We used coyly to call them “women’s problems” but now, thankfully, women are at liberty to discuss their sexual and reproductive health more openly. This section deals with those elements of women’s health that, if they need specialist care, are the province of obstetricians and gynaecologists.

When it comes to having a child, there are some key choices to be made from the moment you become pregnant. There are also some key questions that should be directed at your doctor or midwife. For the other areas we cover — recurrent miscarriage, infertility and hysterectomy — the priority is finding a consultant who really knows his or her stuff and then making sure you’re getting all the right treatment options.

PREGNANCY AND BIRTH

Women should now be offered a variety of options for their maternity care and where they give birth — whether it be at home, in hospital or at one of the new generation of midwife-led birth centres. However, women might be limited by what is available in their particular area. These are some key questions for your midwife or GP that may help you get what you want.

KEY QUESTIONS
Do I have a choice in who cares for me?
All women should be offered a choice as to who looks after them in the period up to the birth (antenatal care); but women with low-risk pregnancies will be offered care led by a GP or a midwife and centred on a hospital-based maternity unit. Only women with a higher risk of complications will see an obstetrician. If you have obstetrician-led care, it is worth finding out about their experience and special interests, and expressing a choice if you have one. You can find consultants’ details here.

What tests will be done during the pregnancy and when?
You will usually have an ultrasound scan at about 12 weeks to check that the pregnancy is proceeding well and confirm your dates. In some units this scan can also be used to screen for Down’s syndrome. An eight-week scan to provide early warning of certain conditions might also be available but not all units will offer this. A further ultrasound scan is usually carried out at about 20 weeks. Find out what tests are available, when you can have them, what they cover and whether there are any associated risks. Click here to find out which maternity units routinely offer which tests.

Do I have a choice of where to give birth?
Most women have views on whether they want to give birth at home, in hospital, or in a midwifery unit attached to a hospital. But doctors and midwives have differing attitudes to issues such as home birth — how much choice you have may depend on their view and the policy of the maternity unit (attached to a hospital) that you have chosen. Dr Foster data show that some maternity units record more than one in 10 births at home but the average home birth rate is less than 2 per cent.

Will I have the choice of a water birth?
You will for many hospital births — about 75 per cent of maternity units have birthing pools, although many have only one or two, so there may not be one available when you go into labour. Some units deal with as many as 800 water births a year. If you are having a home birth, birthing pools are available to hire — but you need to make sure that your midwife is happy with this option.

What pain relief is available?
Many women want to go through their labour without pain relief but it is worth checking about the types of pain relief available in case they are needed. Etonox (gas and air) and the painkilling drug pethidine will be available in almost all units. About 33 per cent of women will have an epidural — a painkiller injected into the membranes around the spine. But these may not be recommended and are not normally available on request. Talk to your midwife about each form of pain relief. Click here for more information about which types are available in different maternity units.

What is the Caesarean-section rate?
Caesarean-section rates vary between different units — some are less keen to perform this procedure than others. Dr Foster data shows that the average emergency Caesarean rate is almost 14 per cent but for some units it can be as high as 20 per cent. It’s worth checking out your maternity unit’s Caesarean rate and asking your midwife or doctor about the circumstances in which Caesarians are conducted. If you would prefer a birth with the minimum of intervention, find out what is available in your local unit to support your choice, such as special birthing rooms where all the hi-tech equipment is hidden away. Make it clear if you have a strong objection to interventions and investigate alternatives with your midwife and obstetrician.

What are the unit’s intervention rates?
Some maternity units are more likely to use instruments or induce the birth than others, so ask your midwife or doctor about intervention rates. The average rate for forceps use during delivery is 3 per cent and for ventouse (helping the baby out with a vacuum device) is 7 per cent. Click here for details of intervention rates at your maternity unit.

What care is available if things go wrong?
If there are problems with the birth, you want to know that you or your baby can get the necessary care as soon as possible. The Dr Foster birth guide here shows whether paediatricians and obstetricians are available 24 hours a day at your maternity unit and whether there is a special baby unit.

RECURRENT MISCARRIAGE

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