Working mum of three

Figuring it out as we go along. Blogging is cheaper than therapy.

I heart our NHS

on August 17, 2013

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‘Privatised medicine’ always made me think of those Bupa ads: soft lighting, smiling relaxed nurses, luxurious settings. We’ve had two children in the US, and our third in the UK. In my experience, the quality of care has been very similar, once you find the right medical professional. But what’s frightening is the cost that comes with that same service in the US.

The #RoyalBaby served to highlight that the cost of childbirth is double in the US, but even that is misleading: we don’t get billed in the UK. Luckily we had health insurance in the US so the financial side was covered. Imagine the bad moments we had when we opened bills for $30,000 for my labour and delivery and $9000 for the baby’s care in the first 48 hours. And those were for straightforward, non medicalised labours. Of course, I cant compare the fees as I never see a bill in the UK. Not even a bill to show me what I would have paid.

So it’s the difference between healthcare as a service or as a business. During our time in the US, we had experience of medical opinions that have appeared to be motivated by finances rather than ethics. Take ‘cord blood banking’: in the US, you are overwhelmed with adverts for emotionally charged cord blood banking services: for a down payment and regular fee, they will store the stem cell rich cord blood to be used in the event that your child needs it later in life. I repeatedly tried to donate my cord blood for general use but the service wasn’t available. In the UK the midwife automatically collected the blood as a part of the delivery so that it can be used for someone who needs it now. That seems pretty sensible.

Pregnancy care in the US is a bit more intense: it was all doctor lead (midwife/doula services are limited and costly). I was weighed at every appointment, had more scans, and was generally poked and prodded a bit more (blood tests, breast exams, even a heart monitor). But the most surprising difference for me was the element of choice I received in the UK. I had options. I could refuse tests. I even heard a story of a friend who turned down her dating scan at 12 weeks because she was so confident of her own dates. I suppose I could have taken more control in the US, but we were firmly lead down a medicalised route because services were not offered as choices but as obligations, for example, lots of children’s doctors wouldn’t accept kids if they didn’t have all available vaccinations.

We’ve had interactions with individual professionals with varying perspectives on both sides of the pond. Medical treatment depends so much on personal relationships, and we didn’t get off to the best start in the US. In innocence, I mentioned to my first OBGYN in New York that I would consider a home birth. This took us away from our so far pleasant conversation to a lecture about illegal home birthing, why would I want to be crawling around the floor and spitting at my husband, and ‘if you can’t get that baby out within three hours, then I’m taking it out for you’. needless to say, this was the last time we saw that doctor. We will always have a great memory of Dr Randall from Tennessee (of all places!) who delivered our first and fully accepted my desire to deliver naturally with the phrase ‘women have been doing this by them selves for centuries’. And Dr Rosenberg who delivered the second and gave us a great story when she appeared moments before delivery in full splash proof gear, including elbow length gloves, galoshes and a face visor. At the crucial moment she famously announced to the room ‘she’s not pushing, she’s just screwing up her face’. Ahh, we can laugh about it now.

In Britain, my medical appointments were much more conversational, friendly in fact – I was given mobile numbers for several of the midwives and encouraged to phone and text them. The conversation about my birthing plan in the UK brought me to tears as the midwife casually went through the standard options and explained that this was to be my birthing experience. It felt so different to what we had been through in the US, where it often felt that we had to convince them that it was ok to have a natural labour and delivery. When my series of appointments came to an end with my midwife, I felt like I had lost an old friend.

We took pre-parenting classes in the US, so I can’t compare, but it seemed that the medicalisation has become deeply intrenched into US culture. The growing want to take preventative action rather than trusting nature. Our classmates’ key concerns were around how to book a c-section and circumcision. Ok so circumcision is a religious thing, but as the lovely Dr Randal told our group of anxious new parents ‘there is no medical reason for that procedure’. Certainly not all of our peers were Jewish, but the expectation to take an intervention when it was available weighed heavily. Not one medical professional in the UK discussed circumcision with us.

Giving birth is never fun and my personal approach to getting through it is a whole different blog (if you ask, I’ll tell you all about my ‘kylie’ technique!). In the US I was strongly encouraged to have the epidural. During my first labour, the anaesthetist pressured me to sign my consent for it in the early stages of labour, because I would be too stressed later. The following day, he came in to remove my epidural and insisted I show him my back to prove that I hadn’t had one. During my second labour, the nurse had to ask the anaesthetist to leave the room as he relentlessly pressured me to have the epidural. Their insistence was so great, you would be forgiven for thinking they were on commission.

If I could have taken one thing from the US, I would have been the baby monitoring. It was not intrusive (a few pads stuck to the belly for short periods). It enabled the medical team to see what stage I was at while monitoring the baby. They were also able to monitor from outside the room, so didn’t need to disturb us. It meant that Rich was able to more easily track when my contractions were building, and therefore to talk me through them. During this third labour, I felt that I was progressing faster than the midwife did. By the time I was examined, it was too late to get into the birthing pool as the baby was delivered within the next 30 mins. Monitoring would have helped alert the midwife earlier.

In the NHS, and after our quiet time in the delivery room, I was helped into the shower by the nurses and Rich and baby were moved to our private double room. More like a hotel than a hospital, we were given tea and toast, supported by helpful while non intrusive staff but most significantly, Rich was allowed to stay overnight, giving us dedicated time to bond with the new babe. I know this service is not widely available on the NHS, but it represents the difference approach. To illustrate the contrast: when we arrived at the hospital for my first labour in NY, Rich was whisked away to fill out the same forms in triplicate while I anxiously waited alone as my contractions built.

Then there is the after care at home. I have been amazed by the level of follow up care, from midwives who have advised on breastfeeding, asked how I am feeling and have even covered domestic violence, to health visitors who have made sure everything is right with baby and me. All this in the comfort of my own home. This is certainly not part of the standard care package in the US (but no doubt you could pay for something similar).

I can’t speak highly enough of the NHS care we received. I was treated as an individual, my opinions were respected, my experience was my own. The midwives and other medical professionals were my equals (in fact they told me that I was the star of the show). They treated me like a friend, rather than a customer. And that was exactly what I needed. How lucky we are to have this incredible service, which is envied around the world.

I have to add a few disclaimers here. I know countless stories of problems with the NHS maternal health system, but I only talk here about my own experience as it relates to the US system. When I went overdue with this pregnancy, I began to get a feel for the pressure I would face to take interventional route. So I am not trying to argue that the NHS is perfect, show me an organisation of this size and responsibility that is. The point is that despite its shortcomings, we are so fortunate to have it. Based on our experience in the US, it is a myth that privatisation would improve the service: rather, it would only force us to pay for it at source and allow others to profit.

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One response to “I heart our NHS

  1. carol o'b says:

    Hi Rhi – very interesting comparison of the two different systems. I know that when our (adult) daughter was seriously ill 4 years ago and needed 2 specialist, umpteen MRI scans, a neurosurgery team and a stay on a high dependency ward we had lots to worry about but ” How are we going to pay for this?” wasn’t one of them Very grateful for that.
    BTW, not very convinced by Dr Randall’s ” Women have been for centuries etc etc” remark. We know the cost in maternal mortality and morbidity for that!

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