Yes, I'm at it again. Comparing apples to oranges and wondering about maternity services on all side of the pond and what's "normal". Of course, normal is questionable as well, isn't it? What's normal for one person is completely abnormal to another. What's necessary for many may not be necessary for all. It's hard work to come up with the perfect, Utopian package for maternity care but there are some interesting differences wherever you look.
We all know I am American but I have not had the pleasure of having a baby in the US of A. As most of us know, there is no National Health Care currently in the US. This means that anyone needing medical care of any kind either has to foot the bill themselves or work for an employer who in part or in most will cover the cost of monthly insurance premiums. There is a plethora of private health insurance companies who all have different plans, costs and coverages. On some US health insurance plans, certain aspects of pregnancy/labour/delivery may not be covered. It is then the burden of the individual to pay for those uncovered charges. This is very difficult for many Americans who may possibly end up in debt after unplanned medical expenses.
I am exceptionally grateful that the UK provides us with the NHS. Free medical care for all regardless of income or condition?! Free prescriptions for a year for pregnant women? Free prescriptions for all children until the age of 16? Free contraception? This is a miracle! The US is desperately hoping for a miracle of it's own.
The other day, I started thinking about my antenatal care for this, my 2nd pregnancy. It hasn't been ideal but it hasn't been horrific either. But what I did realise is that, at 24 weeks pregnant, I have only seen my community midwife TWICE. I won't see my midwife (whom I really don't even know and who won't deliver my baby) again until 28 weeks of pregnancy. So that means, once for the booking in appointment (8 weeks) and once at 16 weeks. That's it. I have had a Dating Scan in there (11 weeks), an appointment with the consultant at 17 weeks (due to having risk factors with this pregnancy) and an anatomy/anomaly scan at 20 weeks. However, I have not had any antenatal checks since that 16 week appointment. Maybe I'm crazy, but doesn't that seem a bit off? I know that I am a relatively healthy person but still. Seeing your midwife TWO times in 28 weeks? I don't know...it just seems too little.
I decided to compare and contrast the standard US "prenatal" care with the NHS standard ante-natal care and UK Private Insurance ante-natal care. Here's what I found:
- US Pre-Natal Care: 1 appointment with Ob/Gyn or Midwife every 4 weeks until 28 weeks (7 appts); an appointment every two weeks from 28-36 weeks (4 appts); an appointment every week from 36-41 weeks (5); an appointment every few days until delivery = Total (avg) of 16 appointments until close to delivery (also have Dating Scan at 11-13 weeks, Anatomy Scan at 20 weeks; Growth Scan at 32 weeks + multiple blood tests throughout the pregnancy)
- NHS 1st Pregnancy: Booking in appointment with Midwife at 6-8 weeks; 12 week Dating Scan; 14 week bloods; 18 week midwife visit; 20 week Anatomy Scan; visits with midwife at 24, 28, 30, 32, 34, 36, 38, 40, 41 = Total of 11 visits with midwife
- NHS 2nd Pregnancy: Booking in appointment with Midwife at 6-8 weeks; 12 week Dating Scan; 16 week visit with midwife; 20 week Anatomy Scan; visits with midwife at 28, 34, 36, 38, 41 = Total of 7 visits with midwife
- Private Health Care (BUPA- UK): Booking in appointment with midwife/consultant before 10 weeks; 10-13 weeks Dating Scan; Blood Tests for Genetic abnormalities 11-14 weeks; 20 week Anatomy Scan; 28-32 weeks Growth Scan; Midwife Visits at 23, 27, 30, 34, 36, 37, 38, 39, 40, 41 weeks = Total of 11 visits with midwife (The Portland Hospital offers 14 antenatal visits plus scans at 12 weeks, 20 weeks and 32 weeks)
- Of course, these various comparisons are based on a low-risk, healthy pregnancy. No matter where you are, if you fall into a higher-risk category (multiples, health problems for mum/foetus, other risk factors), you would of course receive the additional support and care that was required whether that be through a midwife, consultant, ob/gyn or GP.
Obviously, in the US you're paying for the care you receive and if you choose to go private in the UK (as long as private will cover your pregnancy care which it doesn't always), you will be paying for the care you receive. What I don't understand is why, on the NHS, is a first pregnancy one standard of care and a second pregnancy an entirely different standard of care? So if you've already "been there, done that" you don't need to have the same amount of time with medical professionals? Yes, I know that provided you are a healthy woman with low risk you generally won't need a lot of "intervention" the second time around. But shouldn't you have the same access if you want it? Every pregnancy is different. You may have different symptoms and/or difficulties associated with a second pregnancy. You may have more stress and challenges the second time around as you're already looking after one child. Maybe the "breeze" that was your first pregnancy won't be the same with your second?
Yes, in most cases, you can ring up your midwife and speak to them over the phone about your concerns or even schedule an "unauthorised" appointment to talk about any niggles. But it seems to me that regardless of 1st or 9th pregnancy, you should be provided with the same standard of care unless you choose to opt out of it. What do you think? Did you feel that your antenatal visits were pointless and unnecessary? Would you have appreciated more time with your midwife? Did your community midwife (the one you saw for antenatal visits) attend to you for labour and delivery as well? Were you fortunate enough to have a medical problem diagnosed and thus treated as a result of your antenatal visits?
**Due to previous displeasure with me bringing up the topic of antenatal care on the NHS, I would like to reiterate that I am eternally grateful for the NHS care which has been afforded me and my family and for which I have not had to pay out of pocket although I have contributed to through my taxes and NI contributions as a result of being gainfully employed in the UK for more than a few years. I am not criticising the NHS but QUESTIONING the services which are provided to us which any tax-paying resident is entitled to do.**
***I would also like to acknowledge that the NHS provides midwife visits for several weeks IN THE HOME immediately following delivery of your baby and a Health Visitor will continue to see you IN THE HOME until you both feel that you are fully prepared to be discharged to your local surgery. This would NEVER happen in the US. Once you leave hospital with your baby in the US you're on your own. The NHS scores mega-points with this highly beneficial service.***