Can you buy a better birth?
13:56 26 July 2005
Your own personal midwife, therapists to treat you during labour, a private room and hired help afterwards - can paying for your baby's birth make a difference?
Countless thousands of women have given birth on the NHS and been extremely happy with the care they received.
But in today's cash-starved health service, you may also come up against run-down facilities, staff shortages, lack of privacy, inflexible policies on how labour is managed and few, if any, comforts that can help you cope better with labour.
1. Private hospital
There's a range of private birth units across the country (your midwife may know what's available locally or check out Dr Foster's website, see Find out more, below), with a greater concentration in the South East. Provided everything's okay medically, you choose what sort of birth you want, eg water birth, as the necessary facilities will be on hand and you'll have one-to-one care from experienced midwives and doctors.
Pros:Pros: private room, state-of-the-art facilities, one-to-one care during labour and afterwards, complementary therapists on hand, decent meals and peace and quiet (if your baby allows it!).
Cons: the most expensive choice and, depending on the unit, you may be transferred back to the NHS if there's a medical emergency.
Cost: varies widely, depending on what sort of package you opt for and in what area. As an example, the Hospital of St John & St Elizabeth in London (where Kate Moss had her baby) charges from around 1,840 for the first 24 hours of labour including normal delivery of a first baby and 740 for each day after that. Add to that, midwifery antenatal care costing from around 1,350 excluding blood tests and scans.
Cheaper alternatives: there are still some smaller NHS birthing units run by midwives where you can have an intimate and relaxed birth. Take things in to hospital to make your stay more comfortable or consider a home birth as you'll be guaranteed privacy and one-to-one midwifery care throughout labour! Or book a private amenity bed (see below) for after the birth.
2. Independent midwife
Booking a private midwife to care for you during pregnancy, then deliver your baby will guarantee you'll know the midwife delivering you baby. It's also a popular option among women planning a home birth. Your local National Childbirth Trust (NCT) group (see Find out more, below) may be able to put you in touch with women who've used a private midwife.
Pros:truly individualised care as you'll build up a relationship with your midwife and she'll provide one-to-one care throughout your pregnancy and labour.
Cons:independent midwives are facing problems getting professional indemnity insurance to the extent that many are now uninsured due to soaring costs. Check with your chosen midwife when you book as, generally, those covered by insurance charge much higher rates to cover premiums. If anything goes wrong during labour at home, you'll need to be transferred to an NHS hospital but your midwife can go with you.
Cost: vary according to where you live but the Independent Midwives' Association has a regional list (see Find out more, below). As an example, The Birth Centre in London charges 4,600 for its "New Family Package" which includes all antenatal and postnatal visits and two independent midwives to attend the birth, either at the Birth Centre, your home or in hospital.
Cheaper alternatives: opt for a "birth-only" package and have your antenatal care on the NHS.
3. Complementary therapies
There's nothing to stop you hiring a complementary therapist, such as an acupuncturist, aromatherapist or reflexologist to treat you during labour, especially if they helped you during pregnancy. But you'll need to check that the midwife delivering your baby and your NHS maternity unit are happy about this (they'll want to verify their qualifications, registration and insurance details). 'The therapist should be accredited to the proper organisation, well qualified and have knowledge of treating women in pregnancy and labour as they need to understand the physiology,' says midwife Zita West, who runs a complementary therapy and pregnancy nutrition centre in central London (see Find out more, below).
Pros: anecdotal evidence suggests that complementary therapies can ease labour pain, often by releasing the body's natural painkillers called endorphins, so they provide a non-invasive alternative to conventional drugs.
Cons:not all hospitals welcome you bringing in your own therapist so make sure you check policy before booking someone. May become an expensive option if labour drags on and you want your therapist to stay.
Cost: variable depending on how long you require the therapist, at what time of day or night etc. Expect fees of anything from around 30-50 an hour and try to negotiate a total fee in advance.
Cheaper alternatives: book a couple of sessions with your chosen therapist before the birth (see Find out more, below) and ask him or her to explain or demonstrate treatments, such as massage, that you could use during labour. Alternatively, buy a specific pregnancy/labour aromatherapy kit (certain oils should be avoided), such as Zita West's Pregnancy Essentials Collection, 34.50 plus p&p or the Active Birth Centre's Organic Labour Massage Oil, 12.95 plus p&p (see Find out more, below).
4 Birth doula
Birth doulas (from the Greek word meaning "woman caregiver") are trained and experienced in childbirth although they are there to focus on your needs during labour, rather than give clinical support.
Pros: It's good to have someone you've already met and like, focusing solely on your needs, especially if you won't know the midwife. Also useful if you're worried about how much use your partner is going to be during labour! Research suggests that having a birth doula can shorten labour and lower your risk of needing medical intervention.
Cons: It's yet another person at the birth so your midwife, doula and partner will need to work together and communicate well to ensure that that everything runs smoothly. Doulas can't override medical decisions--she'll have to go with the doctor's decision.
Cost: Birth doulas tend to charge a fixed fee from around 250-500 including at least one antenatal visit. Postnatal help is charged at around 10-15 an hour.
Cheaper alternatives:Take along a close friend who's had children, like Kate Moss did with Sadie Frost. Or if you're close to your mum or sister, enlist their support.
5. Hired birth pool
Many hospitals now have birth pools but occasionally may be reluctant to let you to deliver in the water, especially if there aren't any midwives experienced in water birth on duty. If you encounter problems and have the funds, consider hiring a birthing pool to use at home or in hospital. If you want to hire a birthing pool (and be cared for by NHS midwives), you'll need to agree it with the Director of Midwives!
Pros: Water birth - at home or in hospital - is a lovely, relaxing option for "low risk" women who want a non-medicalised birth.
Cons:If you suffer any last minute complications eg high blood pressure, you won't be able to use the pool. And if anything goes wrong during labour eg labour fails to progress or the baby becomes distressed, you'll be transferred to hospital quickly (if at home). The only pain relief that can be used during water birth is gas and air.
Cost: The Active Birth Centre in London (see Find out more, below) offers a national delivery service for various water birth pools. Their popular hexagonal pool costs from 117 for one week's hire (plus 5.95 for each day after that), including extras such as a ground mat, video and disposable liner.
Cheaper alternatives:Check out birth pool availability in local NHS hospitals and their policy on its use. Be assertive as you do have the right to choose where to give birth (within reason!). If a birth pool is not available locally, use your own bath in the early stages of labour and ask your midwife if you can have one after you go into hospital.
6. Private room in an NHS hospital
Often referred to as an "amenity room", these are private rooms on the postnatal wards of NHS hospitals, although not all units have them. Midwives allocate them on the basis of clinical need eg if someone's had a caesarean, but you may be able to book one if there's availability after your baby's birth.
Pros:Having your own room means you can sleep when you want (or when your baby lets you!), see visitors in private and not have to worry about being "on view" all the time.
Cons: If another woman needs the room for medical reasons, she'll take priority. You may lose out on camaraderie with other new mums on the ward.
Cost: from around 45 a day, ask about availability when you go on your hospital tour.
Cheaper alternatives: as long as your birth is uncomplicated and you and baby are well, you can go home to familiar surroundings as soon as you like after the birth. Alternatively, there are still some small midwife-run units where the atmosphere is intimate and relaxed - ask your midwife about what's available.