Antenatal Care- What’s Normal?
Yes, I’m at it again. Comparing apples to oranges and wondering about maternity services on all side of the pond and what’s “normal”. Of course, normal is questionable as well, isn’t it? What’s normal for one person is completely abnormal to another. What’s necessary for many may not be necessary for all. It’s hard work to come up with the perfect, Utopian package for maternity care but there are some interesting differences wherever you look.
We all know I am American but I have not had the pleasure of having a baby in the US of A. As most of us know, there is no National Health Care currently in the US. This means that anyone needing medical care of any kind either has to foot the bill themselves or work for an employer who in part or in most will cover the cost of monthly insurance premiums. There is a plethora of private health insurance companies who all have different plans, costs and coverages. On some US health insurance plans, certain aspects of pregnancy/labour/delivery may not be covered. It is then the burden of the individual to pay for those uncovered charges. This is very difficult for many Americans who may possibly end up in debt after unplanned medical expenses.
I am exceptionally grateful that the UK provides us with the NHS. Free medical care for all regardless of income or condition?! Free prescriptions for a year for pregnant women? Free prescriptions for all children until the age of 16? Free contraception? This is a miracle! The US is desperately hoping for a miracle of it’s own.
The other day, I started thinking about my antenatal care for this, my 2nd, pregnancy. It hasn’t been ideal but it hasn’t been horrific either. But what I did realise is that, at 24 weeks pregnant, I have only seen my community midwife TWICE. I won’t see my midwife (whom I really don’t even know and who won’t deliver my baby) again until 28 weeks of pregnancy. So that means, once for the booking in appointment (8 weeks) and once at 16 weeks. That’s it. I have had a Dating Scan in there (11 weeks), an appointment with the consultant at 17 weeks (due to having risk factors with this pregnancy) and an anatomy/anomaly scan at 20 weeks. However, I have not had any antenatal checks since that 16 week appointment. Maybe I’m crazy, but doesn’t that seem a bit off? I know that I am a relatively healthy person but still. Seeing your midwife TWO times in 28 weeks? I don’t know…it just seems too little.
I decided to compare and contrast the standard US “prenatal” care with the NHS standard ante-natal care and UK Private Insurance ante-natal care. Here’s what I found:
- US Pre-Natal Care: 1 appointment with Ob/Gyn or Midwife every 4 weeks until 28 weeks (7 appts); an appointment every two weeks from 28-36 weeks (4 appts); an appointment every week from 36-41 weeks (5); an appointment every few days until delivery = Total (avg) of 16 appointments until close to delivery (also have Dating Scan at 11-13 weeks, Anatomy Scan at 20 weeks; Growth Scan at 32 weeks + multiple blood tests throughout the pregnancy)
- NHS 1st Pregnancy: Booking in appointment with Midwife at 6-8 weeks; 12 week Dating Scan; 14 week bloods; 18 week midwife visit; 20 week Anatomy Scan; visits with midwife at 24, 28, 30, 32, 34, 36, 38, 40, 41 = Total of 11 visits with midwife
- NHS 2nd Pregnancy: Booking in appointment with Midwife at 6-8 weeks; 12 week Dating Scan; 16 week visit with midwife; 20 week Anatomy Scan; visits with midwife at 28, 34, 36, 38, 41 = Total of 7 visits with midwife
- Private Health Care (BUPA- UK): Booking in appointment with midwife/consultant before 10 weeks; 10-13 weeks Dating Scan; Blood Tests for Genetic abnormalities 11-14 weeks; 20 week Anatomy Scan; 28-32 weeks Growth Scan; Midwife Visits at 23, 27, 30, 34, 36, 37, 38, 39, 40, 41 weeks = Total of 11 visits with midwife (The Portland Hospital offers 14 antenatal visits plus scans at 12 weeks, 20 weeks and 32 weeks)
- Of course, these various comparisons are based on a low-risk, healthy pregnancy. No matter where you are, if you fall into a higher-risk category (multiples, health problems for mum/foetus, other risk factors), you would of course receive the additional support and care that was required whether that be through a midwife, consultant, ob/gyn or GP.
Obviously, in the US you’re paying for the care you receive and if you choose to go private in the UK (as long as private will cover your pregnancy care which it doesn’t always), you will be paying for the care you receive. What I don’t understand is why, on the NHS, is a first pregnancy one standard of care and a second pregnancy an entirely different standard of care? So if you’ve already “been there, done that” you don’t need to have the same amount of time with medical professionals? Yes, I know that provided you are a healthy woman with low risk you generally won’t need a lot of “intervention” the second time around. But shouldn’t you have the same access if you want it? Every pregnancy is different. You may have different symptoms and/or difficulties associated with a second pregnancy. You may have more stress and challenges the second time around as you’re already looking after one child. Maybe the “breeze” that was your first pregnancy won’t be the same with your second?
Yes, in most cases, you can ring up your midwife and speak to them over the phone about your concerns or even schedule an “unauthorised” appointment to talk about any niggles. But it seems to me that regardless of 1st or 9th pregnancy, you should be provided with the same standard of care unless you choose to opt out of it. What do you think? Did you feel that your antenatal visits were pointless and unnecessary? Would you have appreciated more time with your midwife? Did your community midwife (the one you saw for antenatal visits) attend to you for labour and delivery as well? Were you fortunate enough to have a medical problem diagnosed and thus treated as a result of your antenatal visits?
**Due to previous displeasure with me bringing up the topic of antenatal care on the NHS, I would like to reiterate that I am eternally grateful for the NHS care which has been afforded me and my family and for which I have not had to pay out of pocket although I have contributed to through my taxes and NI contributions as a result of being gainfully employed in the UK for more than a few years. I am not criticising the NHS but QUESTIONING the services which are provided to us which any tax-paying resident is entitled to do.**
***I would also like to acknowledge that the NHS provides midwife visits for several weeks IN THE HOME immediately following delivery of your baby and a Health Visitor will continue to see you IN THE HOME until you both feel that you are fully prepared to be discharged to your local surgery. This would NEVER happen in the US. Once you leave hospital with your baby in the US you’re on your own. The NHS scores mega-points with this highly beneficial service.***
Related Posts
-
PND Journey- The Beginning
Posted on Mar 15, 2012
-
Musings on a Hospital Stay
Posted on Nov 30, 2011
-
A Tale of Two Pregnancies
Posted on Sep 29, 2011
-
In Praise of Midwives
Posted on Jul 27, 2011
Tags
Share This
The schedule of routine antenatal visits is less for second (or more) mums as if you have had a healthy first pregnancy (particularly in regard to your blood pressure) then you are at a much lower risk of developing complications in subsequent pregnancies – the guidelines are based on research and are suggested by NICE. It is, however, a guideline – women who are having a pregnancy with a new partner, or if it has been a long time since the previous pregnancy (10yrs or more) then the schedule reverts to first time pregnancy guidelines. You can also expect a greater number of antenatal checks if you have had a complicated previous pregnancy or if you suffer from certain medical / obstetric complications. If you develop complications in pregnancy, then again, you will also be seeing your midwife & / or consultant more frequently. If you need additional emotional support or have social difficulties, you will have additional appointments.
Basically, if you are a healthy low risk lady then your appointments are fewer as you and baby need less monitoring for wellbeing, though obviously if you are at all worried or concerned, the hospital maternity unit is staffed 365 days a year, 24 hours a day, and you should contact them straight awayif you develop any worries or concerns between appointments so that they can advise you as to best course of action, whether that be an appointment with your GP, appointment with your community midwife or to come into the hospital to be assessed.
Hope this clarifies why you are seen less frequently xx
I found that with baby number 6 – even though it was my husbands first baby we were still told that we couldn’t go to the ante-natal classes as there was ‘no need’ as I could ‘tall my husband all there is to know’.
Once you have had your first baby you definitely notice a change in how many times you get to see your midwife and indeed their attitudes towards you in some cases.
ps. I do love the NHS mostly ! x
But Karin we aren’t in Utopia and costs have to be saved somewhere and subsequent pregnancies do generally, provided they are low risk, require less care because you have been there before
Would you rather that people with high risk pregnancies had less care? In my PCT I couldn’t have a scan at 18 weeks to tell if my baby had died when I was thought to be miscarrying because of lack of funds – I had to just wait and see. Or would you rather we cut special care?
Its not perfect but in general a 2nd pregnancy does need less care mostly because you know when something is wrong and can get a midwife involved if you need one
I guess we’re talking about how many appointments do you need vs. how many do you want. My question (speaking as both a second time mum and NHS employee) would be what would you actually need to have happen at the extra appointments? Are there specific tests or investigations that you would want done? If it is more for a sort of regular reassuring chat, although I can totally understand why you might want that, I’m sadly not surprised that resources don’t run to it.
I was classed as a ‘high risk’ mother due to pre-eclampsia leading to an emergency c-section with my first pregnancy but still only had the ’2nd timer’ appointments next time around. Speaking personnaly, I’d have been happier with even fewer as they just seem like such a waste of time until quite near the end (when growth measurements, blood pressure, urine dipping etc become more relevant).
The booking appointment was a farce as where I live they are done in groups with many women bringing their husbands along so there is no opportunity to raise anything remotely sensitive or confidential. I’m hardly going to confess my drug habit, relive my previous birth trauma or seek support for domestic violence in a room full of 20 strangers, am I?
The following appointents just seem to ask if you’ve had any of the symptoms you’ve already been warned about (heavy bleeding, all over itching etc) to which the answer would surely be ‘no because if I had I wouldn’t have waited eight weeks to come and tell you about it, I’d have called the emergency number and got it sorted’.
Don’t get me wrong, when I’m in labour there is nobody I want to see more than an experienced midwife but with both my pregnancies I’ve found the pre-natal appointments as much use as the proverbial chocolate teapot. I certainly wouldn’t want any more.
Have you considered employing an Independent Midwife?
I had one and she was happy to offer antenatal appointments that were in my own home, and in the evenings so my husband could be there as well and I didn’t have to take time off work.
http://www.independentmidwives.org.uk/
I also hear good things about independent midwives
No offence Karin but I think the first commentator is spot on. Really there’s not much to monitor between the 16wk and 28wk appointment and in that time frame you can also have a growth scan. So the longest period you are going without seeing anyone is about 8 weeks. If you are concerned or worried then in my experience you do recieve the extra care you need. When I was about 35 weeks pregnant with my third child I felt a decrease in movements and was able to go up to our local hospital and stay a while in their monitoring suite, to ensure all was well. Are you particulary anxious about this pregancy? I don’t mean to pry but just reading your blog you do seem quite worried about it all. Maybe you should talk to someone who could put you more at ease? Someone once said to me we should remember pregnacy is a natural thing, not an illness. Good luck with it all, I’m sure you & baby will be fine
Thought I should come back to balance my previous massive rant by saying on the one occasion I was actually worried (when baby number 1 didn’t move for hours after I had a car accident) the hospital were fantastic, had me in straight away to check and monitor for an hour or so. I honestly think the NHS is excellent at doing what needs to be done, just not so great at the associated caring/supporting/communicating side of things. If you are remotely worried you should feel free to call the midwife between appointments, you won’t be the only one.
I have to go against the grain slightly of the other comments here and agree with you Karin.
I think that the NHS is wonderful but very, very stretched. I know they are short of time, money and staff.
I agree that you should be offered the same care during every pregnancy, whether it’s your first or your tenth, and if you don’t want it you have the option to opt out. After all, every pregnancy is different.
I was so lucky when I had Boo to know the midwife who delivered her. I had a home birth and my labour was perfectly timed (!) so I got the two midwives who I had seen for the duration of my pregnancy. Personally, I think it is so valuable to have a relationship with the midwife who assists you during labour. I remember when mine walked through the front door as I was leant over a chair and said ‘it’s Karen, are you ok?’ I thought ‘thank god’ and instantly felt so much more comfortable because I knew her.
No matter how many children you have had, surely that relationship is important? The idea of meeting a midwife for the first time as she tells me I am almost ready to push freaks me out a bit.
I can only talk from my experience and I cant say I noticed a great deal of difference between first and second baby in terms of care and to be honest IMHO i’m happier not dragging my child to see the midwife at the docs if its unnecessarily. I think you know if something is wrong. Now into my third pregnancy, the care is even less, but to be honest, I would be stressed and rushed off my feet if I had to go to all those appointments. I know that people are there to help me if I need them.
It is exceptionally difficult to opt out of something medical (the guilt is there) but IMHO easy to opt in and get the care if you need it.
I’d much rather that the money went to those that really needed the help than to funding routine mainly pointless appointments.
A good midwife is a good midwife no matter how many times you have met them…