Differences in care. — The Bump
3rd Trimester

Differences in care.

Hey all,

I've got two children, DS is 3, DD is about to turn 1.
I'm in the UK, and OH (DDs dad) is in the USA. After being here for her birth, we had a talk about the differences in health care across the pond.
The conversation started up again the other day, so I thought I'd bring it up here, for anyone who's interested in sharing experiences.

So, over here:

POAS.
Once positive, you go to your doctor surgery, tell them you're pregnant, and you think you're approx (x) weeks along.
You fill in some papers, then get a letter through the post informing you of your appointment time with (midwife). This will be at around 8 weeks, or ASAP if it's already passed.

At the first appointment, you'll first provide a urine sample for the midwife to confirm you are pregnant, then you get given a big folder (PN, or purple notes).
You keep your PN, and they go everywhere with you until birth.
Your PN starts off with basic questions in this first appointment. Family history and all that. Bloods taken. Weight. Points out the numbers to call if needed and gives you an idea of things to look out for. She books your 12 week US, which comes through the post in the next week. You can choose just a dating scan, to confirm due date, or you can have a nuchal scan, which also looks for markers for Downs and other things.
As you leave, you book your next MW appointment for 12w at reception.

12w you go to your hospital for the scan. You first drop a urine sample at the nurses station along with your PN, and wait for your scan. Your sonographer does the required thing, sometimes talking you through what they're seeing (this is the femur, we measure this to add to other measure blah blah), (hopefully) tells you everything's okay, and gives you a slip to take back to reception to book your 20w anatomy scan.
If anything is flagged, you are sent to wait for a consultant, who will discuss your scan with you. They may ask you to go back for additional scans.

You go to MW at 12w, more bloods etc, and book an appointment for after your 20w scan.

At 20w you go for AS, where you are hopefully told that everything is growing normally. If you were seen by a consultant before, you'll follow up as necessary, and either be discharged from consultant care, or booked in for further scans and appointments.

At your 20w MW appointment, more urine etc, and a follow up of how your scan went. Book for 28w.

28w more urine, start fundal height measurements, and listening to baby's heartbeat. Book for 31w.

31w as above, start discussing birth plan. Book for 34w.

34w as above, book for 36w.

Same for 36w, 38w, 39w, 41w.

Sweep offered at 41w, induction discussed.

I had monthly scans with DS, fortnightly scans with DD.

DS came on his own at 40w. DD was induced at 37w, came at 37+1. Both involved a hospital stay of approx 36 hours, both small but otherwise healthy, with "normal" deliveries.

It's a complete toss-up on whether you see the same MW, sonographer, consultant more than once.
The Longest wait to get in for an appointment was 45 minutes.
All of it was completely free (including early scans for bleeds, extra bloods for rhesus neg, and flu and whooping cough vaccines).

Both labours I had pethidine, as I didn't want an epidural, and certainly didn't want c-sec unless medically necessary, but couldn't handle just gas and air. Both deliveries were on hands and knees. (Everything I see about USA birth seems to be flat on your back, with an epidural being the only offered pain relief)?

Both times baby was placed straight on my stomach after a quick check over whilst I delivered the placenta, then when I was ready, I went and showered and re-humanised whilst they cleaned baby, weighed, fully checked over, and dad cuddled. After this, I was taken to a ward with 3 other beds until I was discharged.

On the ward, baby was given vit K injection, had sight and hearing checked, and had heel prick test.

There was a breastfeeding specialist available at all times to help, and health visitors came around at intervals to help with whatever, including first nappy change and so on.

At 5 days post-birth, you take baby for a check with a health visitor, where they are weighed and you are asked about how you're doing.

At 10 days, a health visitor comes to your home to do it all again.

And that's it.

There are weekly health visitor clinics where you can take baby and discuss anything you're worried about (anything you want help with but doesn't necessarily need a doctor), and get advise on standard "new mum" questions (sleeping, weaning, etc).

You then have a health visitor come to your home around 10 months to check up on baby, hitting milestones, how you're feeling.

All still free.

If you've read all that, thank you. Please feel free to explain how your experience has differed. For example: since nosing around on here, I've discovered that circumcision is a thing. It's definitely not over here, unless requested for religion.
I find the differences quite interesting.

Re: Differences in care.

  • *WHOA LONG*

    I'm in the US and receiving a-typical care from a birth center that sounds pretty similar for prenatal. Seeing a midwife, though it's between the same 5 women every time and whichever one of them is on call when you go into labor will deliver the baby. They confirm pregnancy when you receive a positive test and get papers filled out and initial check-ins, blood test, and urine sample run. There's a 12 week scan, 18 week check-up, and a 20 week scan. Then check-ups are monthly. At 28 weeks there's a gestational diabetes blood draw. At 32 weeks the check-ups are bi-weekly. At 36 weeks there's a group B strep swab that determines if the mother will require antibiotics during labor. Then check-ups at 40w, 41w, and 42w. Check-ups are maternal weight, blood pressure, heart rate of baby, talking about sleep, diet, exercise, and any concerns. If you make it to 41 weeks they do a stress test to see how baby is doing and talk about natural induction using castor oil or a foley bulb. At 42 weeks if natural induction fails, you risk out to the hospital to have a pitocin or cytotec induction and deliver with the hospital.

    If labor starts on it's own between 37-42 weeks, you're admitted to the birth center when contractions are 3-1-1 and you're in active labor. There is a birth tub, yoga ball, rebozo, squatting stick, shower with support bars, toilet (under the shower to labor on toilet with shower), and nitrous oxide all meant for pain management. There are 5 identical private rooms with these amenities as well as kitchenettes and beds. The baby can be born anywhere in the room including in the water and husbands or the mother herself have the option of "catching the baby". Once the baby is born there is 1 hour uninterrupted skin-to-skin and during that hour the placenta is delivered and placed in a bowl to the side where it continues to pump until it's drained then clamped and parents are given the option to cut or burn the cord (cutting the cord using a candle). Placentas are generally sent home with the family in a cooler as it's the norm to encapsulate or otherwise eat the placenta. Newborns are weighed, measured, and wiped off (though bathing is not recommended for 24 hours). Parents have the option to have eye ointment applied and a vitamin K shot or oral vitamin K administered, and hearing is checked. There is pitocin available (for afterbirth only) should the mother hemorrhage or have trouble delivering the placenta. After a 3-8 hour stay where the mother is helped with latching, required to eat a full meal, and pee the new family is sent home. There's a 2 day and 2 week in-home postpartum check-up and baby would start seeing a pediatrician.

    The out of pocket cost is $4,000 without insurance including all care and birth, although nitrous is an additional $175 flat fee if used during labor. I have insurance through my job which covers the full cost of the center as well as the required classes. All new parents are required to take a 4 week birthing class, 1 lactation class, and 1 PP/NB care class to prepare for using the center. I assume insurance covers this because compared with a hospital birth, this is a pretty low figure. I'd really like to know how much people here anecdotally have ended up paying for hospital births as it's come to light recently that in the US it's extremely difficult to get an accurate cost estimate from different hospitals so as to cost shop their fees which can vary thousands of dollars.

    Has anyone been offered an estimate? STMs how has your estimate compared with the final bill?
  • I'm in the US and the procedures can vary by doctor, medical needs of the patient, insurance and hospital practices. 

    I will say, I have excellent insurance and pay no out of pocket costs for prenatal care. I only have to pay 250 dollars for the hospital stay, and that includes everything. But costs vary by insurance.

    My experience has been 8 week ultrasound to verify pregnancy and 8 week doctor appointment to go over questions and family history, blood tests etc.. Overall, most pregnant women in the US are seen every 4 weeks until 28-30 weeks, then once every other week until 36 weeks and then every week or more until delivery.
    I had a 12 week NT scan, and the ~20 week anatomy scan (I got mine at 18 weeks). Due to non pregnancy related medical reasons, I also have additional ultrasounds, but those are not routine for everyone.

    24-28 weeks a glucose test is done. Around 32 weeks you are given the whooping cough/tetnis/diptheria vaccine. 36 weeks you get the GBS swab test. Every appointment you give urine, check weight and blood pressure, and after 16 weeks they listen to the heartbeat on the doppler. 

    I see the same doctor every time, though she may not be the one who delivers my baby. Other practices have patients see different doctors so you are bound to see the one that delivers your baby. This varies by practice and doctor and hospital.

    I'm a FTM and haven't given birth yet, but from my childbirth and infant care classes, they highly reccomend the 1 hour skin to skin after birth. If baby and mother are healthy, then all routine tests can be done right in the room while the baby is on the mother (Vitamin K shot, apgar, eye ointment, Newborn screening tests (blood tests to test for various genetic diseases).

     Epidural is the most common  pain relief option, but there are other options that are not as effective, but available. My hospital offers many positions to labor and deliver in, but if you have an epidural you will be in the bed (though they have peanut balls and birthing beds so you aren't necessarily flat on your back).

    Some hospitals have the labor and delivery in the same room as you stay. My hospital has an L&D floor, and then you are moved to the post partum unit where you have a private room. Insurance is required to pay for 48 hours after a vaginal birth and 96 hours after a c section in the hospital.

    Our pediatrician will see the baby 1-2 days after we are discharged from the hospital. Obviously a pediatrician will check over the baby while in the hospital. After the initial check up a couple days after birth, Infants in the US are generally seen at 2 months, 4 months, 6 months, and 9 months and 12 months. Moreso if needed.



  • Im in nz and care is pretty standard across the board for a standard low risk pregnancy, although some MWs may have their own protocol.
    go to gp, gp will order bloods
    find mw, they will book you in for about 8 weeks. Either gp or mw may refer you forca scan if you dont know when you got KU. 8 week appt all your paperwork done, you get given a maternity book to carry everywhere. 
    Appt at 12w, nuchal scan if opted.
    mw appts monthly until 30w, fortnightly until 38, weekly until 40, every few days until birth. 
    Scan at 20w. birth in either hospital or birth unit, options are gas, pethadine, epidural (hospo only) standard 3 day stay or you can go home when you like. MW will see you at least 2x first week then 1x weekly until discharged. Then wellchild/plunket until your child is 5. All completely free. We have a good maternity system, we also get 18weeks paid maternity leave from the govt, plus additional up to 10 weeks paid leave for premature babies. 
  • smn14smn14 member
    250 Love Its 100 Comments Second Anniversary First Answer
    I'm in uk and saw the same midwife at every appt. It was nice to have the same lady throughout. 
  • smn14 said:
    I'm in uk and saw the same midwife at every appt. It was nice to have the same lady throughout. 
    Same here 
  • I'm in the UK and a lot of my pregnancy care differed from yours albeit only in the minor details, perhaps each NHS trust does things slightly different also. For example, my notes were green not purple lol. 
  • I'm in the UK and a lot of my pregnancy care differed from yours albeit only in the minor details, perhaps each NHS trust does things slightly different also. For example, my notes were green not purple lol.

    ------QBF-----

    I've heard this from friends around the country, slight differences in practices.

    My actual notes pages were green, but they had a big old purple cover.

    It's strange how different places have different practices.
  • smn14smn14 member
    250 Love Its 100 Comments Second Anniversary First Answer
    My notes were blue!  
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