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Publius
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What is prenatal care like where you are?
Publius
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When do you generally go in for your first appointment? What do they do? How many ultrasounds is it common to have? What is the birthing process like? Hospital? Midwife?
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Re: What is prenatal care like where you are?
In Malaysia it really depends on whether you're in private care or using that which is provided by the government. If it's the former, it's not uncommon to have an u/s at every appointment if you want it (at a cost of around $13 USD). Even though the Health Ministry here recommends one u/s every four weeks until 28 weeks and thereafter one every 2 weeks until the kid is born, if you're going to a government clinic you'll only get two at most (and if you're lucky because a lot of the government clinics don't have u/s machines, especially in rural areas).
Private hospitals have private room options but government hospitals have like 20 beds to a ward. In a government hospital your husband might not be able to be there for labor and delivery because they won't let men up into the 20 person wards. Also, I've read that the availability of epidurals at government hospitals is very limited and restricted. But on the plus side, government hospitals only cost 5RM to register ($1.75) and that's it.
Public is free as far as I'm aware. Private was around 5k for the OB and I had to pay for the epidural, I think that was a few hundred. Private insurance/Medicare govt covers everything else
I'm on public insurance in Germany, but my SIL has private insurance and her experience wasn't *that* different from mine from what she told me. State insurance covers 3-4 u/s in a normal pregnancy, that includes possibly 1 dating u/s then one at 10w, 20w (the anatomy scan), and 30w. Since I'm HR, though, I have an u/s at pretty much every appointment. They recommend taking folic acid starting about 3 months prior to TTC but otherwise no PNVs are mentioned. With DD my iron got low and I was given an iron supplement.
You can go to only an OB, only a MW (but they don't do u/s, so then you would probably only have one at 20w at a hospital), or both. I go to an OB practice who has an in-house MW there on Tuesdays, so all of his pregnant patients who want to see the MW are scheduled on Tuesdays.
Except maybe in very small hospitals / rural areas where the hospital OBs also have regular patients, your OB will not deliver you but is only responsible for your pre-natal (and post-partum) care. When you go to L&D, it's the luck of the draw as to what MW is on-duty and assigned to you. My midwife works PT at the hospital, so there's at least a small chance I'll get her, but it's unlikely. At the university hospital I live by, a MW student is with you through the whole delivery, the MW comes in during critical times and also just occasionally to check, and the OB will pop in every once in a while to ask if everything's ok or obviously if the MW calls him/her for a problem.
State insurance also pays for 16 PP home visits from a MW to make sure that you and the baby don't need any further medical care and to answer any questions you might have. They check for signs of jaundice, for example, and my MW took out my c/s stitches (well, one long thread) while I lay on my couch.
BFP1: DD1 born April 2011 at 34w1d via unplanned c/s due to HELLP, DVT 1 week PP
BFP3: DD2 born Feb 2013 at 38w4d via unplanned RCS due to uterine dehiscence
I live in Belgium and we have three mandatory u/s, all covered, at 12/20/30 weeks. Most OB/GYN's will do an u/s at every appointment though, without asking money for it.
First prenatal visit is at 6-10 weeks (which is when I had my first u/s). After that, it's every month until 3rd tri, I think it's every week than. Most people have all of their appointments at the hospital with the gyn. I'm having most appointments with my private midwife, but I'll have the u/s appointments at the hospital.
Everyone here has state insurance, and practically everyone has a supplementary private insurance (cheap) for extra hospital costs. So prenatal pregnancy care hardly costs anything at all (maybe 100-200 dollar for prenatal care and delivery combined).
I'm on private insurance here. I think the public clinics can be pretty bad (incredibly long waits, poor conditions). But, given the income inequality here, it's not surprising that there are two levels of care.
I had an initial u/s, bloodwork, and history check with the OB at 9 weeks. But I'll be seeing a midwife for all the rest of the appointments until I see OB again at 36 weeks. Midwives aren't that common here though, I just sought one out because I'm looking for a more persona and natural process.
NHS:
1st visit us around 6 to 8w to date the pregnancy via u/s and ensure its not ectopic. After that you've got a visit every 4w for the duration of the pregnancy. Visits are generally done by an OB at a health neighbourhood center. Bloodwork and urine tests are monthly. NT scan, anatomy scan and growth scan are standard as is the glucose test. Amnio or CVS is included if you are AMA. Everything is free. Births are MWattended in hospital with OB as backup if needed. Most rooms are two moms to a room. Epidural availability varies by hospital.
Private:
1st visit us around 6 to 8w to date the pregnancy via u/s and ensure its not ectopic. After that you've got a visit every 4w for the duration of the pregnancy. Most ppl choosing private care are seen by an OB but you can choose a MW if you prefer. You generally have visits at the OB's private practice or a freestanding birth center if you've chosen a MW. Scans are monthly assuming your OB has an u/s in the office. Bloodwork and urine tests are monthly and you pay an additional copay if your provider requests tests not covered under NHS.
NT scan, anatomy scan and growth scan are standard as is the glucose test but its up to you and your provider. You pay for these scans if you do them privately. The wait list for NHS scans is months long so even those choosing primarily public care sometimes do these scans privately. In Milan they run 150 to 250 euros each. You can choose a private hospital room. They run rightly 500 euros per night. Standard stay is 2 days for vaginal birth or 4 days for CS. You can choose a MW attended birth or OB attended.
I'm in Canada. There are no medical expenses included for pregnancy, except for your hospital room. The government covers the cost of a shared room. If you have extended health care through your employer, most insurance companies will cover 80% of a private room, however, you are not guaranteed a private room. first come first served.
You can choose to have a dr, ob or midwife look after your prenatal care. I, personally, have a midwife. You cannot have 2 care providers.
My first appt was at 6 weeks.
I had a blood test at 10 weeks, and 15 weeks to check my iron, folate. Took a genetic screening test at 10 weeks (this is optional) Took the glucose test at 26 weeks.
Had an ultrasound at 11 weeks, 19 weeks and will have one at 30 weeks.
All these tests and ultrasounds are covered by the Canadian government. 3D ultrasounds are not covered.
Because of the province I live in, they do not give mothers NT scans (the ones that test for downs syndrome/trisonomy) if you are under 35 and have no family history. If a blood test or ultrasound shows that you are at risk for downs syndrome, or something else, you are offered to have an amniocentesis. That test is also covered by the government.
I see my midwife every 4 weeks and we discuss how I am feeling and listen to the baby's heartbeat. I do not have to pee in a cup everytime, or weigh myself like some dr's require you to.
In my city, there is currently no birthing center, but you can choose to give birth in a hospital or at home.
I'm on the public care system in Germany and it was great both for pregnancy and miscarriage. A PP went over the details, so I'll just add that midwives are the only professionals that are permitted to deliver babies. A really old law that is 'followed' until there is a problem. For example, my son's heart rate slowed and the midwive asked the doctor to step in. Which was great.
I don't think I would want to have a baby anywhere else. The post-care is fabulous: a midwife came to my house every day for two weeks and then every other day for another couple of weeks. We had some starting problems and it was wonderful to have extra support, especially with my family so far away.
Also fabulous: my boy was put onto my chest before any checks or being washed or anything else. We were given two hours alone, just the three of us and that was remarkable for me.
I'm in Scandinavia using the national public healthcare.
For a normal pregnancy you see your GP at 8 weeks to fill out paper work. You have the option to schedule a NT scan that is done at the hospital.
As far as I know (I don't know about the private option ) you are only able to see midwife unless you are high risk or carrying multiples.
Somewhere around 14-16 weeks you meet with a midwife. This was mainly to get a ton of information. BP was taken and a urine sample. No doppler was done.
18-20 weeks anatomy scan (last or only ultrasound given unless high risk or problem occurs).
I had GD testing down at 20 weeks due to risk factors
21-22 weeks meet with the midwife
25 weeks meet with your GP
29 weeks meet with midwife
GD testing done at 30 weeks if your at risk, had previous complicated birth, or had a child over x weight
32 meet with GP
35 meet with midwife
37 meet with midwife
39 meet with midwife
Since I had an ectopic I called my GP right away when I found I was pregnancy so my GP could refer me to see a GYN that has access to an ultrasound machine. I had my first scan at 6 weeks and 2 days, my second scan a week later, and my last once with the GYN at 9 weeks (it was suppose to be a week later but I was traveling). This was my last appointment with this dr. From that point on I only saw my own GP and midwife.