london private consultants

[emsken]

Hii all,

I am pregnant with No 2 - not due til april so am being WAY ahead of myself BUT.... I had no 1 at the portland but my consultant has now retired. Can anyone recommend any consultants at private wings in london and also how much do they charge for whole package?

Thanks

[emsken]

anyone??!

[BagofHolly]

Everyone will have their own opinion, and as for package you'll need to call their secretaries and get a price. If you're able to go through your insurer you get charged a different, lower rate.

[sh77]

Mark Johnson - delivers privately at the C&W and Portland. You won't find a negative word about him on the net. He delivered my son in March. Very reassuring, beautiful manners, very kind (as well as being very experienced). He gets booked up very quickly.

Nick Wales at the C&W gets v good reviews also.

[coffeeaddict]

Yes was going to post Nick Wales and Keith Duncan at C&W.

[spudulika]

Just out of interest - would you expect/want an obstetrician to give you figures for outcomes for women in their care? Rates of emergency c/s, assisted delivery, episiotomy? And would you want these to be better than typical rates in the NHS for women having midwifery care?

I think that if was paying someone ££££££££'s to ensure a good birth, I'd want some evidence of this.

[BagofHolly]

You're not comparing like with like though, Spudulika, as private consultants get such a high proportion of their patients via insurance, which only pays out if you have complications or need a cs.

[emsken]

Its not just the birth, its the pre-care, the birth and the post care... all of which i think are better than on the NHS - or at least from my experience!

thank you all for suggestions.. x

[spudulika]

I must be misreading what you've said Bag - are you saying they may have higher rates of intervention because they only get paid if something goes wrong?

Or are you saying they deal with more complicated cases than NHS consultants and therefore have higher rates of c/s etc?

I would assume a private obs are the only doctors in the UK who routinely care for low risk women in pregnancy and labour. NHS obstetricians wouldn't have any involvement in the care of this group.

The private midwives I know keep very detailed records of their deliveries - the risk status and outcomes. Surely private doctors do the same?

"Its not just the birth, its the pre-care, the birth and the post care... all of which i think are better than on the NHS - or at least from my experience! "

Well yes - that's true. But if I was paying thousands of pounds I'd expect an optimal outcome: namely, to come out with a healthy baby and an intact perineum and abdomen, if this is at all possible.

No amount of posh magazines in the waiting room and pampering after the birth is going to make up for a shredded perineum.

[BagofHolly]

Firstly, your snippy comments about posh magazines in the waiting room and pampering post birth do you no justice at all. Your previous posts are usually really intelligent and thought provoking. Private obstetrics isn't about magazines and pampering and commenting in such a way highlights your ignorance of what care one can expect.

Secondly, the way that the private sector works in the UK is very insurance driven. Yes, there's a cohort of patients who have the financial weight to simply pay the bills. But the vast majority of private health patients are there because they have insurance, and obstetrics is no different.

Most of UK health insurance policies cover the costs associated with private delivery IF a cs is clinically indicated. Uncomplicated or vaginal births aren't covered as a rule. So therefore private obstricians, because of the nature of the patients they are dealing with, have a higher rate of cs, because they are the births that are covered by insurers. So their cs rate is only a consequence of the financial environment in which they work. The Portland has a HUGE cs rate for example, because many of the patients there are having then on their insurance, and if they weren't, they'd be up the road in an NHS hospital having a VB.

[QTPie]

Actually I am not sure that most private births are complicated cases because that is only what insurance companies cover..... Most of the ones that I am aware of are either foreign nationals (whose foreign insurance covers routine births) or people who just choose to pay for it themselves.

We did a prenatal preparation workshop, at my private howpital, and all (8 couples) were first timers expecting straightforward births. One or two of them MAY have had foreign insurers, but definitely not many.

The top private Consultants are also the top NHS Consultants, so that may (or may not) confuse statistics...

QT

[spudulika]

"So therefore private obstricians, because of the nature of the patients they are dealing with, have a higher rate of cs, because they are the births that are covered by insurers."

Higher than who? NHS consultants? How can that be if a fair proportion of private obstetric care is provided to low risk women? NHS consultants simply don't provide care in pregnancy or labour for low risk mothers.

Again - to press the point, why would this impair their ability to discuss their results in a meaningful way? If private midwives do this then why can't doctors?

"The Portland has a HUGE cs rate for example, because many of the patients there are having then on their insurance, and if they weren't, they'd be up the road in an NHS hospital having a VB."

Are you saying that there are more high risk mothers giving birth at the Portland than at Kings, UCH, Chelsea and Westminster and the other large teaching hospitals in the area?

I wasn't aware it had the facilities for dealing with complicated multiple births etc. or for dealing with mothers with pre-existing complex health problems such as HIV, severe hypertension, severe obesity - something which most NHS hospitals are dealing with on a day to day basis.


Anyway, sorry for being snippy. I'm aware of the wide range of reasons women opt for private care. I had private care myself with my last two children. I didn't mean to sound dismissive.

It just surprises me that people aren't more interested in results when they're paying for a service.

[QTPie]

By their nature, obstetricians do not get involved in uncomplicated births on the NHS - if a birth is uncomplicated, the baby will be wholly delivered by MWs on the NHS... If you see an obstetrician on the NHS, then it isn't for anything good....

It iso only in the private sector that a Consultant has the leisure for (or is paid to attend) a uncomplicated birth.

So I would expect a Consultant's "unassisted/uncomplicated" statistics to be MORE favourable for private sector work....

Private births are not about nice magazines/toiletries/champagne etc, they are about one-to-one care, some semblance of control, access to pain relief/facilities and good post-natal care. It wold b great if we could get that on the NHS, but sadly fairly rare :(

QT

[Sumi76]

I highly recommend Ms. Gubby Ayida at Kensington Wing, C&W.

[jkklpu]

I'm sure all the individuals mentioned on this thread are wonderful. But however great a private consultant was, I'd still rather be in trolley-wheeling distance from an NHS A&E department in case of serious complications for my baby or me.

[QTPie]

Jkklpu, just about ALL of the consultants mentioned practice at private wings within some of the best NHS hospitals in the country (Chelsea & Westminter, St Mary's, St Thomas's etc). Yes the Portland isn't part of an NHS hospital (although there is a huge one right across the road), but just about all of the Consultants who practice at the Portland also practice at one of the NHS Private wings.

So if the OP wants that security (ie those top NHS facilities within feet), then they can choose to see that Consultant in an NHS private wing instead...

QT

[spudulika]

"So I would expect a Consultant's "unassisted/uncomplicated" statistics to be MORE favourable for private sector work...."

Yes - this is what I was thinking.

I'd be asking about their assisted delivery and emergency c/s rates. Also how many of their mothers deliver over an intact perineum.

They ought to have figures for this.

[QTPie]

Agreed - cant see why they wouldn't be able to provide those figures, unless they don't keep track of them. To be honest, though, I wouldn't be surprised if they didn't track them: I wouldn't be surprised if Consultants don't have time to track the data and their secretaries don't seem too brilliant in my experience.... Unless it is a professional body requirement.

Would be easier to get these figures for hospitals (or private wings). The CS rate will be skewed (because of maternal preference etc), but the other stats might be interesting.

However stats can be interpreted in many different ways, deoending on personal views (is a higher forceps rate and a lower CS rate preferable to a lower forceps rate and a higher CS rate? Some people would actually rate a torn perineum over a CS...). To be honest, personal recommendations (if you can trust the person recommending) is the way that I would lean.... Since each birth is individual, it is a Consultant's manner (and so trust and rapport that they develop) that is more important than their previous birth stats. However, since we are all individuals, a good "Consultant's manner" for one person may be very different for another.

QT

[BagofHolly]

QTPie: "Actually I am not sure that most private births are complicated cases because that is only what insurance companies cover..... Most of the ones that I am aware of are either foreign nationals (whose foreign insurance covers routine births) or people who just choose to pay for it themselves."

They aren't necessarily high risk or complicated cases, just cases which fall inside that which an insurer will cover so malpresentation for example.

As for the people on your course, they quite possibly don't represent many insured patients as the insurers are unsurprisingly reticent about signing off the cs until v late in the proceedings - waiting for placentas to move, babies to turn etc so all these patients have all their antenatal care on the NHS.

[BagofHolly]

Spudulika : ""So therefore private obstricians, because of the nature of the patients they are dealing with, have a higher rate of cs, because they are the births that are covered by insurers."

Higher than who? NHS consultants? How can that be if a fair proportion of private obstetric care is provided to low risk women? NHS consultants simply don't provide care in pregnancy or labour for low risk mothers. "

Because (and admittedly im extrapolating) private obs are not under pressure to keep their cs rate down whereas on the NHS there's a pressure to consider an instrumental VB where privately ELCS would be chosen.

"Are you saying that there are more high risk mothers giving birth at the Portland than at Kings, UCH, Chelsea and Westminster and the other large teaching hospitals in the area?

I wasn't aware it had the facilities for dealing with complicated multiple births etc. or for dealing with mothers with pre-existing complex health problems such as HIV, severe hypertension, severe obesity - something which most NHS hospitals are dealing with on a day to day basis. "

No I'm not saying there are necessarily more high risk patients, just more c sections. Although c section isn't without risk, the patient might well be, in all other ways, LOW risk. For example, malpresentation is an indication for cs. So it's perfectly possible for a woman who is low risk in every way, but requests a section, to get it on her insurance because her consultant says the baby isn't lying correctly, in his/her opinion.

As for facilities, my understanding is that they are the same at The Portland as anywhere else. As each consultant manages their own cases they can choose to reject very complicated cases, or advise that they deliver elsewhere - many of the consultants practice in several different places including the NHS. But in every way The Portland is just the same as anywhere else. I had my twins, complicated by macrosomia, polyhydramnios and unstable lie, and on anti coagulants. No one seemed particularly phased, and there was another set of twins in when we were there.

Thanks for your comments about snippiness, it didn't sound like (my perception of) you at all. x

[QTPie]

Sorry - was typing my reply on an iphone, lying on the floor with one hand stuck between the bars of a cot.... :)

See if I can put it better.... (although probably not :) ).

I went to J&Ls - most people who went there went there for a "natural birth" (J&L weren't very pro ELCS on grounds of maternal preference - infact it was hugely discouraged). Portland is different and the hospital will happily accomodate ELCSs (since it makes more business sense than a VB). So my experience would be skewed. Yes, an "insurance case" would probably have their prenatal care on the NHS (and wouldn't attend a private prenatal workshop). However during my 5 days inpatient care, I believe that only one other CS happened - all of the other births were successful VBs. Some/many may have been MW led and not consultant led though.

(UK) Insurance cases would have been very much in the minority at J&L. I had a breech baby and some of my costs were covered by UK Medical insurance. However I had signed up to private care LONG before I knew baby was breech (I signed up at 14 weeks). I wouldn't have gone private (for breech) just on the off chance that insurance would cover it: at J&L they scanned you the morning of the op - so they would have cancelled the CS IF my baby had turned (39w and 1d). If I had been counting on insurance covering the costs and the baby turned.... I think that you want to be really quite certain that you will get your costs paid if you are counting on them (heck I only got a small proportion of mine paid - combination of Bupa and Consultant's secretary being rubbish - so fortunately I wasn't counting on them!). You don't want to be switching your delivery hospital between NHS and private from day to day... I can't imagine too many people taking the risk/stress (last minute). Obviously complications that can be diagnosed and confirmed earlier would be a different matter (the insurer can sign off earlier)

Also, watching "Portland Babies" - they seemed to cover very few "insurance cases" - coincidence? design? Many of the women on that were foreign nationals (and probably having foreign medical insurance - which often covers VBs) and/or expecting straightforward unassisted VBs....

Regardless of my rubbish explaing.... it still doesn't change that a Consultant will come across far more "unassisted VBs" in private practice than in their NHS practice. In an NHS practice, an OBGYN is not called to attend a straightforward, unassisted VB.

QT

[QTPie]

No, I don't believe that The Portland has the same level of intensive care (for adults or babies) as the top NHS hospitals. They do have some, but maybe not quite as good (although that doesn't mean that they aren't "very good") and very costly (this may or may not be covered by medical insurance - some UK private medical insurers will not cover private SCBU for the baby).

BUT it is a risk to weigh up: not all mothers/babies need SCBU/intensive care, if they do then Portland facilities are probably perfectly excellent and it MAY be covered by their insurance or within their financial means. Also there are a number of excellent NHS hospitals within very close transfer range. Some people are comfortable with that risk, others are not.

(since I had my baby at J&L, I obviously was comfortable with that risk - since J&L had no SCBU at all and I was having an ELCS. That was my personal choice).

QT

[BagofHolly]

I think the consultants I've come across in the private sector take rather a philosophical point of view...the consultant's clinical opinion is the last word - so even if the baby had moved on the morning of the surgery, it's still the cons' call whether he highlights that fact about his customer, as it were.

Obviously none of this is discussed overtly.

[QTPie]

Good point, although it also depends on the wishes of the customer.... whether they would still wish to go ahead with the CS knowing that they baby was now head down....

Although I get the feeling that you may be eluding to a bit of a "black market" as it were... Interesting!

Anyway, as I said above, statistics can be looked at in so many different ways.... (no such things as "black and white").

I have a feeling that this thread has gone "all about the houses" - much of which is my fault

[coffeeaddict]

'No amount of posh magazines in the waiting room and pampering after the birth is going to make up for a shredded perineum.'

Based on my unscientific poll of two NHS births and two private consultant births, I would say attention to the perineum was about 1,000 % more in the private births. The midwives (two different hospitals) didn't seem to care and assumed stitches were inevitable. I am still quite shocked at the difference in attitude!

[spudulika]

Have to say - my private midwife was very preoccupied with my perineum too. Managed to deliver an 11lb baby over it and I didn't need stitches afterwards..... That feat alone made me feel her fee was well spent!