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Antenatal care with the NHS or an IM

Why am I writing a blog post about NHS care when I don’t work in the NHS you may be wondering.

I think it’s important that any person who is considering a pregnancy or is currently pregnant, knows what to expect and what options they have.

There is such a huge gap from conception to the very first midwife appointment where there is very little, if any, support or guidance readily available whenever you need it from a midwife. This is such a crucial time too, especially if this is your first pregnancy and don’t know what to expect or know what feels normal. You’re expected to just get on with it, wing it or seek advice online, in books or from friends or family when you can’t speak to a health professional. If this is a high risk pregnancy, or you feel unwell, if you have conceived through IVF or if this is a pregnancy after a loss, or if you’re just extremely anxious, you’re probably going to want to be able to speak to a health professional for additional reassurance more often.

Typically when you are planning on accessing routine antenatal care through the NHS, when you find out you’re pregnant you would usually be expected to contact your GP surgery so they can pass the details of your pregnancy to the community midwife attached to that practice, (in some areas you can register your details directly with the community midwives). They might only be there once a week or fortnight to collect the details of everyone who is pregnant and have left their details with the surgery. Once those details are collected they will work out your gestation based on your LMP and they will usually contact you within a couple of weeks to arrange your first booking in appointment for when you’re around 8-10 weeks pregnant.

Depending on the area where you live and the staffing of the community team, there may be some variation of these timings, but you can usually expect to see the midwife by about 10 weeks. It may be a telephone appointment or face to face appointment and usually lasts about an hour. From your booking, a referral will be made to the antenatal clinic of the hospital you are wanting to book with where they will then generate a dating scan appointment for you for when you’re around 12 weeks pregnant.

If you’re only very early on in pregnancy when you find out that’s a long wait until you get to speak to a midwife about any early pregnancy advice or care you may need or if you have any concerns or questions. This is often a very worrying time for many when access to antenatal care and support is non existent, sporadic or difficult to arrange.

Due to a lot of current constraints and staffing issues in the NHS you may not get to see the same midwife more than once. Continuity of care isn’t always possible and you can’t always get hold of your named midwife to ask any questions.

The standard schedule of antenatal appointments after the  booking and dating scan appointments usually consists of a follow up review at 16 weeks then again at 26/28, 31, 34, 36, 38 and 40+. Appointments are usually at a GP surgery and you’re usually only allocated 15-20 minutes each time. 15-20 minutes for all the usual checks plus any discussions you want to have, any concerns you want to address, any questions and talking about options for birth etc, it’s just not enough time.

You’re considered lucky if your trust is fully staffed and still providing a home birth service however this is not the case for many trusts across the UK. If you are supported with the choice of home birth, you’re also not likely to have met the midwives that will come out to you and who are on call that day you labour. You possibly might have met them before and if you’re extremely lucky, it might even be your community midwife.

Ive had many discussions with clients who are always worried about these scenarios. Either being told last minute that there isn’t enough staff to cover the service and there won’t be midwives available to come out to you when you’re in labour or having a complete stranger arriving in your birth space. The options you’re then left with is to go into the hospital or an MLU to give birth, which if you’re planning a home birth, is the last place you want to go to, or give birth without midwifery assistance (free birth). These are not situations you want to be faced with last minute when you’re about to give birth!

Birth is so intimate and you can often feel so vulnerable, strangers coming into your oxytocin bubble who don’t know you or know what’s important to you, can totally throw you off and create a barrier.

This is the reality of antenatal care and home birth support in the NHS at the moment. It’s has been like this for a long time and isn’t getting any better. The service is on its knees and so many units are really struggling. Staff morale is low because they’re working so hard in an already overstretched and understaffed service, they are struggling to maintain the basic care and it’s the birthing families that are suffering the consequences.

I am not saying this to worry you or discredit the NHS. I worked as a community midwife for many years so know exactly what it is like. The expectations that newly pregnant families have is far from the reality and it’s tough. I know my old NHS colleagues work tirelessly to keep the service going, there are some absolutely fantastic midwives who are still making the difference, but it’s just not enough.

When people don’t know what to expect at the start of their journey or know what antenatal care should look like, they accept the fragmented care that they receive as the norm. They often don’t realise what good care should and CAN look like and that there are choices outside of the NHS. Don’t just accept substandard care. Your pregnancy and birth journey should feel empowering and supportive from your very first positive pregnancy test. DO your research, explore other options of care and know you always have choices and can always feedback if you are dissatisfied with your care.

Continuity of care from the start with available help and support whenever you need it with regular appointments and a known midwife you trust should be the absolute basics. Having these fundamental basics will make a positive impact from the start and throughout your journey.

For these reasons some families choose to hire a doula or book care with an Independent Midwife, where they know they will be the absolute focus of any discussions, care given and planning.  Care outside of the NHS puts you at the centre of everything. Your pregnancy matters to us and we work with you to ensure you have the best possible experience. We don’t work for an organisation or anybody else so we aren't governed by guidelines and policies, you hire us to provide your care which will always be tailored to what you want.

For example with an IM, you have access to a midwife from the point you book care. You will have unhurried and more regular appointments which will be in your own home, you have the time to be heard and supported and all questions answered and concerns addressed. You have telephone and text contact inbetween face to face appointments and you will receive 100% continuity of care and be guaranteed that YOUR midwife will attend when you’re in labour.

Amazing care and peace of mind is worth the investment. There are so many care options available to suit everyone’s needs and circumstances too, from individual appointments to antenatal only care, birth preparation and planning sessions, postnatal only care, intensive breastfeeding support to the full package of care including birth support.

Early pregnancy support and even pre conception support is available. If you would to know more about the options available to you in your pregnancy or need some help navigating the minefield of maternity care and the choices you have, get in touch and we can have a chat. Pregnancy doesn’t have to be an anxious or stressful time especially when you have someone who can be by your side along the way.

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