On the monitor

Giving Birth: The US and UK

Everyone asks the difference between giving birth in the US and the UK. Here is our experience:

America

The States is based on a medical model where data is collected frequently, pain is highly controlled, and prescription pills are given out readily. An obstetrician is the primary care provider. New mamas research heavily into the practice, philosophy and personality traits of this physician and the hospital(s) where they have privileges.

OBGYN appointments are typically once a month for the first trimester, bi-weekly during the second, and weekly for the last month. You get to know your doctor and nurses very well. 

We selected our children’s birthdates and induced at 39 weeks strictly because it worked with our schedules- I needed to be back in grad school after two weeks for our first, and I didn’t want to risk my second sharing his birthday with Thanksgiving.

Photo credits: Marisa Swarbrick Photography

Labor in the US involves a sterile field, frequent checks on dilation, ice chips only, exceptional pain management, IV fluids, and continuous monitoring of baby and contractions. Highly skilled paediatric nurses are present.  

Baby was thoroughly examined by a paediatrician, immunised and respite care by paediatric nurses is available. Lactation consultants, newborn photographers, nurses for mama and baby flood your room. We had over 20 visitors for each of our babies. 

After an average stay of two to three days, new moms are sent home with a bag full of prescription meds to manage pain.  The average cost of having a baby in the US is about $8k (although highly variable).

The UK

In the UK, an OBGYN is only consulted in high-risk cases; community midwives (MW) handle everyone else. You see the MW in your neighbourhood and go to the hospital in your area.

 The UK’s philosophy is very hands-off.  I never got weighed, there was no standard glucose testing for gestational diabetes, and I only saw the midwife for 4 scheduled visits.  Foetal dopplers aren’t performed until 16 weeks, and the ultrasound tech, who we saw twice, was reluctant to use the doppler saying it wasn’t “medically necessary” and something about the risk of exposing baby.

Medical issues were addressed during separate appointments with a general practicioner.  At 40 weeks, I practically begged the MW to be internally examined and was denied- MWs are extremely resistant to do anything that could potentially induce labor.  Midwives hate unnecessary interventions.

Typically, women utilise gas and air (laughing gas) for pain management and an injection called Pethidine during labor.  Although women have the option of an epidural, it is discouraged and ideally reserved for really difficult labours. Women are offered a home birth, are expected to labour at home until 4-5 cm dilated and are sent home from the hospital typically after 4-6 hours after having a baby. Even the Duchess of Cambridge gave birth and went home the same day. In heels no less.

Paracetamol is recommended for post-partum discomfort (the equivalent of OTC Tylenol).  During labor, baby is monitored very infrequently. Labour balls, slings from the ceiling, mood lighting and music, mats, and bean bags create an environment conducive to very engaged participation in labouring. The atmosphere is beautiful.

After birth, baby is weighed, but not measured.  Bathing the baby during the first week is discouraged and considered “detrimental” to the baby. The MW encouraged a responsive feeding schedule based on baby’s feeding cues which is amazing. Our paediatrician in the states always wanted our babies to schedule feed until they met their birth weight- feeding every three hours.

The entire out-of-pocket bill for having a baby in the UK?  £8.00. The cost to park at the hospital.  A MW comes to your house to look over baby several times before handing off baby’s care to a health visitor on day 10. A paediatrician is considered a specialist consultant.

My impression? Each country has its own culture revolving around philosophies of pregnancy and childbirth. One emphasises new technologies, sciences, and takes advantage of third party reimbursement services. It is largely commercial. US hospitals are competing for business and the creature comforts are exceptional. You develop amazing relationships with your care providers. The UK recognises pregnancy as a normal human condition and childbirth as something the body performs best naturally and should be left to do so.  I can see great points to both approaches, and I would love to find the middle ground between the art and science of pregnancy and delivery.

I can’t wait to share our newest arrival’s story. Stay tuned. Kathryn Earl Photography did an amazing job capturing my first contractions to our baby’s first breath.

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