Putting mothers and children first

Daily Telegraph, 17 August 2001

Private maternity facilities need not be the sole preserve of wealthy celebrities. Eliza O'Driscoll examines their attractions

 Can you afford private care?

THE rising rate of elective Caesareans has been blamed on the "too posh to push" syndrome - the feeling that a woman who can afford to go private deserves better than the pain of natural childbirth. But even those planning to give birth the hard way find that there are reasons to wish one was not in an NHS hospital.

Helping hand: Ruth Bowes employed an independent midwife to help with the birth of Adam
The birth of my first daughter in a well-known south London teaching hospital assured me of that. Every time the delivery room door swung open, two electricians working just outside got a grandstand view. After the birth, I had to stagger across the main reception area to reach a filthy shower room with a broken lock.

If you are lucky enough to have a bit of money to spend, you can opt out of the one-size-fits-all world of the NHS, and into one that is limited only by the size of your budget.

The Portland Hospital is the traditional choice of the celebrity mum-to-be. Fergie, Posh and Zoe Ball all had their babies there, and it offers a range of packages to suit individual requirements - none of which could be described as cheap and cheerful. A first birth at the Portland costs a minimum of £1,683, rising to £2,832 for an elective Caesarean. But that doesn't include the consultant's fees, which will add some £4,000 to the bill, and each extra night's stay, which will cost between £631 and £1,082, depending on the type of room and the sort of birth. You will be charged extra if your baby needs special care, too. All in all, new parents would be lucky to emerge from a three-day stay in the Portland with change from £10,000.

Julia and Holly: had a maternity nurse
There are three other private maternity facilities in London. In contrast to the Portland, the Hospital of St John and St Elizabeth emphasises natural childbirth - Jerry Hall, Kate Winslet and Emma Thompson had their babies there. Midwives have expertise in complementary therapies and birthing pools are standard.

Consultant obstetrician Donald Gibb delivers babies at both hospitals, but finds the ethos at St John and Elizabeth more in tune with his own way of working. "At the Portland, the standard way to give birth is flat on your back, while at St John and St Elizabeth they are sympathetic to natural birth positions, such as squatting, and are prepared to deliver a breech birth vaginally, for instance."

The Lindo Wing at St Mary's, Paddington, and Nuffield House at Guy's Hospital are private maternity facilities attached to major NHS hospitals. Nuffield House offers an extra service to women who give birth at Guy's - for £550 a night, you can be transferred to the private wing for your post-natal care.

Under the NHS, straightforward births are almost always midwife-led; an obstetrician becomes involved only if there is a complication. Many women prefer this approach, but for those who feel more reassured by the prospect of an obstetrician-assisted birth, the private sector is the only option that guarantees this.

Even for mothers-to-be who prefer their baby to be delivered by a midwife, lack of choice and no assurance of continuity of care are often cited as drawbacks of the NHS system. This is where the independent midwife comes in.

Ruth Bowes used Thames Valley Midwifery Services for the birth of both her sons. She was originally booked to have a home birth with a community midwife, but, at a 34-week check, a low platelet count meant she was encouraged to abandon her plans. At this point, she contacted the Association for Improvements in the Maternity Services (AIMS) for advice, and Melanie Milan of Thames Valley Independent Midwives took up the cudgels on her behalf, recommending supplements to help stabilise her platelet count and discussing her case with a haematologist.

Bowes decided to book Milan for her birth, even though her community midwife was still prepared to attend her. "If the hospital had put pressure on her, I might have been forced into transferring," she says. "Having the independent midwife gave me confidence." She views the £1,900 she paid for her care as good value. "As my husband said, it wasn't even the labour - although that was quite long and Melanie was here for 24 hours - it was the aftercare, particularly the help with getting breastfeeding established."

Many women who are happy with the services available from the NHS need extra help and support during or after the birth. Maternity nurses are the most well-known form of post-natal assistance. At a cost of at least £600 a week, they are not cheap, and most agencies insist on a minimum booking of a fortnight. But they can be ideal for a mother who has had a difficult birth or who has little experience of babies. "I just loved the idea of being able to get a month's sleep and a chance to get over the birth," says Julia Brookes, who booked a maternity nurse after the birth of her daughter, Holly. "As it turned out, I had a Caesarean and I couldn't walk, so it was a good job I had someone to help. She gave me the confidence to deal with the baby without getting into a flap. I'm the only one of my really close friends to have had a baby, so I didn't have their advice to fall back on.

"I know some maternity nurses are supposed to be really domineering, but I had a lovely Welsh lady who had brought up five children of her own. The agency tries to match you with someone who will suit you. I met her and I knew she would be perfect."

Parents whose babies are giving them sleepless nights, but who don't want or can't afford a maternity nurse, have another option. Television presenter Anastasia Cooke spotted a gap in the market after the birth of her second child and set up an agency that specialises in night nannies. Many are qualified paediatric nurses, while others are experienced nannies. For £70 a night, they will take over the care of your baby from 9pm to 7am, or longer by arrangement. Most of her clients, says Cooke, use her service between two and four nights a week for up to three months, by which time the night nanny should have established the baby's sleep pattern. Night Nannies currently operates only in London and Hampshire, but Cooke plans to franchise the operation in other parts of the country.

If neither a maternity nurse nor a night nanny fits the bill, there is another possibility. Doulas - from the ancient Greek word for the most important female servant in the house - are trained to give the practical and emotional support that, in an ideal world, a mother or sister would provide. Jean Birtles, who set up Topnotch Doulas, now has more than 300 doulas on her books, most of them experienced mothers, maternity nurses or nannies, who have taken the training course that Birtles runs several times a year.

A birth doula, who will attend your labour to lend support and encouragement, costs £250, while post-birth doulas charge £10 an hour and work a minimum of four hours a day. They will do anything the new mum wants, within reason.

"You want the new mother to be peaceful and able to look after her baby," says Birtles. But although a doula will help with the housework they are not there to scrub floors. "We do what the mother needs," says Dawn de Mallet Burgess, who has been a doula for two years. "I had one lady who said: 'I'm going out now, could you vacuum the house from top to bottom?'." She refused.

De Mallet Burgess was a Norland nanny before raising her own family and exudes comforting competence. Many of her clients are older mothers, with successful professional lives, who can be thrown by the unpredictable demands of a newborn baby.

New mum Penny Nugent hired a doula after talking to her health visitor. Her son, Hugh, was a few days old when she realised that she was going to need help. "He's a lovely baby, but he doesn't sleep a lot, and my husband really encouraged me to track down the type of support that I needed," she says.

Nugent's doula, Lisa Dunn, 22, is a former nanny with a three-year-old daughter of her own. "A good doula needs to understand where a first-time mother is coming from," she says. "The mother needs encouragement and support."

"The routine element has been brilliant," says Nugent. "Lisa knows me and the baby, so she suggests things that are right for us. It's made the single biggest difference to my life because for several hours a day I can be me."

Can you afford private care?

You don't have to spend a fortune. This is what a mother gets for:

£500: night nanny for seven nights or maternity nurse for five days or doula for the birth and for one week afterwards

£2,000: birth and aftercare package from an independent midwife or a maternity nurse for one month

£5,000: midwife-led delivery at St John and St Elizabeth Hospital in London or doula 20 hours a week for six months

£10,000: consultant-led elective caesarean at the Portland Hospital, London

£25,000: birth at the Portland. Maternity nurse for six weeks. Doula five hours a day for next three months. Night nanny five nights a week for five months


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