I have little Anglo-envy: the rain is dreadful, the beer is flat, and the pound is whooping my dollar's ass. But in the case of maternity care, I can understand my American friend Jo's sentiment, "Thank God I'm not trying to do this in the States!" She's married to a Brit and they're expecting their first baby at any moment. I've crossed the pond for the event, and in the two weeks I've been on call, I've had a taste of the English way of birth.
Of course, the prenatal care, the birth care, and the postpartum care -- including daily home visits to help with breastfeeding if needed -- are all covered by the taxpayer-funded National Health Service. Another stark difference: midwives run the prenatal clinics and labor wards here. Most women never even see an obstetrician; if they do it's because there's a complication or health concern. So when Jo first became pregnant and confirmed it with her general practitioner, he said, "Brilliant! Congrats! Call the midwives!" When Jo went for her first visit to the midwives, and they assessed her as a healthy woman having a normal pregnancy, one of the first questions they asked was, "So, where would you prefer to have your baby -- at home or in hospital?"
Home birth is no big deal in the UK. In fact, the NHS just launched new guidelines that encourage women to choose their place of birth, and they want to guarantee all eligible women a home birth by 2009 (it currently depends on the availability of the overworked community midwives). One might say this is purely a cost-saving measure, but there's also a call to train some 6,000 more midwives so that every woman -- no matter where she births -- can be guaranteed a dedicated, "named" midwife to support her during labor. That kind of one-on-one care doesn't come cheap, but it makes public health sense because it results in more normal births, as does giving birth outside the hospital.
In the States, home birth is radical; in some places it's seen as criminal. In some states, it is criminal for the midwife attending (see my previous blog about this). If Jo wanted a home birth in North Carolina, where she grew up, she'd have to find an illegal midwife by word of mouth, pay her a couple thousand dollars out of pocket, and hope that she weren't criminally charged or arrested during her pregnancy. (A group of forward-thinking doctors are trying to change that, but the American College of Obstetricians and Gynecologists "strongly opposes" home birth and actively lobbies against legislation licensing home-birth midwives. At last year's ACOG conference, attendees were given bumper stickers that said, "Home Deliveries are for Pizza.") Meanwhile, the NHS-issued handout Jo was given by the hospital says, "There is no evidence to support the common assertion that home birth is a less safe option for women experiencing uncomplicated pregnancies and not anticipated to need medical assistance at birth," and, "Planned home birth is associated with good outcomes for both mothers and babies."
Here's another shocker about childbirth in England: the TENS machine. I mean, it's literally shocking. TENS stands for Transcutaneous Electrical Nerve Stimulation. The gadget is about the size of an iPod, runs on Double A batteries, and creates a pleasing subdermal vibration that rivals skilled petting. I know because I tried it out the other night. I wasn't in any pain like that of labor, but I did have a stiff neck, so we stuck the electrodes on my shoulders and turned up the volume. Ooooh! Oh! Eeeee! Mmmmmmm... English women swear by it for early contractions. Brits also use birthing tubs more than we do (though not at the same time as the electricity, please note), and they're offered "gas and air" during labor, a 50/50 mixture of oxygen and nitrous oxide, or what Americans call "laughing gas" -- the stuff of dentists and whippits.
Women aren't offered these starters in the States. With pain, we seem to be all or nothing: if you're in the typical hospital, as most women are, you either withstand contractions in whatever position you're "allowed," which is increasingly limited to lying in bed, you get zonked with systemic opiates, or you forfeit your motor control and pushing control and get the epidural. The NHS now rates water (a.k.a. the "aquadural") as the most effective, least risky option for pain relief, but how many U.S. hospitals offer a shower, let alone a water birth?
Not that the UK system is perfect. Like in the U.S., the cesarean rate has been rising apace and there's pressure to chemically induce labor. There are also, admittedly, minor NHS indignities, like the reusable urine cup Jo was given in early pregnancy and instructed to bring full to each prenatal visit. On the other hand, her medical records also remain in her possession, and she can review them at her leisure, which she loves. Here in the UK, there's an emphasis on women's choice, and an increasing awareness of the need to support normal birth. It's not just the driver's side that's switched; women are in the driver's seat.