Pregnancy, Child Birth, and the NHS

I think that these posts are a dime a dozen on the interwebs – What was it like, as an expat or an American, to be pregnant and have a baby on the National Health Service (NHS)?  I’ve gathered from friends and family that there is indeed a general curiosity about how it all works over here across the pond.  And people have been surprised, good and bad.

Here’s my breakdown of how it proceeded for me, and what I learned about the system*, which I think was, on the whole, pretty standard, apart from a minor complication towards the end of my pregnancy.

What happens when you find out you are pregnant?

Unlike in the US, women do not have to find their own OB/GYN practice to take care of their women’s health issues. In general, if you have a medical issue ‘down there’ you go to your local NHS General Practitioner (GP) or what would be your ‘family practice’ doctor in the US, who might then refer you on to an NHS specialist if needed. If you have private health insurance (which does exist here on a small scale) or you happen to have a lot of disposable income, you can see your own private OB/GYN independent of your NHS GP, but chances are it will be VERY expensive.

So, when one finds out they are pregnant, your first port of call is your GP.  Your GP will then send a letter to the local midwives who then send you a letter notifying you of your first appointment.

Who manages your care while pregnant?

In the UK, the default for care during a pregnancy is the local midwifery unit.  Midwives are highly trained practitioners in the field of pregnancy, child-birth, and post-natal care, usually completing a three-year specialised degree programme.  Usually each city or town has local unit that overseas all the women in the area, and which is linked to the local hospital.

If you have a prior medical condition or you develop one while pregnant, then you might be then put under “Consultant care” (a doctor).  This means that you might have appointments with an Obstetrician (OB) during pregnancy or have your baby delivered by an OB.  I developed a small complicated towards the end of my pregnancy and was referred by my Midwife to the local hospital where I had appointments with an OB leading up to Freddy’s birth. I still saw my Midwife for routine appointments, but in my case, they deferred to the OB for my overall care.

So, what does midwifery care look like?  You have scheduled appointments at key points in the pregnancy – 12 weeks, 16 weeks, etc where you have a chat about how you are feeling, they take your blood pressure, check your urine, feel your tummy, and listen to the baby’s heart beat.  There is no glucose test unless you are considered ‘at risk.’

Generally, you will have two ultrasounds, one at 12 weeks and another at 20 to ensure the baby is developing as it should (and when you can find out the sex of the baby if you want).  You are told to keep hold of your ‘notes’, which is large booklet with lots of information that the Midwives fill in throughout the pregnancy and where they keep track of your appointments.  It also has an area for test results, your birth plan, and for the actual birth itself.

Where do you learn about stuff like labour and child-birth?

There are loads of antenatal classes in the UK, but by far and away, the most popular are those run by the National Child-Birth Trust or the NCT.  While they are a great space to learn about what’s ahead at the end of your nine months (let’s be honest, it’s more like ten), they are also seen as THE place to make life-long friends as everyone in your class is having children at the same time.  You’ll hear people say twenty-years on that they still meet up with their NCT gang.  But, the NCT costs money and if that’s not your thing, the NHS runs free courses and there are also other private class cropping up all over the place now.  The ‘N’ in the NCT used to be ‘natural’ so they have a clear bias towards ‘intervention’  free (ie, no pain meds) births.  Lets just say when we discussed epidurals there was a lot about the risk of spinal injury and not much else.

Where do you give birth?

Most women have three options now. Home, a Birthing Centre, or the hospital.  Home births are not that uncommon here, and if that is what you wish, your Midwife will come to your home to deliver the baby.  A Birthing Centre is a child-birth facility run solely by Midwives where the rooms are designed to look like a bedroom and there are communal spaces for parents/families.

If you want an epidural or other pain relief medication, or you have a medical condition that is deemed by the Midwives and Consultants to be ‘risky,’ you must give birth at a hospital as Birth Centres only provide ‘gas and air’ and there are no doctors on site. Some Birthing Centres are co-located with hospitals, but not all.  If a serious issues arise while you are giving birth, for example you will require a C-section, the Midwives will call an ambulance to take you to the hospital.

From my experience, there is enormous pressure on women to give birth at Birthing Centres, and without the use of ‘interventions’ like epidurals as it’s seen as healthier and more ‘natural.’ I have many thoughts on this that I will kindly spare you. But to give you a hint of where my feelings might lie, I had a hospital birth and used every pain relief option available, which enabled me to have a very positive and happy child-birth experience.   I know I could have done without if need be, but….science and modern medicine for the win!

What happens after birth?

Depending on where you live, in my case for example, you might spend a couple of nights in a private room at your hospital under the care of midwives, with periodic check-ins by paediatricians or other medical professionals.  You are given what’s called a ‘Red Book’ with most of your baby’s medical information (growth, vaccines, hearing tests, etc) and which you will need to hang onto until your child finishes school. When you are finally home, your midwife will come every few days (or thereabouts) for a couple of weeks to ensure both you and the baby are recovering well.

You then see your GP again at six weeks, and are thereafter back under your GP’s care.  You won’t see a paediatrician for your baby unless your baby has a specific medical condition that requires specialist assessment. You also get a ‘Health Visitor’ assigned to you, who might be a nurse or a midwife as well, who follows your child’s development for several years and does a formal development check anywhere between 9-12 months, and again at two years old.  Health Visitors are really hit or miss.  My first one was awful (demeaning, rude, cold), my new one is fantastic (supportive, warm, caring).

There are also Health Clinics at your local ‘Children’s Centre’ where you can take your baby to be weighed and speak with a midwife or Health Visitor about any concerns you have about your child’s growth or development.  Usually by the time your baby is six months, you don’t need to visit these clinics as often, but they are always there if you feel the need to go or are curious about your child’s growth. Children Centres also have breastfeeding clinics and free music or playgroups throughout the week, among other activities.

How much does this all cost?

If you are a British citizen or legal resident, it’s ‘free.’ I put ‘free’ in quotations because we do pay for these services through taxation, and I had to pay a hefty fee to the NHS just to immigrate and will be required to do so for the next several years until, but you will never see a bill come in the post nor do you have to ever deal with insurance companies.  Hallelujah!


*Not an expert on this in any way, shape, or form.  Did I miss anything?



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