Packages and Costs
Angie offers a free initial consultation to any person or family who needs help. This is usually by phone or video conferencing. The aim is to understand and explore your current concerns and questions, and to explore what support, information and care you may want. You can then decide if you would like Angie to walk with you.
Angie can be contacted by phone or email to arrange a suitable time to talk. This includes evenings, seven days a week.
One off consultations (preconception, before or after birth)
£165 for around 2 hours
Do you have questions about pregnancy and birth, perhaps about your options? Not sure who to ask? Would you like evidence based information? Do you want things explained in plain and practical terms?
Angie offers one-off consultations in your home, at a time to suit you, in which she will answer your questions, offer information and help you to make sense of the information and often conflicting advice that you may have been offered.
Each antenatal or postnatal consultation can include a regular check up for your piece of mind, during which Angie will be happy to explain what she is looking and feeling for and why it is important. A long consultation is a great opportunity to talk deeply about hopes and fears, exploring choices and preparing for pregnancy or for birth.
Midwifery care package (home or hospital birth)
Fees are based on your particular circumstances and needs.
A full midwifery care package can include:
- Continuity of midwifery care from pre-conception until 6 weeks after birth.
- Appointments with Angie, in your home, at a time to suit you.
- Routine antenatal appointments, generally every 4 weeks up to 28 weeks, then more frequently as birth approaches. Most appointments are 1-2 hours long.
- Care commences as soon as you know you are pregnant (usually around 4-8 weeks).
- You decide if others are involved in these consultations. Angie is happy to meet those who are important to you.
- Evidence based advice and information at every stage.
- Loan of books and equipment including TENS machine, birth ball etc.
- Full programme of discussion and information to enable you to make the decisions that are right for you, helping you to prepare for birth and life with your baby.
- Liaison with NHS services as needed.
- Contact by phone, text or email throughout your care, for any questions or concerns between appointments.
- 24hr on-call for you from 37 weeks until your baby is born.
- Personal attendance for labour and birth.
- Postnatal care.
Average package cost for full package including birth is £7,500-£9,000. If you want antenatal and postnatal care, but will birth with the NHS, a package of antenatal and postnatal care costs around £3,500-£4,000. I am occasionally able to offer reduced rates in cases of particular need – please ask if this may apply.
Test results, options and choices
If you have received uncertain or frightening news, or need to talk to Angie to explore options & choices
- Initial in-depth consultation (approx. 1.5-2.5 hours)
- Discussion of test results/choices and their implications
- Information about options for care
- Written summary of consultation and options discussed
- follow up phone call the day after consultation to answer any additional questions
- Attendance with you at one hospital appointment (eg scan or consultant clinic)
- Follow up consultation (approx. 1.5-2hrs) to review and plan future care
Non-invasive prenatal test (NIPT)
A home visit (in Surrey or Sussex) and the test, including the initial consultation and a follow up to share and discuss the results with you
What is NIPT and is it right for you?
In the NHS, women in England are offered an initial screening test for Downs syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau’s syndrome (trisomy 13).The test is the “combined test” (sometimes the quad test) but this has a high false positive rate (worrying people unnecessarily) whilst also missing a significant number of affected babies.
Those who get a result suggesting a chance of 1 in 150 or greater will be offered an invasive test or NIPT. NIPT stands for Non Invasive Prenatal Testing. This is an area of major development in pregnancy care, but it is generally used to refer to a test for these three conditions which are the most common chromosomal issues to affect live-born babies. Search my blog for NIPT for lots more information.
Life is not always straightforward. Angie can walk with you during a complex pregnancy and has wide experience with many issues and concerns and is skilled at working in collaboration with other health care professionals to get the best outcome for you.
Having continuity of care when dealing with complex issues can really help as you navigate a complex path.
Angie’s experience includes:
- Issues affecting the pregnant person (organ transplant, paraplegia, extreme tocophobia, fertility issues, gender issues and many more)
- Surrogacy
- Multiple pregnancy (including quads)
- When baby is expected to have difference and/or major surgery is needed (Downs syndrome, spina bifida, cleft lip, congenital heart issues and more)
- When baby’s life is expected to be short (anencephaly, renal agenesis, chromosomal or genetic issues)
In addition to usual midwifery care, Angie’s involvement offers:
- Attendance at specialist consultations with you
- Liaison with specialist teams and co-ordination of services
- Professional advocacy
- Counselling support
- Detailed birth planning
- Perinatal hospice care
Reduced rates are sometimes available in cases of particular need.
Example 1 of more complex package
Decision making after “high chance” combined test and follow up care
At 12 weeks gestation, Lauren had been informed by her local hospital that she had a high chance that her baby was affected by Trisomy 18 (Edwards syndrome) based on the result of her combined test. She was offered an invasive test but was very unsure what she should do.
Lauren and Ben met with Angie for a 2 hour consultation, during which they discussed the result in detail, the statistical analysis and how they perceive “risk” and “chance” and the options open to them, including what it might mean for them if it was confirmed that their baby was affected by trisomy 18. Angie provided information about the effect of trisomy 18, including experience of caring for families continuing their pregnancy when their baby had been found to be affected by trisomy 18.
They decided to have an invasive test (amniocentesis). Angie liaised with Lauren’s local hospital and this test was arranged at a specialist fetal medicine centre. The couple requested Angie to attend this appointment with them and for Angie to be the one who shared the result with them.
Sadly, trisomy 18 was confirmed. Angie met with Lauren and Ben to give them the result. Based on the earlier discussions, Angie was able to support the couple to discuss the implications of this confirmed result and to reach their decision. This was that they should bring the pregnancy to an end.
Angie worked with Lauren’s hospital to arrange a medical termination and accompanied them both to the initial appointment and during their stay in hospital. She was present at the birth of their baby and supported Lauren and Ben in meeting their daughter and in their grief work. Angie provided follow up postnatal care for Lauren and helped the couple to make funeral arrangements for their daughter Star.
Example 2 of more complex package
Downs Syndrome & Cardiac Abnormality
Simone and Jack had a non-invasive test performed at an ultrasound clinic and were sent the result by email on a Friday evening, telling them that it was almost certain that their baby was affected by Downs syndrome and with information about arranging a termination of pregnancy.
The couple were deeply shocked by this news, having had the test as a reassurance measure. They did not recall any discussion when the test was performed about the possibility of getting this result.
They phoned Angie who provided them with some initial information and arranged a full consultation the following day. Whilst they remained shocked about the news that their baby was almost certainly affected by trisomy 21 (Downs syndrome), they were both appalled by the assumption that they would be interested in termination of pregnancy. Angie was able to support them and to provide much needed information and to discuss the option of confirming the finding by an invasive test (CVS).
Simone and Jack chose to have sessions with Angie, both together and separately, to explore their feelings. This confirmed that they were both fully committed to continuing the pregnancy and felt able to accept the difference that trisomy 21 would bring, but that they did not wish to have an invasive test. Together they discussed how to share the news of their baby’s likely difference with their families.
Angie worked with the teams at several hospitals to ensure optimal care. This included specialist assessment of the baby’s heart because many babies with trisomy 21 have cardiac abnormalities. This identified an atrioventricular septal defect (AVSD).
This knowledge meant that it was most appropriate for their baby to be born at a different hospital to where they had planned. Angie co-ordinated this transfer of care and attended joint meetings with the couple and the obstetric, cardiac and neonatal teams to plan the labour and birth and early care of their baby.
Angie provided regular antenatal checks and was able to provide introduction to another family whose child was found to have trisomy 21 and an AVSD during pregnancy and to several support groups.
Angie attended while Simone was in labour and at the birth, providing focussed support and advocacy for the family. Ongoing care was provided, supporting the couple during their son’s cardiac surgery and the confirmation that he does have trisomy 21.