In a delivery room at Queen Charlotte's and Chelsea hospital in London, Antonia Cloughly is rocking on a large birthing ball while performing deep breathing exercises for pain relief. Her husband, Andy, a patent attorney, 34, is by her side and midwife Jenny Smith is rubbing her back. Unlike the woman down the hall, who is grunting loudly to cries of "Push! Breathe! Push!", Cloughly is not in labour. This is her "birth rehearsal", a vital component of Queen Charlotte's "Jentle [sic] Midwifery" scheme, the first of its kind in the NHS. Named, according to the founders, "after nothing in particular", it is a kind of halfway house between plain NHS care and paid-for treatment. The programme, which has just completed its first year, offers guaranteed one-to-one care from one of three very experienced NHS midwives, throughout pregnancy and childbirth and for four weeks afterwards. All for a one-off fee of up to £4,000.
"We knew we needed something better," says Cloughly, 36, a former PA, "but we weren't sure what. I was 28 weeks pregnant, going through the usual system, and had never seen the same midwife twice. We had no idea who we would see during the birth and I was absolutely petrified: I had heard friends' horror stories over the years, and been so scared of birth that I even thought about not having children at all. When I saw the Jentle Midwifery scheme in a magazine I rang straight away."
The Royal College of Midwives says the UK is short of 10,000 midwives. A recent report by the think-tank Reform found that NHS maternity centres have too few midwives to provide one-to-one care and that there are now serious safety issues in many large, centralised units. Certainly, on the NHS these days it is virtually unheard of for women to see the same midwife throughout pregnancy and birth, despite studies showing that one-to-one care can reduce your chance of caesarean section and other (costly) medical interventions. This could change, however, if the Queen Charlotte's scheme were to be replicated in other NHS units across the UK.
It is a relatively simple idea. "NHS maternity care can be very fragmented," says head midwife Jenny Smith, who runs the Jentle programme. "Many women find this very worrying, particularly with their first babies. This is both an income-generating idea for the trust, and a way to offer some women more control over their care." Philip Bennett, professor of obstetrics and gynaecology at Queen Charlotte's, agrees: "In the UK the quality of maternity care has never been better. But the budget is limited, and the nicer aspects of care, such as knowing your midwife, are often just not possible."
Word of the Jentle scheme is spreading rapidly at posh west-London dinner parties and, to date, 74 women have signed up for a Jentle birth, generating revenue for the hospital of £160,000. "I'm even getting phone calls nowadays from women who have had their first babies with us, and want to discuss possible conception dates for the next one," says Smith.
Cloughly, certainly, feels "much, much more confident" about childbirth these days. She has got to know all three midwives well, and does not mind which one she sees in labour. Her antenatal appointments have been at home "whenever possible", and while she gets roughly the same number of tests, scans and checkups as she would on the NHS, and will give birth using standard NHS facilities, there are some other perks too.
She and Andy have been attending Jentle childbirth classes. Unlike those run by the hospital, where about 40 people come along to learn the nuts and bolts of birth stages, Jentle classes are intimate affairs involving only two or three other couples, where discussions range from creative visualisation (a relaxation exercise) to what an epidural feels like. Then there is the birth rehearsal, which includes a tour of all the facilities and equipment. The tour culminates in Jenny Smith prostrating herself on an operating table to demonstrate exactly who would be in the room, and where, and what they would be doing, should Cloughly end up with an emergency caesarean. Above all, says Andy, "We're paying for peace of mind and continuity of care. It's a no-brainer, really."
Some women in the UK already spend up to £4,000 on one-to-one midwife care by hiring an Independent Midwife (IM). But many IMs, while trained and certified to exactly the same standards as those in the NHS, are only able to attend home births because of hospital insurance restrictions. This, of course, rules out women who want to keep their options open for epidurals and other medical interventions. And this is why a one-to-one midwife scheme operating within the NHS is so appealing to women such as Cloughly, who want more choices and are prepared to pay for them.
While the Jentle scheme is undoubtedly cheaper than choosing a private hospital (a midwife-led package at the exclusive Portland hospital or the trendy Hospital of St John and St Elizabeth, the best-known private maternity hospitals, could cost upwards of £10,000 and there would be no guarantee of one-to-one care. Complications or medical interventions would also cost extra), it still clearly rules out the vast majority of couples. So is this just another step towards a two-tier system that divides pregnant women into the haves and the have-nots?
"Absolutely not," says Maggie Elliott, who is both director of midwifery at Queen Charlotte's and president of the Royal College of Midwives. "This is not a private scheme: far from it." Unlike the private system, she says, "this scheme directly enhances what the NHS can offer."
The Department of Health is, however, defensive. "We expect hospitals to address concerns that individual patients may have with their treatment," says a spokesperson. "However, we are committed to ensuring that the NHS delivers the best possible treatment as quickly as possible, free at the point of need. It would be completely unacceptable for any hospital to ignore their obligations to provide speedy access to NHS treatment, and no hospital should make patients feel pressured into pursuing private treatment."
Elliott argues that there is no chance of this happening. In fact, the Jentle revenues go straight back into the trust and have paid for, among other things, two-and-a-half midwives' salaries. The scheme also frees up the other midwives.
It has lowered costs elsewhere too. "The Jentle scheme dramatically increases your chances of a normal delivery," explains Professor Bennett. "The caesarean rate for first-time mothers on the scheme is 13%, compared with the hospital's overall rate of about 30%. Any scheme that reduces the caesarean rate could be a very good cost saving for the NHS." Since each caesarean section costs the NHS around £2,000, and most women who have a first caesarean have subsequent ones (most caesareans performed in the UK today are repeat operations), if schemes like this rolled out across the country, the NHS could certainly make some savings.
While the Jentle scheme is clearly exclusive, the birth of the Cloughly's baby next month will be a no-frills affair. There will be no free toiletries, luxury birthing suites or gourmet meals. What matters to them is not exclusivity but security: "I know that Jenny, Charlotte or Dee will be with me at the birth," says Antonia. "I trust them, and know I won't have to quibble with anyone in labour. That is very, very reassuring for me. We felt it would be mad to do things by trial and error if there was a better way to have this baby." There are, indeed, far worse things to choose to spend your money on than the birth of your child.
