Monday, February 08, 2010
Differences in Maternity Care UK vs. US
I thought that some of you might be interested in what maternity care and birth is like here in the UK. So far there are a lot of differences that I've noticed and I'm only in my 16th week of pregnancy. Some of my knowledge comes from friends who are also currently pregnant or have recently had a baby.
1. Everyone here sees a midwife, unless you are a high risk pregnancy. If, during your pregnancy, you have an issue arise that might require an OB's help, you have a consultation appointment with an OB. But, you keep seeing the midwife for all your prenatal appointments.
2. You can choose to have a homebirth or hospital birth where a midwife will attend your birth.
3. Even though there might be 6 or 7 midwives in the hospital group you are assigned to, you will typically see the same midwife each visit. This is because you are assigned a particular doctor's office and the midwives don't rotate their stations--they work at the office they are also assigned to. (Usually in the US if there is a group of midwives you rotate through all of them to get to know them and vice versa.) You don't know who will be on call when you go into labor.
4. They don't monitor your weight here. They get an inital weight at your first appointment and then they don't weigh you after that.
5. Some tests, like the glucose intolerance test, are not routinely administered unless there are certain risk factors to indicate a need for the test.
6. You only see the midwife for appointments at 8, 16, 28, 34, 36, 38, and 40 weeks. They routinely do 2 ultrasounds-one around 12 weeks to check for dates and one at 20 weeks to check for abnormalities.
7. You carry your health records with you to every appointment. They fill in information but they don't keep the file--you are responsible for it.
8. You have to bring EVERYTHING with you to the hospital if you have a hospital birth. Pads, diapers, hat for baby--normal things the hospital would provide in the US you are responsible for bringing.
9. It's FREE!
10. There seems to be a general assumption that your birth will be normal.
11. Epidurals are not as common here--somewhere between 30-50% of births, I think. In the US it is about 95%. They do use something here called "gas and air" which is laughing gas, I think. That is very common for women to use during the most intense parts of labor.
12. You get free dental, eye care, and prescriptions while you are pregnant and for 1 year after the birth of the baby. (The prescriptions may not be free for one year after--I can't remember)
13. You also get to bring in your "wee" (pee) at every visit. They provide you with a container that you wash and bring with you for each visit.
Overall there are a lot of good things that come with the NHS and the care you receive here while pregnant. I do wish that I was going to meet with more than one midwife during the pregnancy and also that I went a little more frequently. I know there isn't a lot that is done during appointments early on--checking for the heartbeat and feeling the top of the fundus to make sure everything seems like it is growing like it should, checking blood pressure and urine--but it would have been nice to hear the heartbeat a little sooner. Because of the fewer visits I feel a more disconnected from the practice and shy about calling for problems that concern with the pregnancy. Thankfully, I haven't had any issues come up but I don't feel the same kind of closeness that I experienced at the birth center in Pittsburgh. The system still feels like a system rather than the "mother centered care" value I had grown to love from the midwives in Pittsburgh.
There are independent midwives that are not part of the NHS and do homebirths but they are uber-expensive--I wan't to say around 6000-7000 US dollars. I think I would enjoy working with an independent midwife more but we don't have that kind of money to spend on a homebirth and I think the care I get is adequate.
Once I'm further along into the pregnancy I'll probably have a part II to this. I have my 16 week appointment on Thursday and I am looking forward to it. I haven't heard the baby's heartbeat yet and I'm still wearing my normal clothes. I'm tempted to be thankful that I haven't gained much weight or worried that the baby isn't growing like it should. This is the FIRST pregnancy that I've still been wearing my normal clothes for this long. With the boys I was growing out of my clothes somewhere between 12 and 14 weeks. I think I have another few weeks left in my trousers and I want some reassurance that everything is progressing normally. It works out well since my maternity clothes are still in the US!
Once I'm further along in the pregnancy, I'm sure I'll have a part II for you.