Friday 2 September 2011

Pregnancy and Breastfeeding in the US/UK - #1 healthcare

I must say that I appreciated the NHS a whole lot more when I wasn't relying on it for my family's wellbeing, now I am actually in the UK I'm not so sure.

I was never without healthcare in the US, and I was lucky to work for organizations that provided a pretty good range of policies that didn't care about pre-existing conditions.  I remember reading an article before we left the States saying that many insurance companies now viewed pregnancy as a pre-existing condition.  I had also read in the Baltimore Sun some months before that some women were now being refused insurance because they had told their Doctor that they had not been able to conceive after trying for three months and been labelled as having a pre-existing condition of being infertile.  There are huge debates about healthcare in the US, and especially since Obama came to power and changed the entire healthcare system.

After having a baby on both sides of the pond, I have some big opinions about both systems, so thought it'd be good to talk a little about each, of course experiences would be completely different if you deliver in another hospital, state or county.  I delivered at Anne Arundel Medical Center/Bay Area Midwifery in Maryland, US and Pembury Hospital, Kent UK.

Cost - I paid a monthly premium for my healthcare in the US, my employer also paid a portion of this cost.  My out of pocket costs for the premium ranged from $0-$60 per month give or take.  I then paid at each Doctors visit, emergency room visit, and for prescriptions.  These ranged from $5-$25.  My first pregnancy and delivery cost me a total of $5 above the cost of the premium.  I was very lucky to have good insurance.  I'm sure that a friend of mine told me that her insurance only covered 80% of the hospital stay.  So, if an average stay is $3000-$5000 without including the possibility of surgery or intensive care costs that could happen, this could leave you with a pretty large bill.
I don't think I had to pay anything in the UK, I even get free prescriptions for the first year of my daughters life.  I was even lucky enough to deliver at a brand new hospital that had private rooms, so I didn't even have to share a room after the delivery.

Care - In the US I took an unusual route and decided to see a midwife for my prenatal care, and then deliver at a birth center.  This was something that I had to constantly explain to family and friends because it was so unusual.  The majority of births are handled by obstetricians in the US, whether they are high risk or not.  The prenatal treatment and deliveries are very medicalised, with lots of testing, scans and scare tactics.  I was sent to see a specialist at 36 weeks when I was measuring a whole 1cm too big.  The OB did an ultrasound to check that the baby was OK, he then went on to tell me that the baby was going to be huge and that if I hoped for a natural birth with a midwife I'd better hope the baby came soon.  As a result of this highly medicalised system, there are very high numbers of inductions, c-sections and maternal deaths in the US compared to other developed countries.  One of the biggest benefits of delivering in the US is that you get to choose your health professional, midwife or doctor.  You can shop around to find one you like, and you then see them until they discharge you at 6 weeks postpartum.  I soon found out that in the UK the only way you'd know the person delivering your baby was to has a home birth.  I was really shocked when I found out that the midwife that would deliver my baby would be a stranger.  I have to admit that it was the midwife "situation" during my second delivery that ruined the experience a little for me.  So, I saw my local community midwives during the prenatal period and they came to the house after discharge, but the delivery midwives are purely pot-luck.  On the other hand of course, I got the midwife I least liked for the delivery of my son in the US, but I did at least recognize her.

Which is best?

That's a hard question to answer, I had very different experiences in the US and the UK.  I can however, say that I trusted the information I received from the health professionals that I chose for my care in the US.  We spent time and effort finding a birthing centre that had a tub, we liked most of the midwives and trusted their judgement.  We spent even more time looking for a great pediatrician for our son who had similar beliefs to us, and would take our thoughts into account and not just assume he knew best.  In the UK, I found the health professionals a little cold, quick to get us out the door and they always gave conflicting information.  The UK approach was a little more relaxed you might say, unless there was something wrong with you.  I had hardly any testing done, and only had one blood test when the US results were deemed insufficient.  A lot of preventative tests that I had in the US are not performed in the UK, and many women find out they are diabetic very late on in the pregnancy.  I, myself had protein in my urine from the first time I peed in a cup in the UK, but it wasn't until 16 weeks later that one of midwives decided to do something about it, and we never got the results because Ellie came early.  At the end of my first pregnancy I had been tested positive for Group B Strep and received antibiotics during labour.  In the UK they don't test for this, and when I asked about it was told that unless there was a reason for testing nearer the due date or I paid for it I would not be tested, and no antibiotics would be given unless I'd had a positive test during the pregnancy.  OK, it's a very small risk for the baby, I did not pay for the test.  When I arrived at the delivery room the admitting midwife went thorugh my notes and mentioned the Group B Strep, and we discussed that it had been with my first pregnancy.  She assured me again that they didn't routinely give antibiotics if there hadn't been a recent positive test.  At about 3am, a few hours after delivery as I was settling into my room with my new baby a different midwife came into my room and told me that I should have had antibiotics during delivery and that I should watch my baby closely for signs of infection.  On telling her that I had spoken with the admitting midwife about this very subject, she said that she had called the admitting midwife and she had denied talkng about it with me.

I think overall, a common thread in both countries is that women accept their care as is and don't question it.  This leads to a lot of unsatisfactory birth experiences.  The majority of women who take control of their births come out the other side with much better memories, and huge self confidence.  If I had let the midwife and six Doctors push me into being induced when I was obviously (to me) in labour but the baby had pooped in the womb, then I probably would have had a completely different experience, possibly leading to a c-section (as many inductions do).

So believe in yourself, your body IS made to give birth.  I have now given birth to two beautiful children, one big and one small and both completely without medication.

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