Row, E9 6SR
Tel: 020 8510 5555

Kings College Hospital
Denmark Hill, SE5 9RS
Tel: 020 3299 9000

Kingston Hospital
Galsworthy Rd, KT2 7QB 
Tel: 020 8546 7711

“When I arrived at the hospital, with contractions every two minutes, I had to sit in the waiting room for 20 minutes before they let me into the maternity unit, so I was screaming in agony with a man doing some photocopying beside me! Overall though, my Kingston experience was great.
It was all very clean and the food was like school food - which I love.”
“Something that could be improved, and I think this goes for all NHS hospitals,was that I was discharged too soon. I was readmitted after the first week as Ben had lost too much weight due to my milk not coming in. I believe that if I’d been kept in for a few extra days my milk would have come in, because I would have been resting, and the midwives could have observed feeds.”

Newham General Hospital
Glen Road, Plaistow, E13 8SL
Tel: 020 7476 4000

North Middlesex Hospital
Sterling Way,
Edmonton, N18 1QX
Tel: 020 8887 2000

Queen Charlotte’s and Chelsea Hospital
Du Cane Road, W12 0HS
Tel: 020 3313 1111

Queen Elizabeth Hospital
Stadium Road, Woolwich,
SE18 4QH
Tel: 020 8836 6000

Royal Free Hospital
Pond Street,
Hampstead, NW3 2QG
Tel: 020 7794 0500
The Royal Free is one of the smallest hospital-based maternity units in London, and had the lowest rate of inductions, at 12.8%.
“The midwives were determined I should have a natural delivery but after I’d  struggled for several hours a doctor appeared and suggested a section. The midwives said I could manage, and I was too scared and confused to offer an opinion. Eight hours later I was whisked off to surgery for an emergency section. I’ve always resented those extra eight hours of agony! The after care at the Royal Free was great, except that the nurses and midwives were very hung up on breastfeeding, which I struggled with for quite a few days.”

Royal London Hospital
Mile End Road, Whitechapel,
E1 1BB
Tel: 020 7377 7000

St George’s Hospital
Blackshaw Road, Tooting,
SW17 0QT
Tel: 0208 672 1255

St Mary's Hospital
Praed Street, Paddington,
W2 1NY
Tel: 020 3312 6666

St Thomas' Hospital
Lambeth Palace Road, SE1 7EH
Tel: 020 7188 7188
The busiest maternity unit in
London, with 6566 births in 2008.

University College Hospital
The Elizabeth Garrett
Anderson Wing,
235 Euston Road, NW1 2BU
Tel: 0845 155 5000
“I thought the medical care at UCH was brilliant – the doctors and midwives were fantastic. When the going got tough for medical reasons I was confident I was in the right place. I would definitely recommend UCH to friends as long as they’re more interested in keeping themselves and their babies alive and kicking than the colour of the curtains or the lunch menu.”
University Hospital Lewisham
Lewisham High Street,
SE13 6LH
Tel: 020 8333 3000

Whipps Cross Hospital
Leytonstone, E11 1NR
Tel: 020 8539 5522

Whittington Hospital
Magdala Avenue,
Highgate, N19 5NF
Tel: 020 7272 3070

NHS Birth Centres
There are two stand-alone NHS birth centres in London – Barkantine in East London and Edgware in the North. Both are staffed by midwives and will not have obstetricians, paediatricians or anaesthetists on site, so are suitable for women with a low risk of complications in labour.

Barkantine Birth Centre
121 Westferry Road, Canary Wharf, E14 8JH
Tel: 020 7791 8300
This is the first purpose built NHS birth centre in the UK, and opened in January 2008. There are five rooms, each with a birthing pool and en suite facilities.
The centre offers antenatal check-ups from 36 weeks of pregnancy, active birth workshops, and tours of the unit through the week. In an emergency women are transferred by ambulance to The Royal London Hospital labour ward.

Edgware Birth Centre
Edgware Community Hospital, Burnt Oak Broadway, HA8 0AD
Tel: 020 8732 6777
There are six en suite birth rooms/ postnatal bedrooms where you and your partner will usually be able to remain for the duration of your stay, and three birth pools, as well as birth stools, bean bags and birth balls.
The centre also offers antenatal workshops, including infant feeding, active birth and water birth.

Private Hospitals
Bank balance permitting, a private maternity hospital or birth centre could provide you with more control over your birth experience, and a more comfortable stay.
You will choose your own obstetrician, and whether you want to book a caesarean for a particular day, or ensure that there will be a birthing pool in your room, you can be confident that your needs will be
accommodated. Going private will also guarantee you a single en suite room for as long as you need it.
Exactly how much you’ll have to pay depends on which services you need, a caesarean is more expensive than a natural birth and a consultant-led birth will cost more than a midwife-led one. 
As a rough guide, once you have paid the hospital for the use of their facilities, and settled the bill from your private consultant obstetrician, you’ll be lucky to walk away with much change from £10,000.


The Portland
205 - 209 Great Portland Street,
W1W 5AH
Tel: 020 7580 4400
www.theportlandhospital.com
The Portland is probably the best known private maternity hospital in the UK, and it could be seen as the spiritual home of ‘too posh to push’ caesareans.
In fact, the hospital offers all kinds of birth options including midwife-led natural births.
This is probably the most comfortable place that you could choose to give birth, there are options to pay extra for a deluxe room or a suite and you can even order celebratory champagne. Unsurprisingly,
The Portland has attracted a myriad of celebrities including Victoria Beckham and Fergie.

“Celeb mags give you the impression that the Portland will be like a glamorous boutique hotel - it actually isn’t.  It’s very much a hospital, just a really nice, small, clean one with helpful staff and the amenities you would hope to have had you just given birth. The facilities are very good – private rooms with their own bathrooms cleaned regularly – at least daily – and helpful nursing assistance on call.
The food brought on room service is also really nice, and you need to bring very little kit with you - they provide clothes for the babies while in the hospital and nappies and toiletries for the baby and you.”
 
The Hospital of St John
and St Elizabeth
60 Grove End Road, St. John’s Wood, NW8 9NH
Tel: 0207 806 4090
www.hje.org.uk
John and Lizzies is smaller than The Portland and has a reputation for taking a more natural approach to childbirth. Midwives have expertise in complementary therapies and birthing pools are standard. The rooms are all fitted with double beds, so partners can stay overnight.
The hospital boasts an impressive list of past clients including Jerry Hall, Kate Winslet and Kate Moss.

The Birth Centre
37 Coverton Road, Tooting, London, SW17 0QW
Tel: 020 7498 2322
www.birthcentre.com
This is an independent birth centre adjacent to St George’s Hospital.

It offers a private, natural childbirth experience in South London. It can also supply an independent midwife for a home birth. The Birth Centre aims for a calm and holistic approach to childbirth, which results in less likelihood of medical intervention. If there are complications clients will be transferred next door to St George’s Hospital. Davina McCall and Jane Horrocks have both used The Birth Centre’s services.

Home Birth
Giving birth at home could be the ultimate solution for the pregnant woman hoping for a natural birth. Your own home is the place that is most familiar to you and where you are least likely to feel under stress. You won’t have to make a hasty trip to hospital, you can arrange food and entertainment to suit yourself and you don’t need to worry about privacy or whether you’ve got an en suite bathroom.
If there are complications during the birth and you need medical help then you’ll have to go further to get it, though research has shown that medical intervention is less likely to be needed if a woman is labouring at home. If there have been no complications so far in your pregnancy then you should be able to book a home birth through your local hospital and a midwife will be sent out to you when you are in labour. If you are having difficulty booking a home birth through the NHS, or if you would like to select your own midwife who will take time to get to know you and your family before the birth, then you may want to consider an independent midwife.
Independent midwives are fully qualified midwives who have chosen to work outside the NHS. Most of them specialise in home birth, and some are experts in specific areas such as breech or twin births. They will usually provide  antenatal care in your home, as well as attending the birth and visiting for up to a month afterwards. They can refer you for scans and other antenatal tests, in your local NHS hospital. They can also refer you to an NHS obstetrician if necessary.

Doulas
The role of a doula is in offering emotional and practical support to women - ‘mothering the mother’. In many cultures women are encouraged to rest for forty days after giving birth; here we’re usually expected to get back to normal a bit more quickly. Hiring a doula can provide much needed after care and practical help, allowing the mother to have as stress-free a birth experience as possible, and spend the maximum amount of time bonding with her baby.
Doulas can offer assistance and encouragement during pregnancy, during the birth itself (although they are not clinically trained, and will not replace a midwife) and can help out at home in the first weeks after the birth. Some doulas specialise in either pre or post birth services and some offer both.
What will it cost?

NHS                                Free!
Postnatal doula              £10-£15/hour
Birth doula                     £200-600           
Independent midwife     £2,000-£4,000
Private birth centre        £4,000-£5,000
Private hospital              £5,000-£10,000


Useful links:

www.birthchoiceuk.com
Contact details and statistics for all UK hospitals and birth centres
www.homebirth.org.uk
Information and advice on planning a home birth
www.aims.co.uk
Association For Improvements In Maternity Services, support and information for pregnant women
www.independentmidwives.org.uk
Information on independent midwives and how to find one
www.doula.org.uk
Advice, information and how to find one.

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