This one will be long. You sitting comfortably? Okay.
I was never pregnant while I lived in America, so I don’t really have anything to compare my prenatal care experience to. I can only go by what I’ve read on other blogs and by what friends with kids have told me. And I can only conclude, based on both my anecdotal experience and published evidence, that overall, mothers in the NHS system are better off than mothers in US private healthcare. This is in spite of the fact that Britain has similar rates of high-risk pregnancies, and also the hands-down worst teen pregnancy rate in Europe. On top of that, it is SCARY SOCIALIZED MEDICINE– EEEEK!!!!!
But seriously. There are other parts of the NHS that need fixing– it shouldn’t take Trev 3 months to get a physical therapy appointment, and folks over 65 are often treated disgracefully. At many hospitals, MRSA is a real concern. But maternity? The NHS beats any health care system in the USA (unless you’re talking about The Farm).
Part of the NHS’s success is an institutional attitude towards pregnancy that does not see it as a medical condition. Gestation and birth are treated as normal human events that should be monitored for problems, but that don’t necessarily need technological interventions. Unless you have a high-risk pregnancy (in which case you are assigned an obstetrical consultant), your primary care is handled by a midwife or midwives. These are not 17th-century crones in rags with dirty instruments. Nor are they yogurt-knitting earth mothers who offer you chakra balancing as a method of pain relief. They are trained, degreed nurses with extensive experience in the medical aspects of pregnancy and labor.
But there’s more to it than that: your midwife develops a relationship with you. In addition to making sure you don’t get gestational diabetes or pre-eclampsia, she (very rarely he) is your front-line contact for everything from how to file for maternity benefits, if you need them, to how you are coping with the idea of becoming a mother to what kind of breast pump to buy.
My midwife not only knows about the height of my fundus but also the names of my cats. She’s met my husband and had tea in my living room. She probably will not be there on B-day (more about that later) but she’ll pop around when we’ve returned from the hospital to meet the baby she’s been dopplering and palpating since July. This approach to maternity care helps reassure an expectant mother, demonstrates that the state values women and children, and is also a clever way to nip social services problems or things like maternal depression in the bud. It isn’t perfect or foolproof, but I bet women in the US would have to pay thousands for it.
So, here is what my care has been like:
In June I learned I was pregnant. I phoned my doctor’s office and met with one of the general doctors. She took a urine sample, my blood pressure, and went over my medical history. She described the two nearest hospitals with maternity units and asked which one I would prefer to be registered with. I chose Birmingham Women’s. Three days later I received a telephone call from my midwife, Shelley, and made an appointment to meet her at our house during my seventh week.
Our initial interview lasted an hour. We discussed everything from exercise and nutrition to how Trev and I met and her experience as a midwife (ten years, several hundred babies delivered). She began to fill out a file of green notes, gave them to me, and told me they would have to be brought to appointments. She also mentioned that from week 37 onwards, it was “a very good idea” to carry them with me wherever I went. She also handed me a urine sample vial. I was expected to carry a plastic container of my own wee– ideally the day’s first– to every appointment. Whenever I walk to the clinic, I worry about being stopped and searched and arrested for… something. Some sort of wee-fetishism. I’m sure there’s a law.
To resume: Prenatal appointments are scheduled for every four weeks until week 32, when they begin to occur every two weeks. During week 10 I went to a clinic appointment where I was weighed and measured— the only time this has happened, thankfully. I was then tapped for several vials of blood to confirm my blood group, immunity to rubella, iron levels, and whether or not I had nasties like HIV or Hepatitis B (nope). This was also the dating scan week, where the fuzzy image below confirmed that I was baking a small person and not just the victim of very persistent gas:
And auntie Steph was there to see it.
After that the pregnancy continued smoothly. I am blessed to be so sturdily built: no stretch marks, no backache, no complaints, really, to speak of, other than being tired and breathless in these latter weeks. My boss Yelena assigned me revisions of a very famous pregnancy website for the summer. I continued going to the gym and running, much to my mother-in-law’s horror. I made a conscious effort to eat more vegetables and actually succeeded in doing so. Every four weeks I checked in with Shelley at my GP’s office to get prodded, discuss cat ownership and US politics, and spend some time hearing the very reassuring WHOOSH of Bean’s heartbeat. In October Trev and I went to the hospital for the anomaly scan, which made Trev cry and confirmed that Bean was, as I strongly suspected, a she-tus. Later I read that her teeny tiny reproductive system was already formed, including all the eggs she would ever have. In other words, I am carrying not only my daughter, but bits of my grandchildren inside me. That is amazing.
In December I attended three childbirth classes at the hospital. Based on the editing I’d been doing, and other pregnancy websites I’d been browsing, I had very low expectations. Pregnancy resources seem to treat women having babies as if they are babies, too– and don’t even get me started on the stuff addressed “to Dads”. Fortunately, this class was run by the very wonderful National Childbirth Trust. The instructors were down-to-earth ladies who treated us all like adults, which was refreshing, and offered very tasty cookies and tea, which were refreshments.
At about the time I was taking the classes I was also reading Ina May Gaskin’s Guide to Natural Childbirth. I recommend it even if you plan to have an epidural fitted while you’re registering at Labor & Delivery– the birth stories submitted by women are very encouraging to read, and while Gaskin is very very down on the medical model of birth, you come away from the book reassured that you’re made to give birth; that, as she says “Your body is not a lemon!”
I mention this because one of the childbirth educators actually said it while talking about contractions: “Your body is not a lemon! You are not being injured!” She explained that in early labor a woman’s mindset towards pain has a measurable effect on how the first phase of labor progresses (or not). I thought this was an amazingly reassuring thing to hear in a hospital setting. Am I wrong?
Even more reassuring was the hospital itself. We toured the ward. The regular delivery rooms have dimmable lights, adjustable beds, and shower units in addition to all the important life-saving equipment. You are allowed to bring your own pillows, music, light snacks, birthing props, and two birth partners. During your labor you have the right to walk around and adopt any position you like for delivery. You are not required to have an IV or a fetal monitor strapped to you, and when baby is born they encourage you to immediately adopt kangaroo care while they take care of the third stage. Unless baby is struggling or the room is needed, the midwives will let you all bond for up to an hour, and even make you and your partner a cup of tea. Then they will run baby through his or her APGAR tests, administer Vitamin K, and help you clean yourself up while baby is given a hospital band and dressed. If your partner wants to dress the baby, she or he can, and a midwife will help out if needed. You can stay at the hospital for up to two days, but you can also opt for a minimum stay of six hours. Whenever you decide to leave the hospital, a midwife will visit you at home on the next working day.
That’s just the regular ward. There is also a super-deluxe birth centre for women who are low-risk. Trev and I toured this on Sunday, and it is wonderful. The rooms are large and done up like a mid-range hotel. They have their own bathrooms and there is a fully functioning communal kitchen. There is a retreat room and a little peace garden for laboring in, and the midwives will make toast, cereal, or fruit smoothies for the mother (birth partners fend for themselves). The midwives at the birthing centre are trained in massage and aromatherapy. They use very little pain relieving drugs beyond entonox–nitrous oxide to you Yankees– but their outcomes are fabulous. And, glory of glories, there is a birthing pool (I will spare you all the reasons I want a waterbirth for another article).
All of this wonderfulness is not in some rich-lady enclave. Many maternity trusts throughout the UK offer the same services and some offer even btter services. This– a dignified birth without an assembly-line attitude– is available to any UK resident, regardless of her marital, social or financial status. Not bad.