The most common question I get asked by my US friends about the birth of my third kid is how does free healthcare compares to the US healthcare.  Pretty well, actually.  My first birth in US was a very standard one at St. Lukes Hospital, above average with all the bells and whistles.  Unfortunately, the doctor who led my pregnancy wasn’t available and his back up turned out to be an inadequate schmuck which resulted in what most likely was an unnecessary c-section.  (drawn conclusion: money can’t buy you a good doctor).  For my second birth, which was to happen 16 month after the first one, I had a hard time finding a doctor who would attempt a vbac.  Most doctors gave me a very wise ‘if you were my relative I wouldn’t recommend it.’  Fair enough.  I found a midwifery, that delivers at St Luke’s, with MDs as back-ups, that would take me on.  At the time of my delivery, one of the 6 midwives on rota was available, but not an anaesthesiologist.  It was a vbac, all right, a completely drug free one.  (drawn conclusion: money can’t buy you drugs when you need them).  Now I understand that have I gone to a private clinic and shelled out the dough I would probably avoid all of the above, but didn’t I already having paid for my insurance year after year?   Above mentioned are very standard occurrences during child birth in US, just roam the blogs.

When I got pregnant in London, I had these two previous experiences to rely on when making my decisions on how and where.  I was also pregnant and perhaps, wasn’t thinking straight.  It could happen.  We still have our insurance, so I had two choices: go the free NHS route or the private insurance route.  My prego brain decided (after talking to other expats who gave birth here and had enough to say about questionable care at NHS) that I will try and go the NHS route  (because what could go wrong during childbirth).  Lucky for me we live close enough to one of the better hospitals in London (Chelsey and Westminster), a solid comparable to St Luke’s.  So my fears of potential disaster were somewhat pacified.

Antenatal appointments

• Pregnancies in UK are led by midwives. The doctors are there in case of complications or risk cases.
• The care schedule in UK is similar to US. You meet with your healthcare professional and do a confirmation test.  The first ultrasound is done between 8 and 14 weeks to determine the due date and at the same time a blood test is done to check sugar and protein content.  16 week discuss anomaly scan.  18-20 weeks do another ultrasound to determine if there are any physical abnormalities.  Next meetings are set at 28 , 34 and 38 weeks.  After you hit 38 you come in at 40, 41, 42 until they will try to induce you.  Before any drug inductions they will do membrane sweeps, which in US were only done by midwives (up to 5 years ago, could have changed since).  You are also offered the standard whooping cough and flu vaccines.  Every time you come to the hospital and meet any one of the midwives on shift.  The only curiosity I noted is the fact that there was no sanitary wipes in the toilets for the urine tests  – it’s bring your own or use a faucet.
• And the only difference in their approach was complete comfort with vbacs.  I noted no hint of surprise when any one of the staff read the history of my first vbac.  It was a given.

Delivery

Once you arrive, you are entered into the system and are checked for labour stage.  In my case, I was ready to go so I lied in the admissions until I felt my water break.  At this point I have realized that I’m still wearing my street clothes.  I asked the nurse if I will be changed at some point and she shrugged.  It dawned on me to at least take off the skirt.  When the contractions started rolling in and the memories of things to come finally hit me I informed the midwife that I absolutely must have an epidural.  The crazy hysterical note in my voice has probably alerted her that I am in no mental state to do this drug free and off she went looking for anaesthesiologist.  At this point, recalling all the horror stories of anaesthesiologist not being available, I faced a grim possibility of having to do this al natural one more time and the only time I regretted not going the private route, which would at least increased the possibility that an anaesthesiologist would be available.  Alas, when the doctor miraculously appeared, I was elated.  From this point, it was a by the book birth.  We chatted with hubs, who left briefly to drop of kids at a friend’s house, we discussed female anatomy related to labour process with the midwife.  I even facebooked.  The birth was so easy and pain free I am still not sure if I cried from happiness of how easy it was or because we had one more baby girl…

Aftercare

Here is where the main differences lie – the aftercare.  The main ward under NHS houses 6 women with their respective babes in one room.  Babies stay with you the whole time.  There’s no ‘nursery’ for the night.  If you are a first time mom there is plenty of supporting staff to get you through breastfeeding-pooping-new-baby-what-do-i-do-now questions.  When it’s your third their attitude is significantly more laid back.  Like waaay back.  So for the one night I was going to spend in the hospital I wanted to know what my options are for the ward with at least not as many women in one room?.  In the states, I had one neighbor both times and that was ok.  Mostly.  Except for my first neighbor, who had a rotating schedule of her 25 relatives day in and day out. (drawn conclusion: money can’t buy you quiet unless you shell out more money for the uber private suite).  In UK my options were free 6 women+6 new borns in one room or a £1k private room with concierge service.  Can we shell out 1k, may be.  Do I think it’s reasonable to spend that kind of money for 1 night?  No.  It was then that the nurse mentioned that they do have brand new birthing rooms available for rent pending availability at a whooping 400 quid.  We decided that for some peace and quiet it’s a worthy price and have settled on the birthing room.  The room was brand new and very well equipped for the birthing.  It was not, however, a great place for a post-birth mom as it turned out.  After I was relocated there with my baby an MD came for a check-up. In my case, the doctor recommended to elevate the lower portion of my torso (my bum) and apply an ice pack to appropriate parts.  This is when it started getting interesting.  The nurse did not have ice packs.  She has, however, produced a glove full of ice cubes on which, she suggested, I should sit on.  Needless to say sitting on a bag of ice cubes in a normal state would have been challenging, but I gave it a whole hearted attempt.  The second part of the task, to elevate the bum, has also proved to be a challenge.  The bed was a birthing bed –  flat, hard and nonadjustable.  The nurse obviously enthused with her success with the rubber glove cold pack brought in 5 duvets and started arranging them in a pile in the middle of the bed.  After the constructions, I plopped my tush on top of the heap and it promptly went flat the second the two made contact .  As this was the nurse’s one and only idea and I was too tired to come up with one of my own I graciously let her go.  Big mistake. Huge.  This was the last time we saw anyone until the morning hours.  They were not surprised to see us still breathing at the morning rounds.  That same night I faced with another challenge which would have been incomprehensible in the US settings.  After the birth of my first child I did not pack the hospital bag.
Why bother? They give you everything you need and more.  Unless, of course, you are fussy about your shampoo, soap, slippers and can’t wait a day.  I’m not.  So with my preparations for the 3^rd birth I didn’t bother until the last moment until someone… someone mentioned that, gasp, they won’t give you a diaper,  a wet wipe, a cotton swab.  You get nada.  I somewhat packed the necessities thinking this to be silly and impossible in a great modern hospital.  Surely, this one, in a good neighbourhood that it is. will have some…stuff… the rubber glove was my first hint that it was not so.  I was somewhat fooled by the familiar look of the baby trolley with the drawers on the bottom.  You know with the shelves stacked with all sorts of hospital goodies.  Then came the ‘oh crap’ moment when you hold your new born like a chicken by the feet in midair with one hand with the glorious black ooze coming out in disproportional, to the baby’s relative size, amounts and with another hand you search the cupboard for the sign of anything at all that can be used as a wipe.  This is also a moment when you realize that you and your oozing baby are standing on one side of the room while the hospital bag you packed are on the other side of the room hopelessly unreachable (the ‘come-hither’ button near the bed is equally unattainable).  Yes, there was a way and I managed just fine, but the question remained.  Why such a great marketing tool as giving a mother a bag fully of supplies for her new born has not crossed over.  I know that the reason I prefer pampers over huggies is because that’s what I was given at a hospital same with butt cream and wipes and million other things they managed to stuff it with.  Two words – brand loyalty.  It works.

Conclusion. The only difference between the two systems is the bells and whisles.  You want them pay up extra.  You don’t – you’ll probably be fine without that extra cushion or a cold pack.