Well, I say we were crazy, but we were blessed, too. I’ve told you about the routine antenatal care we received; it’s overdue that I explain what care is available for birth.

As standard, NHS midwives lead 8 hour courses (usually broken into 4 classes over 4 weeks, covering birth and baby’s first month) to educate parents on the facts and their options. You might be surprised to learn the options. There is also a non-profit organisation called National Childbirth Trust which offers a range of services, including classes, for a fee.

For those who want very little medical intervention, and for whom there are no contraindications, a home birth can be arranged (by week 37) with the community midwives in most areas. The midwives will bring supplies like a baby heart monitor and oxygen tank to your home at 37 weeks so that you are ready when the moment comes. Two midwives attend the birth, but they are in your home so you have quite a bit of control over the big event at the same time that you have personal medical attention (which doesn’t change for the duration of the birth as contrasted with hospital births) and someone to advise should anything out of the ordinary occur.

For slightly more access to medical intervention, in situations where there have been no complications in pregnancy, most hospitals have a step down unit or birth centre near by or on site. These facilities are set up for natural births, some having birthing pools. Each room is equipped with birth aids like a walk in shower, railings, cot, yoga ball, and birthing stool. Laughing gas, diamorphine, and pethedine (rarely used) are available. Midwives lead these units, but their attention is split between patients as mums get on with labour. Mums ready to push get priority of course! Midwives in these facilities work in shifts, but they usually have a small number of patients, maybe two or three. After birth, mum and baby are transferred to the maternity ward if staying overnight; the stay after birth is usually between 6 hours and three days.

Hospital labour wards offer access to the full range of medical staff and equipment. On the labour ward mums can opt for natural birth, laughing gas, oral pain meds, induction hormones, and epidural. Equipment assisted birth and Caesarian are available if required and can be requested if physician/mum can justify their use in a non-emergency situation. Primary care through labour is still provided by a midwife, but physicians are available when required to administer medications or perform procedures outside the remit of the midwife. In addition to any amenities in the room to aid natural childbirth, equipment is available to revive, warm, and measure a baby. Operating theatres and a neonatal intensive care unit are nearby. After birth mum and baby are transferred to the maternity ward; the stay after birth is usually between 6 hours and three days. Dads can’t stay overnight in the hospital unless the use of an amenity room is purchased.

No matter where birth occurs midwives are meant to see you through birth, assist with breastfeeding, and ensure that you are ready to be on your own with your new baby. After birth a midwife will visit you at home–if you were in the hospital they visit you on your first and fifth day at home. Then, a health visitor will check on you around day ten. Mainly these visits are aimed at ensuring the baby is feeding properly (weight being checked at the second midwife home visit) and that you are comfortable caring for them. You can also ask the midwife to check your incision/stitches/etc. Until babies return to their birthweight they are checked weekly by community midwives in a nearby clinic; once that milestone is reached, babies are discharged from midwife care to the care of the health visitors who run weekly well baby clinics at your GP’s office. Health visitors can weigh your baby and answer routine questions any time you drop in to the well baby clinic.

The GP will see the baby at 6-8 weeks for routine checks, after which the GP sees you as needed. A nurse administers immunizations as required.

It seemed confusing at first–I admit that I still ask for clarification about who to see when and in what order quite a lot… We are so fortunate to live in the borough of Islington where the free services on offer are extensive. The local tax I pay is certainly coming back to me.

Coming next: our birth story. Stay tuned. I am typing with one thumb.

Photo courtesy Elsa Konig

I had a fair bit of anxiety taking the second pregnancy test and went through the motions of seeing my GP again. It was a blessing to be incredibly busy in a new position at work while we waited for the first early scan. However, we were lucky enough because of our history to have three early scans scheduled for us although they are not usually offered before the 12 week scan. When all was confirmed to be progressing normally, we were given a ‘booking appointment’ with a midwife from the hospital for 8 weeks. At a booking appointment you fill in your medical notes; these you carry with you everywhere you go because you see healthcare professionals at multiple locations. You definitely carry your notes with you when you travel so that you can always just hand your antenatal record to a medical professional in any situation where you need to see one. All of this documentation is archived by the hospital after delivery.

At your booking appointment the midwife performs a set of routine checks and conducts a lengthy interview. Then she (or he) answers any questions you may have and walks you through what the rest of your appointments will entail, given that your pregnancy is straightforward, and how they are scheduled.

8-14 weeks– booking in (and dating scan if required, to determine the due date)
12 weeks–Down syndrome screening scan
16 weeks–routine midwife visit
20-22 weeks–scan to assess baby’s growth and mum’s health (placenta, cervix, etc.)
25 weeks–routine midwife visit
28 weeks–routine midwife visit
31 weeks–routine midwife visit
34 weeks–routine midwife visit
36 weeks–routine midwife visit
38 weeks–routine midwife visit
40 weeks–routine midwife visit
41 weeks–routine midwife visit

Routine visits include blood pressure and urine checks as well fetal heart monitoring and a manual check of the position of the baby. At each visit there are unique items to discuss and sometimes blood tests which are recommended to be performed. If there is a complication at any time, you are referred to a specialist. For example, when I complained of a serious spike in migraine activity, I was referred to an obstetrician and a neurologist as well as a midwife acupuncturist. I was lucky that the migraines subsided naturally after 20 weeks and I have only had a small handful of related symptoms since then.

Ultimately the philosophy seems to be that pregnancy is a normal, natural occurrence and requires minimal medical intervention in straightforward situations. I have heard the argument that the approach that the NHS takes is centered around being cheaper, not better for me. Having been a recipient of care in this model I can understand where this argument gets its basis, but I can argue from personal experience that routes of escalation are in place and physicians are available when a midwife reaches her (or his) limit of responsibility. I have also witnessed the expertise of the midwives; it should be pointed out that they attend far more births than physicians. Ask any nurse, the people who provide care day in day out catch things, see things, and usually engage in a more personal way with the patient. An obstetrician is essentially a surgeon (many train in gynecology, especially in the US where midwifery is not standard in the care model, in order to be able to provide more well rounded care to women). Due to the way medical professionals specialise in the UK, there isn’t a need to involve an obstetrician in routine antenatal care.

I am not interested in opening a debate or changing anyone’s mind about whether the system in the UK is better or worse than the care I would have received in the US, but I do want to share what I am learning as well praise the caregivers who have been looking after us. I would like to give our loved ones comfort that we have in fact been looked after though rumor may have had it we were left to the wolves. For my own way of thinking, I am thrilled to have been given the opportunity to experience care from this side of the antenatal philosophy. My GP had a point back in those early days; in some cases, the US care model introduces treatments and interventions that are more costly (some potentially introducing unnecessary risks) due to the way the system operates. Surely there is some middle ground where we could all meet…

Coming next–Birth: preparation, the big push, and the baby’s first month
Followed by–our own personal birth story

Disclaimer: I am given to understand that there are some differences in the care offered by different hospitals based on the needs of the region they serve and due to way that services are managed by trusts in that region.

I can’t wait to see how Peanut reacts to these–they are brilliant stimulation for the senses!  This book, of course, is completely perfect eye-catching contrast.

So is the peacock(?), but the peacock also reflects, crinkles, rattles and has lots of different pieces to grab… We consider that Graham is probably an expert on what babies really like; this must be the cool thing to do this season! Thank goodness we have the inside scoop from someone in the know.

Sending love to the Mitchell family for this fun gift!

Booked In–Registration with a particular facility, declaring your intent to present for treatment under the care of the staff of that facility. In this case, my GP booked me in at University College Hospital for antenatal care and for the birth.

Being booked in means that my first point of contact for antenatal care is a team of midwives based at the hospital of my choosing. As needed, a full medical staff is available to me as well.

Midwife–A medical professional with an academic and professional qualification to provide antenatal care, including birth and newborn baby care. Typically, full time courses take 3 years to complete and are comprised of 50% course work and 50% practical based experience. The NHS only employs midwives who hold a midwifery degree and who are registered with the Nursing and Midwifery Council. (My midwife team holds a weekly clinic in my GP’s office for my convenience; that’s where I have my regular check-ups.)

Though the midwives perform the routine checks, ultrasound scans and treatment of complications require hospital visits and are handled by doctors and/or specialists. A full range of medical services is available for any non-routine situation and your case is triaged.

It was a little strange (ok, maybe a lot strange) to be booked in to a hospital and assigned to a team of midwives without really understanding what to expect of those two things. It was more shocking to need emergency care before I had wrapped my head around routine care. We don’t like to dwell on the loss we experienced in January but you have to know, to get the full picture, that we were handled quickly and carefully. Not every staff member we met was incredibly pleasant, I didn’t mistake the hospital for a five star hotel, and I did need to be clear about what I was experiencing and what I wanted.

I can’t tell you how many times I was seen by the emergency staff in the antenatal unit, though there was one Ambulatory and Emergency visit (A&E, like the US ER). The point is that the care I needed was given to me. I didn’t pay a single co-pay or fee and received medication completely free (not all medications are free all the time). For more routine type follow up appointments my GP fit me in on short notice; if my GP was not available another GP at my practice was. (It should be noted also that my employer treated me with the utmost kindness when I needed medical leave.)

I didn’t have time or energy in January to assess whether the care I received was what I expected–it was all so much… We were offered free counseling. We were assured early antenatal scans in the event of another pregnancy. I was seen as a priority at my GP’s office. My initial confusion and discomfort with the workings of the NHS system took a backseat to finding a groove of honest and open communication and then participating in my care. This was a very powerful thing. Perhaps that’s when the change in my perspective began…

Photo courtesy Elsa Konig

www.drewandjengotolondon.com

Photo courtesy Elsa Konig

Turning up to my GP (General Practitioner, a.k.a. Family Practice Physician) pregnant was a strange experience. I fully expected her to confirm what I thought I knew with a blood test but it puzzled her that I would even think to suggest it. “Do you think you did it wrong?” she asked about the urine stream test. After I calmly explained that I was only asking because of my familiarity with the routine in the US she replied, “I get the impression that they are more interested in collecting your money than confirming what a urine test has already told you.”

I sat stunned through the rest of the visit, trying not to be so blatantly American (a.k.a. ignorant and annoying to GPs). She handed me a purple book and told me to make a decision about where I would like to be ‘booked in’–I hoped that the purple book would tell me what ‘booked in’ meant. She asked me if I wanted to ‘go private’ or ‘go NHS’. When I explained that I didn’t think my private insurance covered antenatal care, she suggested that I check and make a decision about that, too–but she did praise the NHS care at UCH (University College Hospital) local to me explaining how commonly her patients delivered there. In all truthfulness, I had never considered whether or not to ‘go NHS‘… (In all truthfulness, getting pregnant in the UK was less of a calculated plan than a weakening in the knees at the sound of the sweetest man on Earth saying the sweetest things I had possibly ever heard.) I guess she assumed that Mrs-I-am-American-where-is-my-blood-test-damnit?! would want private healthcare, hence her pro-NHS cheerleading.

She calculated my due date, she gave me a flu shot, and she said that when I made a decision to give the office a call so that my midwife appointments could start at 16 weeks. I think she wished me luck before she shuffled me out.

I remember feeling incredibly alone. I remember being angry. I remember wondering how I could have been stupid enough to have agreed to live out such a serious life event in this backwards place. But those feelings are a complete 180 degrees from my perspective these days… I am grateful for the care I have received to this point and I look forward to our birth experience–I was hardly aware of what happened to bring me into this light. If you are curious to know what changed my mind, I am eager to share my introspection with you. Keep tuning in.

www.drewandjengotolondon.com

Photo courtesy Brooke Kelly Photography

On my second first day as a house wife in London, I feel less guilt about being home. (I feel absolutely no guilt about the nap that I took from 10.30am to 1.15pm.) I feel somewhat inclined to make two hot meals a day for the man that goes to work, but I also feel like I am doing something incredible by just getting myself showered. More than anything though, I have that sense of being on the edge again.

Here we are. Same city, same crazy kids, different adventure… What have we gotten ourselves into this time?

www.drewandjengotolondon.com