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By Dr Fiona McAndrew
Having gone through it myself twice recently, I know how exciting, but daunting, it is to be pregnant. It is especially hard if you have just arrived to the UK from abroad, as you may be unaware of how the National Health Service (NHS) or Private Practice work or which one is best for you. When you find out that you are pregnant, your first port of call is your General Practitioner (GP), whether this be within the NHS or within the private sector.
When first seeing a NHS GP, they will refer you to your local NHS hospital or midwifery unit. There may be a choice of hospitals that provide maternity services within your area and your GP should advise you on what is available. Your first antenatal appointment or ‘booking’ with the midwives takes places at 8-12 weeks, with your first scan taking place around 11-13 weeks. You will be provided with a set of notes and assigned to a team of midwives who will look after you throughout your pregnancy. In a hospital maternity unit you may not have the same midwife for each appointment or during labour. At this stage of your pregnancy, you can discuss the possibility of home birth or delivering in a midwifery unit and antenatal classes will be offered to you.
Some GP’s offer shared care, where your antenatal appointments are shared between your GP and midwifery team. On average, in your first pregnancy, you will have ten antenatal appointments, whereas for future pregnancies, you will have only seven. At each antenatal appointment, you will be seen by a midwife, unless there is some reason you are considered to be high-risk and need to see an Obstetrician.
At 11-13 weeks, you will be offered Down’s syndrome screening. This is currently the ‘combined test’, which includes taking blood samples and carrying out a Nuchal Translucency Scan (NT scan). This scan assesses the thickness of the back of the baby’s neck alongside other markers for Down’s syndrome. Scans are then taken at 20 and 32 weeks, and you will have antenatal appointments occurring roughly each month and more often at the end.
In the last few weeks of your pregnancy, your antenatal appointments will focus on labour. Information will be provided regarding induction or Caesarian section, if appropriate, and your birth plan and wishes for pain relief will be discussed.
During active labour you will be looked after in a single room on the labour ward. The midwife will be with you at all times and will manage the whole of your labour and birth, unless there are complications, in which case you will be seen by the on-call obstetric team of doctors. In hospital, you have access to anaesthetists for an epidural, but in a midwifery unit this is not possible. Some maternity units do have birthing pools.
After the birth, you and your baby will be moved onto a postnatal ward and discharged when all the checks have been carried out and you are well enough to leave. On discharge, your local NHS GP practice will be contacted and a community midwife will come and visit you during the first ten days after giving birth. After this, you will receive visits from your local Health Visitor, who will introduce you to the local baby clinic for regular baby checks.
Those who choose to use private practice throughout their pregnancy will be referred to a Consultant Obstetrician who will see them at each antenatal appointment throughout their antenatal care. Your private GP can tell you what different services are available in your area and the pros and cons of different maternity units.
The Obstetrician may wish to see you more often than is required within the NHS and may also do extra tests that he or she feels are appropriate. Quite often an early dating scan is carried out and there are a number of extra scans carried out to assess your baby’s growth and wellbeing in later pregnancy. Despite these extra appointments and scans, the framework within private antenatal care is very similar to that of the NHS. Some units or hospitals also offer private midwife-led care, which is often cheaper than consultant-led care and can be a very good halfway house.
During labour you will be in a private room and your obstetrician will be present soon after admission. A private midwife will look after you throughout the majority of the labour, with your obstetrician visiting regularly and directing the course of your care before finally delivering your baby.
After giving birth, you will stay in your own private room, avoiding the postnatal ward, until you are ready to be discharged. This is quiet and there will be lots of help with breastfeeding and caring for your baby in the first few hours. This is often a huge relief after what can be an exhausting time in labour. Once home, you will be visited by the NHS community midwife and then by the Health Visitor, as with the NHS route.
With either route you choose for antenatal care and delivery, you may also want to consider hiring a maternity nurse or doula who can live in or out to help with the care of the baby in those first few tiring days or weeks.