Private versus NHS – five things to consider before you give birth
Having a baby can be one of the most joyous and defining experiences in any woman’s life. But sadly it can also be doused in fear, disappointment, even heartbreak, if things go wrong. Recent shocking statistics from the Care Quality Commission (CQC) claim that nearly two-thirds of England’s maternity units have dangerously substandard care that puts women and babies at risk. Add to that staff shortages, strikes and a wider financial crisis that’s decimating NHS resources, and belief in the system’s ability to provide adequate treatment is low.
Tory MP Theo Clarke recently recounted her personal birth story when she experienced a third-degree tear during labour, saying, “The expertise of the doctors and nurses was amazing, but the aftercare left me traumatised. With different trusts, it’s a postcode lottery as to whether you get the right support or not.”
The Office for National Statistics reports there were 605,479 live births in England and Wales in 2022. And while having a baby in the UK is extremely safe for both mother and child, in 2021 there were still 1.4 deaths of babies (aged under 28 days) per 1,000 live births.
One of the most common complaints from parents is feeling out of control. So, understanding what options are available – whether that’s choosing NHS, private, or a mixture of both – can help to alleviate fears and empower parents to make the best choices for them and their baby.
And while complete private maternity care can be a bank-buster, a significant number of people selectively turn to private when different demands occur. Natalie Hitchins, the head of home products and services at Which? says, “Our survey in 2022 found that out of 1,400 parents, nearly all of them had paid for some private services during pregnancy or birth.”
Here are the choices available.
Antenatal care
Support, midwives and doulas
Under the NHS, you’ll be offered up to 10 antenatal appointments with a GP or midwife, but you’re unlikely to see the same midwife.
Another option for your antenatal, birth and postnatal care is hiring a private or independent midwife, where you will see the same person regularly. Jacqui Tomkins from Independent Midwives UK (IMUK) says, “Continuity of care is the gold standard of maternity care. We endorse and provide the relationship between midwives and women. This has been shown to be protective for the safety of mothers and their babies. Smaller caseloads and less-burnt-out health providers keep women visible and central to their best interests.”
Private hospitals also give you the choice of their own midwife-led care, which is recommended for mothers who are considered low risk. Consultant-led care tends to be either patient choice or when complications around age or medical needs are part of the story.
Consultant obstetrician Dr Chrissie Yu’s fees for a pregnancy monitoring only package (including consultations and scans but not including a private delivery) are around ￡5,000. She says this works well for patients who wish to stay on the NHS – or return overseas – for their baby’s delivery but benefit from her expertise up to around 30 weeks pregnancy.
Another possibility is bringing a doula alongside. They act as a birth partner, encouraging a positive experience throughout by offering practical, informational and emotional support for the entire family. They are not a replacement for midwives. Last year they supported 3,805 families.
? Cost of a private midwife: a complete package of care throughout pregnancy, birth and postnatal can be anything from ￡6,000 to ￡8,500 – up to ￡11,000 if employed by a hospital
? Cost of a doula: between ￡500 and ￡2,000. Contact doula.org.uk for more information
Scans and blood tests
The NHS offers at least two ultrasound scans at eight to 14 weeks and 18-21 weeks. The first is the dating scan to estimate your due date and to assess your baby’s development; the second anomaly scan looks in detail at the brain, heart, spinal cord, face, abdomen, kidneys and bones. You will also be offered various blood tests to check for conditions like Down’s syndrome, sickle cell and HIV.
Private hospitals provide similar tests but also offer a variety of others. The Portland, which is the only private maternal hospital in the UK, provides a 36-week scan “for reassurance and to check in on the baby”. First-time mums, older mums, or those with complicated medical needs may want the comfort of these more comprehensive tests.
Many private centres pride themselves on having state-of-the-art equipment so parents can opt for more specific results, like the revelation of a gender scan, or a 3D, 4D or even 5D scan with video footage of the baby moving around the womb.
? Cost of a private anomaly scan: ￡200-￡300 depending on the scan
The hospital experience when going into labour and giving birth
When it comes to the expertise of the obstetrics team, you might find it hard to differentiate between NHS and private. The standard is generally high everywhere and many of the doctors work across both. And, of course, the beauty of the NHS is its availability to all. But government cuts, staff shortages and even a busy night in the delivery room can stymie your choices and affect your experience – there might be someone else using the birthing pool, shift changes meaning different midwives, a shortage of anaesthetists for pain relief, and overworked teams struggling to cope.
Private maternity care isn’t referred to as “luxury” for nothing. You get everything from an en-suite room with a king-size postnatal bed, to complimentary toiletries and dressing gowns, to a celebratory afternoon tea. Queen Charlotte’s & Chelsea Hospital even offers aromatherapy massage.
Another bonus is consistency. You see the same consultant and their team throughout, and contact is frequent. Dr Yu says, “The majority of pregnancies are normal and natural – but no two are ever alike. My priority is consultant-led care designed around clinical best practice and the unique needs of mother and baby, for a positive birth experience.”
On top of general package costs, there are usually extra fees – anaesthetist, delayed discharge from the hospital or an emergency caesarean – which inflate the total price even further. Always ask up front exactly what the costs include. It’s also worth remembering that most private centres are based in or near an NHS hospital and may not have the necessary facilities for an emergency, so there is the chance you or your baby could be transferred to an NHS theatre or neonatal department if difficulties arise.
? Cost of a consultant-led vaginal delivery package: ￡6,000-￡12,000 (extra costs often apply, such as separate consultant fees)
The private amenity room in an NHS hospital
Again, if you can’t afford the whole private shebang, there is the option of a private NHS amenity room next to the maternity ward. Generally, you can’t book them up front, only after delivery. And they are allocated on a first come, first served basis, so are often booked up. They are fairly basic and you may have to share a bathroom, but you might get a little more privacy and sleep. They are especially worthwhile for women after a caesarean, who will be in hospital for longer.
? Cost of a private room in an NHS hospital: ￡100-￡150 a night
Postnatal care
Support, midwives and doulas
Mum and baby will be put in a postnatal ward in an NHS hospital until discharge, and then the community team visits the home to monitor the baby’s progress up until day 10. A health visitor will then take over the baby’s care, and a postnatal check is given to you at six to eight weeks by your GP.
Private packages can include home visits from day one. Consultants will also provide a six-week health check and, sometimes, physiotherapy, plus they are more likely to be at the end of the phone if you need help during that time.
If you have chosen a private midwife or doula, you can continue to pay for appointments for additional support – some new mums want advice on breastfeeding, sleeping and newborn behaviour. Leila Baker, a director of Doula UK, says, “Doulas support families in the postnatal period, providing assurance and encouragement to new parents as well as practical support. We have evidence that our babies are healthier and mothers are more likely to have positive feelings about their parenting.”
Tomkins from IMUK adds, “In my opinion, postnatal care is the most important element of care, as having a trusted health professional at the end of a phone and visiting frequently will take the terror and exhaustion out of early parenting.”
For women who find breastfeeding a challenge, there is the option of paying for a certified counsellor (in the NHS, a midwife or health visitor will give guidance). A private breastfeeding counsellor offers non-judgmental advice and practical tips on reaching your breastfeeding goals. Your local NCT group should be able to put you in touch with nearby experts.
Equally, if you are struggling with getting enough sleep, a night nanny experienced with newborns will be alongside to help with bath time, night feeding and sleep routines, while giving you a chance to catch up on your rest.
? Cost of a night nanny: ￡15-￡20 an hour
? Cost of a private breastfeeding counsellor: ￡150-￡200 consultation and support; follow-up face-to-face or video support, ￡50-￡75 an hour
Frequently asked questions
Do I need to go private from the start?
No. According to your needs, financial situation and health issues, you can opt for private care throughout your pregnancy. Some women choose to have certain tests, such as screening scans for those in high-risk groups – for example, older women and those with health issues.
What if I want to choose a home or water birth?
Either of these options can be discussed in your antenatal appointments with your midwife or GP. Home births through the NHS or a private midwife are only available to women in low-risk groups. Both NHS and private hospitals will have birthing pools in private rooms, and you can request one on the NHS, but depending on availability, they are not always a guaranteed option.
Do you get a private room when giving birth in the NHS?
You can book and pay for a private amenity room located off the maternity ward post delivery. But this depends on availability and the needs of other patients.
How many birth partners can I have?
The NHS states one to two named birth partners, but they can be flexible in certain circumstances. Private hospitals are more flexible; the Portland provides extra beds for partners and family, and room service menus.
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