Currently, pregnant women are able to opt for NHS based Midwifery care, or care from an Independent (Private) Midwife. Women can also opt out of the Midwifery system, choose to have shared care with a GP, or opt to have private care with an obstetrician.
A qualified Midwife can provide you with support, advice and care throughout pregnancy, labour and birth. They are experts in normality. Healthy women experiencing a healthy pregnancy, with no known pre-existing health conditions, can choose to have Midwife to provide all care needed throughout their pregnancy, birth and postnatal period. However, even women with complex medical histories and pregnancies are still able to access support and care from Midwives, as they work alongside obstetricians, paediatricians and other health care professionals, ensuring you and your baby receive appropriate care.
In addition to offering health checks, such as checking blood pressure, urine testing and monitoring baby’s growth, a Midwife can provide information, advice and support. Midwives endeavour to include and support both parents, through antenatal classes about birth, infant feeding and so on. A Midwife can also act as a signpost, directing you to other appropriate sources of support and advice locally. Once your baby is born a Midwife provides ongoing support, until you are confident with your chosen method of feeding and both you and baby are well, up to a maximum of 28 days post birth.
Women choosing to book with the NHS midwife system can usually expect the majority of their antenatal care to be given via appointments at their GP surgery or, occasionally, their local children’s centre. Many community midwives work as part of a team, meaning that you may not always see the same Midwife at each appointment, although it is usual that women be allocated a ‘named midwife’. Depending on the progress of your pregnancy, you may also encounter a ‘specialist Midwife’. Specialist Midwives have additional training and expertise in specific areas of pregnancy, for example diabetes, VBAC (vaginal birth after Caesarian) or breastfeeding.
Independent Midwives (IM’s) are often able to provide a level of ongoing continuous care that is not always feasible through the NHS. Their case-loads are much lower, meaning that they can spend more time getting to know you, your family and your individual wants and needs. Pregnant women choose and pay for Independent Midwifery care themselves. (Visit www.independentmidwives.org.uk for more information on IM’s.) However, Independent Midwives are currently unable to obtain indemnity insurance, meaning that they are not covered for the care they provide. There are ongoing efforts to try to rectify this situation by IM’s themselves as, under current circumstances, they will be unable to offer care without indemnity insurance from October 2014. This is a rapidly changing situation, so there is hope that a solution may be found in time to allow IM’s to continue offering their highly personalised levels of care.
Some GPs have an interest in women’s health, including pregnancy and birth, and may offer some antenatal care as part of the NHS Midwife package. Although they are able to perform some antenatal checks, pregnancy care is not their main area of expertise.
Private Obstetric Care.
Women can also opt to pay for private obstetric care. An obstetrician will oversee all of your pregnancy care and also during the birth itself. This can be for a vaginal birth, elective caesarean or if you require emergency obstetric treatment. Obstetricians do not offer care for homebirths. Some antenatal, labour and postnatal care may be carried out under the Obstetrician’s instruction by qualified Midwives, employed by the private facility you select. Once your baby is born and you are at home, it is usual that your postnatal care be provided by the local NHS community Midwives.
By Lorraine Berry – Midwife