Ideally – both partners need to be living a healthy lifestyle, cutting out cigarettes, reducing alcohol intake, exercising regularly, and eating sensibly. It is worth bearing in mind that being overweight can make pregnancy more high risk for both mother and baby.
Taking folic acid supplements (400mcg daily) is advisable, ideally for 3 months before becoming pregnant.

For most couples the natural fertility rate is about 25% per month, so in any case it may take at least a few months to get pregnant. Waiting patiently for this can be difficult once the decision to try for baby has been made.
In order to become pregnant, women need to be ovulating regularly, the fallopian tubes need to be open, and the partners’ sperm need to be good quality. The timing also needs to be right, so sex needs to happen around ovulation. With modern stressful lives this isn’t always easy to achieve. If in doubt whether/when ovulation is taking place, it may be useful to purchase an ovulation kit. This can also help with timing.

Where women have pre-existing medical conditions, such as infection, inflammatory disease, diabetes, high blood pressure or epilepsy, it is essential to seek advice from a doctor before becoming pregnant (preconception counselling). This is because medication may need to be commenced, adjusted or changed, blood sugar levels optimised etc.

If there is a history of pelvic infection, especially with chlamydia or if there is a history of endometriosis (see Pregnancy Problems) then the fallopian tubes may be damaged making natural conception difficult or unlikely. Sometimes this will require specialist investigations and treatment to improve fertility.

Increasingly, women may be in their late thirties or early forties before being in a position to start trying for a baby and wish to know what their chances are. There isn’t a perfectly accurate way to assess this but new blood tests such as Anti Mullerian Hormone (AMH) which test for ovarian reserve can be very useful in the decision making process.

Weeks 1-4
Embryo Formation:
As the cells of the Zygote divide, the ball of cells moves from the fallopian tube to the womb (uterus). This takes around four days and by day seven, when the cell cluster is known as the ‘blastocyst’, it has implanted into the womb.

Within a few days of implantation, hormonal signals are sent to stop the next period occurring and after 12 days a pregnancy test will be able to detect the presence of the hormone human chorionic gonadotrophin (hCG), which is produced by the placenta.

How you may feel:
Some spotting (also known as implantation bleeding) may occur at this time. This bleeding can sometimes be confused with a period or early miscarriage but generally this bleeding is extremely light and lasts only a day or so.

Most women do not feel pregnant immediately but slowly notice changes such as breast tenderness, increased frequency of passing urine, and then nausea (which isn’t always just in the morning).

If feeling sick, eating small amounts of simple carbohydrates often, will usually help. Feeling/being sick is not something to worry about (unless it becomes very severe) and usually settles by around 12 weeks gestation. However, although not medically serious, it can be really miserable and there are other remedies to try, such as acupressure wristbands, acupuncture or medication if necessary. Very occasionally women with severe vomiting (hyperemesis) require admission to hospital for intravenous fluids and vitamins.

Weeks 4-8
Embryo Formation:
During the second month:

• The embryo’s primitive heart, kidney and lungs are already in place and ready for further development
• The head end of the baby grows much more quickly than the body
• The ‘neural tube’ forms and this develops into the spinal cord and nervous system. (Folic acid (400mcg daily) taken before and during early pregnancy helps this neural tube to fuse and prevents neural tube defects such as spina bifida)
• The embryo has eyes, ears and limb buds
• There is a high growth rate, the embryo reaching 4mm by the end of week 6 and 9mm (the size of a small bean) at 7 weeks.
• By week eight the baby may be seen to move on an ultrasound scan

Your pregnancy care:
An ultrasound scan at around 6-8 weeks is advisable as it confirms that the pregnancy is in the right place, the heartbeat can be seen and the estimated delivery date calculated. If the baby is the right size and the heartbeat is seen at this stage it is then very unlikely that the pregnancy will miscarry, which gives added reassurance.

Weeks 8-12
The baby’s development:
By the end of the third month, all the body parts are present and the embryo is now called a ‘fetus’.

• The baby/fetus is now about 5.4cm long and weighs around 14g
• The skin is still very thin and transparent
• The baby is starting to look more human
• The sex organs start to develop but it may still hard to determine the gender (sex of the baby) accurately.

Your pregnancy care:
A further scan is offered at around 12 weeks of pregnancy. This is combined with blood tests to assess the individual risk of chromosomal abnormalities such as Down’s Syndrome. See our Pregnancy Problems page for details on this condition, or visit the fetal medicine centre website to see where these scans will take place.

Once this scan is done, this is often the time people start telling friends and family about the pregnancy.

Weeks 13-19
The baby’s development:
The placenta is now fully formed and feeding the baby all the necessary nutrients and oxygen.

• The baby can suck its thumb and curl up its fingers and toes.
• Tiny finger and toenails are sprouting, as well as hair, eyebrows and eyelashes, and the baby grows a fine downy hair all over its body (lanugo).
• Your baby should measure 12cm at 13 weeks, growing roughly 2cm every week at this stage.

How you may feel:
The second trimester is usually the easier part of the pregnancy for the woman. Nausea is starting to ease and the rapid changes in bodily functions are starting to ease off. As a result women tend to feel stronger and fitter. The pregnancy is also not yet so big as to be really uncomfortable and it is still relatively easy to sleep.

As the womb (uterus) enlarges, it becomes too big to be contained within the pelvis and moves up into the abdomen, as a result the pregnancy suddenly starts to show much more at around 17-18 weeks.

Your pregnancy care:
We usually see women every few weeks to check all is well.

A comprehensive series of blood tests are offered at 12-15 weeks, including screening for infections, testing for rubella immunity, checking blood group, blood count and so on. The detailed scan is offered at around 20 weeks. (See Weeks 20-23)

If there are risk factors for pre term labour, you may require cervical length scanning to look for cervical shortening, which is offered at OBGYN Matters.

Weeks 20-23
The baby’s development:

• At around 20 weeks the baby weighs an average of 0.28kg (10oz).
• The baby now starts putting on weight, approximately 56g (2oz) a week as it lays down muscle, ligaments and fat
• The skin is coated in a greasy white substance called vernix.

How you may feel:
This tends to be a relatively happy and straightforward part of the pregnancy. Most women first feel their baby kicking at around 20 weeks of pregnancy, sometimes later, or may even be earlier. These early movements have been described as ‘like a fluttering butterfly’, and are sometimes dismissed as wind.

Your pregnancy care:

A detailed scan at 20-22 weeks will look in detail at the baby’s heart, spine, brain and other organs. See
our Maternity care page for details on the scanning we offer at 20 weeks or the fetal medicine centre website to see where these scans will take place.

Week 24
The baby’s development:

• The baby is now well formed, and may survive if born now.
• The body has grown so the head no longer looks too big
• The eyes are still closed but can sense light and darkness
• The baby becomes more active as it is gaining control of its limbs
• The baby’s lungs are developing “branches” of the respiratory “tree”.
• On average the baby now weighs 600g (1.3 lb)

Week 25-28
The baby’s development:

• The baby now grows by half its body length and more than double in weight
• The baby’s eyes will open and eyelashes will grow.
• By 28 weeks the baby is around 26.5cm long and weighs about 1.3kg (2.9lb).

Week 29-32
The baby’s development:

• The baby’s movements now take on a pattern of periods of sleep and wakefulness
• The baby can open and close its eyes and will kick vigorously, although movements will alter, as there is less space in the womb
• The brain has now matured so much it can regulate body temperature, and nerve cells in the brain are forming fast
• The baby may start to move in response to noise or music
• The baby will continue to grow

How you may feel:
This is an exciting time as the end of the pregnancy is now in sight and women/couples can begin to prepare for the birth.

Braxton Hicks contractions may start to occur (in some cases even earlier in the pregnancy). These prepare the body for labour and are experienced as a tightening or hardening of the uterus, which lasts from 30 seconds to two minutes.

Your pregnancy care:
We offer a growth scan at around 32-34 weeks and additional scans for reassurance can be performed at other visits if the women/couples wish. Further blood tests are offered at around 28 weeks.

Weeks 33-36
The baby’s development:

• The baby starts to look fully formed
• The baby is now laying down fat in preparation for being born
• The fingernails will be fully grown
• The lungs are secreting a chemical, ‘surfactant’, that will allow them to expand after birth
• The eyes now look blue
• The head grows more than the rest of its body to accommodate the expanding brain
• The baby passes nearly a pint of urine every day a day into the amniotic fluid. This fluid is swallowed and breathed into the lungs and re-circulated
• The baby weighs around 2.3kg (5lb) and will continue to put on about 220g (8oz) a week until it is born
• In a woman’s first pregnancy, the baby’s head might ‘engage’ (move into the pelvis) in week 36, in preparation for being born. In subsequent pregnancies the baby’s head might not engage until labour begins.

How you may feel:
Once the baby is engaged (see above), the upper abdomen feels a little more comfortable and it may be possible to breathe a little easier.

Your pregnancy care:
Further bloods tests will be offered at 34 weeks. A growth scan may be offered to check that all is going well.

The last few weeks
The baby’s development:
In the final weeks:

• The baby fattens up ready for the outside world. In the few weeks before birth, the baby normally gains around 15g (half an ounce) of fat a day
• The lungs finally mature
• The lanugo hair and vernix begin to disappear

How you may feel:
During this time, most women will develop some of the more annoying symptoms of pregnancy – for example, heaviness, swollen ankles and fingers, difficulty sleeping, exhaustion, constipation, varicose veins, piles, symphysis pubis pain or dysfunction (SPD), and general aches and pains. As the head pushes on the bladder it is not unusual for women to experience some incontinence of urine especially on laughing, coughing or straining. We are happy to discuss any of the above. Women often need reassurance that what they experience is part of normal pregnancy. Women also start to experience pressure and sometimes shooting pains in the vagina during this time, and down the inside of the legs. The breasts may start to leak colostrum.

As the due date approaches the cervix softens and thins (ripening process) and this may loosen the mucus plug that has been sealing it. This is a ‘show’ and is one sign that things are getting ready.

Your pregnancy care:
During the last month, we offer a weekly antenatal check-up. This is to monitor that all is well with the baby and that the woman is not developing problems such as pre-eclampsia. Swabs for Group B streptococcus are offered at around this time. See our Pregnancy Problems page for details on Group B streptococcus.

This is usually the time to discuss birth preferences (birth plan) in more detail and talk about choices for birth with us. Both Alison and Christian are very keen to facilitate personal choice wherever possible. Womens’ choices for birth can be informed by our assessment of the position of the baby in the pelvis, whether the cervix is favourable and so on.

There is much media advice to avoid certain foods which can sometimes be over cautious and lacking in robust evidence. At OBGYN Matters, we feel that it’s important to bear in mind the logic behind this advice; especially as some pregnant women end up restricting themselves unnecessarily.

Oily fish
Oily fish (sardines, herring, pilchards and mackerel) is rich in essential fats and it is recommended to have one or two portions a week. However, it is better to stick to the smaller oily fish, because bigger fish, like tuna and salmon, can accumulate toxins from the environment, including mercury, which is not good for the baby in large amounts.

Cheese
It is actually sensible to avoid unpasteurised soft cheese, especially from sheep and goats, produced in other countries in Europe, as these can carry an infection called Listeria which is potentially harmful to the baby. Most cheeses sold in this country are now pasteurised but if in doubt it is worth checking the label.

Nuts
There is a lot of discussion about nuts – some people think that to avoid peanuts may guard against childhood allergy but there is no good evidence for this. There do not appear to be any concerns about other nuts and they are a great source of energy and protein, as well as essential fats. They’re also high in calcium – (particularly brazil nuts and almonds) which is beneficial in pregnancy.

Shellfish
Some health professionals recommend avoidance of shellfish. This is because of the possibility of food poisoning so we would advise being careful about where you eat it! So, especially after the first 12 weeks, it’s not necessary to avoid all shellfish but we would recommend steering clear of oysters from unreputable sources.

Green vegetables
Along with taking folic acid tablets to reduce the risk of spina bifida, (400mcg from 12 weeks before conception until 12 weeks of pregnancy), naturally occurring folic acid is also beneficial. The best sources are ‘cruciferous’ vegetables, such as broccoli, cauliflower, kale, radishes and other greens.
Green vegetables are a good source of iron and especially important for vegetarians.

Red meat
Many pregnant women develop anaemia (iron deficiency), which can make them feel tired and lacking in energy. The blood volume increases in pregnancy, so the red blood cells which carry oxygen are more diluted. Ideally, it’s better to get dietary iron, rather than from supplements, which can cause constipation, and red meat is a good source.
It is probably best to avoid rare meat, especially when traveling to countries where Toxoplasmosis is more common (a parasite that lives in animal meat), as catching this infection can be harmful to the baby. For vegetarians, there are plenty of meat-free sources of iron, such as green vegetables, pulses and dried fruit.

Alcohol
Alcohol intake in pregnancy is controversial. Obviously, in excess it can be harmful to the baby, but there is currently no consensus on the safety of small amounts of alcohol in pregnancy. Various national bodies in the UK have given differing guidance. On balance we believe that once past the first 12 weeks, the occasional glass of wine is very unlikely to cause harm.

Vitamin supplements
Most vitamins and minerals required for a healthy pregnancy will be contained in a healthy, balanced, nutritious diet. Sometimes women may need extra iron and/or calcium which is best taken as part of a multivitamin complex for pregnancy.

Folic acid is an exception as studies have shown that most women cannot get enough folic aid in their diet, no matter how healthy, so folic acid supplements are recommended.

Vitamin A should be avoided in excess which is why it is advisable to take multivitamins especially formulated for pregnancy.Read our up to date News section for recent research suggesting that taking vitamins in pregnancy may not be as beneficial as previously thought.

Weight gain in pregnancy
Pregnant women are no longer expected to ‘eat for two’ but it’s not a good time to diet either. 12.7kg (around 2 stone) is often quoted to be the average weight gain during pregnancy but this does vary. It also depends on your starting weight or body mass index (BMI) and that is something we are happy to discuss further with you during your consultation.

Keeping active during pregnancy is important for lots of reasons. It can improve circulation, help reduce constipation and tiredness, and can also boost energy levels to help your body cope with pregnancy and labour. Small amounts of gentle exercise, even walking to the shops and back, can be beneficial. The level of exercise appropriate during pregnancy depends on how fit the pregnant woman was before. Lots of women go to the gym before pregnancy and there is no reason why this should not continue.

It is generally recommended pregnant women stick to fairly low impact exercise and for women not to push themselves too hard. Because of the pregnancy hormones (particularly relaxin), joints and ligaments can be more vulnerable to injury. Pilates and yoga are ideal for low impact activity and classes in these are offered by specialists at the Portland. For classes elsewhere, we recommend ensuring the teacher is aware of the stage of pregnancy so can guide the level of activity accordingly. We do advise against contact sports or activities with risk of falling such as horse riding or skiing, particularly later on in pregnancy.

During the first 12 weeks (usually because of feeling dizzy and nauseous), and in the last few weeks, (more difficult to be mobile!) exercise is not so easy. We suggest that women follow their own instincts and only do what feels comfortable to them.

Couples sometimes avoid sex during pregnancy because they worry it may be harmful and/or are too shy to ask their doctor about it. Most women wish to stay sexually active during pregnancy and for most women it’s perfectly safe. Partners may also be concerned that they can harm the baby during sex but there is no evidence this can happen in a straightforward pregnancy.

Sometimes pregnant women are not so interested in sex, especially in the earlier stages, when suffering from nausea, dizziness and breast tenderness but these symptoms usually resolve. As the pregnancy progresses, most women (although not all) become more interested in sex as the hormones change. Nearer the due date, as the pregnant abdomen becomes more cumbersome, couples may need to experiment with positions that are more comfortable for the pregnant woman.

There are specific pregnancy problems which mean penetrative sex is not advisable, such as placenta praevia (low lying placenta), infections, bleeding, or where there is a high risk of preterm birth. If there are any concerns, Consultants Christian and Alison are very happy to discuss any aspect of this further with individual women or couples.

There are few evidence based guidelines on sleeping position during pregnancy yet many text books for pregnant women contain extensive advice. This is mostly based on the assumption that when the pregnant womb presses on the great vessels in the abdomen, slowing venous blood returning to the heart, reduces cardiac output and thereby reduces perfusion of the placenta.

Certainly it is true that women who are heavily pregnant find it difficult to sleep on their back as they feel uncomfortable and may feel dizzy or sick. This would seem fairly obvious and would make women adopt a more comfortable position. So one could argue that advice about sleeping position is superfluous.

In fact there is little evidence that sleeping position reduces placental blood flow, particularly in healthy pregnancy women with normal size babies. It may however be the case that growth restricted babies where the placental resistance to blood flow through the placenta is already increased might be more affected by sleeping position.

The current study reported by Stacey and colleagues compares women who had a late stillbirth with pregnant control women who went on to have a healthy baby.
They found that women who reported that they did not sleep on their left side on the last night before their late stillbirth were roughly twice as likely to have a late stillbirth as women who reported going to sleep on their left side.

On the surface this result would suggest that we sould be supporting a ‘not back to sleep” campaign. However, as is so often the case there are serious problems with this study.

First, the study is retrospective, asking women to recall what position they were sleeping in the night before stillbirth, it might be that this recollection is biased by previous knowledge about the best sleeping position for pregnancy.
Second, we cannot be sure how many of these stillbirths were actually ‘unexplained’ as we have no details of the type of stillbirth or post-mortem examination findings.
Third, it may be that women with growth restricted babies find it easier to sleep in positions other than the left side because their pregnancy is not so cumbersome.

The biggest problem with the study is methodology. The investigators collected lots of data on different sleep related issues looking for a possible association. They did not set up the study to test a particular hypothesis. This means that the authors have identified a possible hypothesis which now needs to be tested rather than showing a definite association between sleeping position and stillbirth.
Other results in the study show that women who slept during the day were more likely to have a stillbirth, as were women who slept longer. Women who got up at night to go to the toilet were less likely.
These findings are also difficult to make sense of. It has previously been found that resting increases placental blood flow which should improve fetal outcome. Getting up at night might be related to the baby moving a lot which might explain why this appears to be a protective factor.

Our advice is that we cannot as yet support a campaign urging women to sleep on their left side. We feel that women should sleep in the most comfortable position for them. For most women sleeping on their left side seems to be the most comfortable and we suggest that women in their late pregnancy might try to adopt this sleeping position.

Women often ask if travelling in pregnancy is safe? Most women who are pregnant are well, considered ‘low risk’ and it is perfectly safe for them to fly. Some women will have medical problems that make it unsafe but this is unusual.
Medical concerns are either risks associated with the travel itself or risks associated with the destination.

What are the travel guidelines?

Many airlines place restrictions on travel in advanced pregnancy but these are not consistent and vary from one airline to another.

Typical guidelines are:

• Unlimited travel to 28 weeks
• Doctors letter required after 28 weeks
• Twin pregnancies, no flying after 32 completed weeks of pregnancy.
• Singleton pregnancies, no flying after 36 completed weeks of pregnancy.

Our advice is to check with the airline.

What are the risks at different gestations?

In the first trimester, up to 12 weeks, there is an increased risk of miscarriage and ectopic pregnancy. This risk is probably not increased by flying. One study of pregnant flight attendants has shown that the risk of miscarriage may be slightly increased by airline travel, but the data in this study is difficult to interpret and the increase risk is small.

If a miscarriage or an ectopic does occur in the destination country then it may be difficult to access high quality medical care or the cost of the medical care may be high. The second trimester is the best time to travel. The pregnancy is usually well established, most women feel fit and well, the risk of preterm delivery is small and few medical check ups are needed during this period.

Travel in the third trimester is a little more difficult, firstly the pregnancy is bigger making flying more uncomfortable, there is an increase in the risk of deep vein thrombosis and a small chance of premature birth. The risk of premature delivery is around one in ten pregnancies and women are at increased risk if they have had a previous preterm delivery, recurrent episodes of threatened preterm labour, a multiple pregnancy or a history of cervical trauma.

What are the specific risks of airline travel?

Risks are related to low oxygen saturation, exposure to radiation, venous thromboembolism (DVT) and miscarriage and preterm birth.

Low oxygen saturation
In commercial aircraft the oxygen in the air supply is lower that that at sea level. The difference is not large but women may experience an increased heart rate, a slight increase in blood pressure and slight shortness of breath. The amount of oxygen in the blood stream also goes down slightly but this does not affect the baby. The reason for this is that the blood in the baby has a higher affinity for oxygen than the maternal blood so the baby is able to maintain oxygen saturation.

Radiation exposure
Exposure to cosmic radiation (gamma rays) at 35,000 feet is greater than at sea level. The additional amount of radiation exposure is small. For a transatlantic flight the exposure is around 0.05 mSv which compares to 0.1mSv for a standard chest x-ray. In other words flying to The States and back is similar to having a chest x-ray! This sounds alarming but needs to be put in context: current opinion suggests that exposure to radiation above 50mSv is needed to cause an increase risk of fetal malformation or miscarriage. Flying is therefore very safe and it is only frequent fliers and airline staff who need to be cautious.

Venous thrombosis-embolism (DVT)
DVT is 10 times more common in pregnant women than matched controls. Prolonged periods of immobility, dehydration and reduced oxygen in the blood further increase the risk. As a result the risk associated with airline travel is two to four times higher even for non pregnant people.

There are a number of steps that can be taken to reduce this risk:

• Take 75mg Aspirin before the flight (it thins the blood slightly).
• Wear elastic stockings during the flight.
• Drink plenty of liquid throughout the flight.
• Mobilise regularly and do exercises during the flight (an aisle seat helps with this).

Miscarriage and preterm birth
As mentioned previously there may be a very small increased risk of miscarriage caused by flying alot, but there does not seem to be an increased risk of preterm birth. The message here is that flying is not dangerous in this respect.

Indications for caution before travel Some women who are pregnant need to be careful about traveling because of a previous medical condition which may increase the risk to them or their baby.

The following list is not exhaustive but gives some idea of the relevant conditions.

• Recent amniocentesis
• Severe anaemia or heamoglobinopathy
• Multiple pregnancy
• Hypertension
• Diabetes
• History of cardiac disease
• Intrauterine growth restriction
• Placenta praevia
• Previous pre-term delivery
• High risk of thrombosis

All of these increase the risk of flying and may be a contraindication to airline travel whilst pregnant.

Travelling to exotic locations

More of us are now opting to fly to exotic locations in the search of winter sunshine or because of work, but of course when making plans there are additional considerations for pregnant women. There are concerns regarding vaccination, tropical diseases such as malaria and travellers diarrhoea.

Vaccinations in pregnancy
The risk of vaccinations in pregnancy on the development of the baby is unclear. Most sources agree that there is no evidence of risk from vaccination of pregnant women with inactivated virus, bacterial vaccines or toxoids. Yellow fever is live vaccine and should be avoided (a doctors letter may be required). Typhoid vaccination may cause a febrile reaction and is best avoided unless the risk is considered high.

Other diseases
The disease prevalence of some diseases such as Rubella is much higher in developing countries and the vaccine cannot be given in pregnancy. Women who are not immune should avoid these areas. Primary HIV infection in pregnancy also carries a greater risk of transmission to the baby. Other diseases such as Dengue fever and Hepatitis E are more dangerous in pregnancy and there are no vaccines. Food hygiene may also not be so high so there will also be a greater prevalence of Lysteriosis, Typhoid and Toxoplasmosis.

Malaria
Malaria in pregnancy carries a substantial risk to the mother and baby, especially infection with Plasmodium falciparum. Malaria prophylaxis carries a low risk to the baby compared with the substantial risks to the pregancy if malaria is contracted. It is essential that women sleep under treated mosquito nets and wear long trousers and long sleeved tops after dark. On balance it is probably best to avoid areas where there is a high risk of malaria as the disease may be particularly severe in pregnancy and the drugs that can be used all carry a potential risk for the baby.

Travellers diarrhoea
It is difficult to avoid getting travellers diarrhoea and it affects up to half of visitors to to tropical and sub-tropical destinations. The best advice is to be meticulous in hand washing, to drink only unopened bottled water and to not eat uncooked food. Despite these precautions it is difficult to avoid. In most simple cases the main problems are fever and dehydration which may lead to ketosis and an increased risk of premature birth. Fever can be controlled by oral Paracetamol which is safe to take during pregnancy. Rehydration with sugary oral fluids such as ‘Flat Coke’ is very effective though sometimes intravenous fluids may be required. Not all cases are ‘simple’ and sometimes oral antibiotics are required (not all of these are safe in pregnancy).

Summary
Most women are safe to travel in pregnancy, most of the risk lies not in the travel itself but in the risks associated with the destination. It is always best to consult with a doctor when making pladuring tropical and sub-tropical destinations during pregnancy.

Finding a good, Private Obstetrician in London involves some research and number of personal decisions.

There are a number of possible resources that can help with the decision. Many women will follow the advice of friends and family. This is often the best place to start, as these individuals do not have a vested interest in the final decision, have first hand experience and even inside information!

Some women will follow the recommendation of their GP, or use the Internet to see what is available in their area. There are a number of chat rooms and sites such as ‘mums’ net’ where people can post information or chat on-line about their recent maternity experiences. Private maternity units often have well developed websites from which contact details and information on Consultants and hospital services can be obtained.

Finding a good, Private Obstetrician in London involves some research and number of personal decisions.

There are a number of possible resources that can help with the decision. Many women will follow the advice of friends and family. This is often the best place to start, as these individuals do not have a vested interest in the final decision, have first hand experience and even inside information!

Some women will follow the recommendation of their GP, or use the Internet to see what is available in their area. There are a number of chat rooms and sites such as ‘mums’ net’ where people can post information or chat on-line about their recent maternity experiences. Private maternity units often have well developed websites from which contact details and information on Consultants and hospital services can be obtained.

It is important to know which private hospitals the Obstetrician is attached to as facilities vary widely. Some private maternity units will have excellent facilities for normal birth but only basic emergency services available on site. Some may be attached to an NHS hospital but still be detached from emergency services. Others will have 24 hour, integrated, on site, anesthetic and neonatal services and easy access to high dependency care.

Women and their partners have different expectations of what they would regard to be ‘the best’ maternity care. Most will be hoping for an uncomplicated natural birth and to be treated in a holistic way with minimal medical intervention, whilst others might want increased medical input such as an epidural and some would prefer an elective Caesarean Section.

Having chosen a private Obstetrician, the next step is to make an appointment and to find out if he/she supports the type of care that is preferred. Not all Consultants offer real choice.

To find out more about your Consultant it is worth asking how he/she feels about different birth preferences and if he/she also works in the NHS or only in private practice? If the consultant only does private work then how many deliveries does he/she do every year and how do they keep up to date with best clinical practice?

What is the availability of the Consultant? Does he/she work in a team and are there well organized, cover arrangements in case he/she is unavailable? Is there an emergency contact number that works 24 hours a day, preferably a direct mobile for the doctor? Will the Obstetrician be there during the whole of the birth or does he/she delegate much of the work during the delivery to the midwives?

To ensure a good outcome it is crucial that there is trust between the Obstetrician and the pregnant woman, that she feels confident that he/she listens to her and that she will be supported whatever her birth preferences.

There are clearly different opinions regarding which type of birth represents ‘best practice’. What is important however is that the right type of service is available for each individual’s choice and birth preferences and that the Obstetrician has an open minded approach to support the woman and her partner in their choices, whilst maximizing safety for mother and baby.

Individualised pregnancy care in the private sector is expensive, so it has got to be good to be worth it. In the United Kingdom most women who are pregnant have NHS antenatal care and only a very small number will decide to do it privately. In order to examine whether or not private care is worth the money it is necessary to examine how care is provided in the two systems, private and NHS.

Within the NHS maternity services are provided by a combination of Midwives, general practitioners and hospital doctors. Most women are initially seen within a community setting and are booked in for their pregnancy care by a mid-wife. Antenatal risk factors are identified and a plan for antenatal care is made.

The vast majority of women are deemed to be at low risk of complications and continue to be seen by midwives throughout their pregnancy. Some will occasionally be reviewed by GPs. Provided all remains normal they will not be seen by a consultant, they may be offered a home birth and may not attend a hospital except for their scans.

If risk factors are identified then a hospital appointment will be arranged. At the hospital antenatal clinic women are reviewed by hospital doctors working in a team headed by a Consultant. It is unusual for women to be seen by a Consultant unless they have a serious problem that needs to be discussed such as high blood pressure, diabetes or a Caesarean Section.

Within the NHS system, when labour starts most women will come to hospital and their delivery care is provided by a combination of midwives and the on call Consultant lead team. Most busy antenatal units provide a consultant on site for 60 or 72 hours hrs a week. Anaesthetic and paediatric cover is arranged in a similar way.

After the birth women are discharged home and are then given care in the community by midwives who do home visits and clinics within GP surgeries close to home.

The NHS provides free health care for all and some of the best clinical outcomes for Mother and Baby in Northern Europe so why do some women choose to go privately? What benefits does it bring – and is it worth the money?

There are a number of major differences between NHS and private care, mostly to do with a lack of bureaucracy within the private system. Women will identify a Consultant Obstetrician whom they wish to see. They phone or e-mail to make an appointment and because the numbers of women are much smaller and the system is much more streamlined and personal, they are usually seen within a week.

A Consultant Obstetrician sees all women from the outset. Most private appointments are for half an hour, potentially giving women more time to discuss their individual wishes and concerns. The choice of Consultant is individual and can be changed at any time. There may also be a choice of private hospital for delivery.

The same Consultant Obstetrician (or a team of Consultants) provides care so there is more continuity, notes do not get lost, results are filed and a secretary is always available on the end of a phone. Women should be provided with a number for medical emergencies and usually a mobile number for their individual Consultant.

Birth preferences and choices can be discussed directly with the Consultant who will be providing the care during the birth. More choice can be given as women can choose not only to have a natural, low intervention birth but also to have an elective Caesarean Section if that is what she wants.

Appointments can be made to suit the individual woman and her partner, waiting times are shorter, and there is more continuity of care, less repetition and hopefully more confidence as a result.

Once labour starts women know where to go and who will be there to meet them. The delivery suite is far less likely to be busy and there will be more time to individualise care, which will be provided by their Consultant.

There is a Consultant anaesthetist on site 24 hrs a day and a paediatrician with neonatal facilities from 30 weeks.

The hospital surroundings are cleaner, bed occupancy is lower and the staff to patient ratio is higher. Most women elect to stay in hospital for a few days to recover; there are good nursery facilities, breast-feeding counsellors and much better house keeping facilities.

Clinical outcomes for mother and baby seem to be much the same whether women choose the NHS or private sector. What the private sector offers is a far more personal and reassuring service.
It is important to remember that having a baby privately usually costs cost around £10,000 so it is only worth it if the care that is given is of the highest standard.

This is for women/couples who wish to have private care (with either Consultant Christian Barnick or Alison Wright) throughout their pregnancy, delivery and after delivery. With the availability of reliable home pregnancy testing kits, many women are now aware of their pregnancy at an early stage. We can be contacted directly at this time for an appointment.

Initial Consultation
This first visit is a really good time for women and their partners to ask us all the questions concerning them and to confirm their decision to be looked after by us. We like to see women/couples for their first pregnancy visit as early as possible, ideally between 6 and 8 weeks. The first visit will generally involve a full consultation and a routine examination. An internal examination is not usually necessary, but we may recommend a trans-vaginal ultrasound scan to confirm that all is well and that the pregnancy is developing as expected.

At the first visit we will also discuss the options available for screening for chromosomal abnormalities such as Down’s Syndrome. We offer a nuchal translucency scan at 11-13 weeks, combined with blood tests, which make the screening more accurate.

The next few early consultations:
A comprehensive series of blood tests will be offered at around 12-15 weeks. We arrange a detailed ultrasound (anatomy scan) at around 20 weeks when the growth of the baby is usually such that a careful examination of the development of all the crucial organs can be made.

The second half of pregnancy
We continue to see our clients at least at 24, 28, 32, 34, 36, 38, 40 and 41 weeks, sometimes every week in the final few weeks. These consultations usually last 30 minutes during which we check blood pressure, urine, baby’s position and heart beat and make sure that the pregnancy is progressing as it should. It gives us an opportunity to get to know each other, to build trust and confidence, and to discuss any concerns or difficulties. It also enables us to try and answer any questions that may arise.

Blood tests and ultrasound scans are performed as necessary, depending on the individual pregnancy. We would usually repeat blood tests at least at 28 and 36 weeks and perform a growth scan at least at the 32 weeks stage. As the pregnancy draws to a close we can also discuss your birth preferences. We will listen to your preferences and guide you on what we think are the best choices for your individual pregnancy. At around 38 weeks we perform a vaginal examination to assess the pelvis and the neck of the womb (and offer swabs for GBS). This examination may give us additional information on how long we might expect the pregnancy to continue and how easy or difficult we think the birth will be! Towards the end of the pregnancy, a plan for the birth/delivery will be discussed in more detail. We will talk about the signs to watch out for associated with spontaneous labour in addition to the pros and cons of induction of labour and Caesarean Section if required. We will ensure that all our clients are able to contact us 24 hours a day for advice or assistance and that they are aware of what to do in the event of a problem. Once in labour, we aim to provide continuity wherever possible, so that women are looked after by their own Consultant (Christian or Alison), together with one of the Portland’s excellent midwives.

Postnatal
A postnatal check at 2-3 weeks after going home completes the complete pregnancy care package. This appointment provides an opportunity to discuss the birth experience with us, and any concerns, whilst we can check that mother and baby are well.

We feel passionately about the importance of making the whole birth experience a happy one, which women and their families will want to repeat with us in the future!

The call at 01:45, I knew it was coming. She is one day post dates and has been contracting a bit since the previous day when I had seen her. At the time I had done a membrane sweep in the hope that this would promote the onset of labour, clearly, this has worked!

On assessment both mum and baby are fine but the contractions are rather more painful than had been anticipated. An expertly placed epidural, set up by one of our resident consultant anaesthetists, soon sorts this out sufficiently so that I can seek refuge in my bed.

Waking feeling slightly guilty and surprisingly refreshed at 05:30 I get up and head back to reassess the situation.

The epidural is working brilliantly and mother, baby, husband and grand-mother are doing really well. Quite lively and optimistic, only the dark bags under their eyes give away their lack of sleep.

The contractions aren’t great so I am not surprised to find that the cervix is only 5cms dilated, but, it is much thinner than before and stretchy, which makes me optimistic that it should dilate rapidly if I can just increase the contractions a bit.

We have a friendly chat about this and we all decided that a bit of Syntocinon should do the trick and the ever-present midwife rapidly sorts this out.

Grandma and husband are dispatched for a walk to get some fresh air and some breakfast in Regents Park and an epidural top up is administered. By this time it is 0700 and we decide that another examination at about 1100 should be about right, unless there are any new developments!

This gives me a couple of hours for a final look through my slides for a talk I am going to give tomorrow at the Royal Society of Medicine – not the way I normally like to spend my Saturday – but an offer to speak at the RSM doesn’t come along that often.

As expected I am called at 0905 “are your slides ready yet” asks the organiser, I should have had them in yesterday, “yes” I reply with a sense of satisfaction “shall I drop off the memory stick later today”, result!

I then go and check in on a postnatal woman on the 1st floor, she wants to go home 36 hrs after her elective Caesarean, all looks good, she is walking around, the baby is fine and it is her second child, so we agree that she can go but that she will call me on the mobile if she has any problems over the weekend.

Back on delivery suite all looks to be going rather well, the contractions have been coming regularly and an examination confirms full dilatation of the cervix, just as I had hoped. Fortunately the epidural is great, the mother and the baby (on CTG) look fine, and so we opt to wait for an hour to allow for passive descent of the babies’ head.

Meanwhile my previously planned day on the NHS delivery suite at the Homerton is being covered by one of my delightful NHS consultant colleagues. I give him a call and he confirms that all is well but that he would rather swap the whole day. This sounds great to me as it looks as if my patient will deliver somewhere around 1300 (at least that is what I have told her), this will give me time to go through my talk again or to attend a scientific lecture afternoon at the Homerton hospital.

1210. An hour has passed, the CTG shows a few early decelerations, which might indicate that the head is descending in the birth canal and we decide that it is time to start pushing. She is very excited but also looks rather anxious at the prospect!

The epidural is still working really well but despite this she manages to push really well with some encouragement from the midwife and me. After about 45 minutes it looks as she is getting a bit tired and that we may need to assist in the delivery with a KIWI ventouse, but a change of position is enough to cause further descent of the baby and she has a lovely spontaneous vaginal delivery: I opt for a small episiotomy to assist this as her perineum is really tight and looks as if it will tear badly if I don’t. A lovely baby boy is born in great shape to the sound of laughter from grandma, husband and even new mother. Either the Midwife or I can resist the infectious nature of the situation and we all end laughing together. What a way to come into the world!

In the meantime the placenta is delivered and the episiotomy expertly sutured, even if I say so myself.

Really lovely experiences for all of us and even after all the checks have been made, photographs taken and some tea and toast have been ordered it is still only 1400. A bit too late for that scientific meeting but early enough for a last look at that talk and a little power nap before getting on with Friday night. Just the one glass of wine though as I need a clear head and have another lady who may well go into labour over the weekend. Don’t let anyone tell you this isn’t a great job and a great privilege.