Dispatches from the North: Pregnancy in Britain- The First Trimester

Several months ago I took a sabbatical from blogging, mostly because I found I was well settled and there were very few things that were new to me anymore. Well all that changed in mid-May when I found out I was pregnant with my first child. I’m 13 weeks pregnant today, and already have been thrust head first into the thick of the NHS.

I should preface this series of posts by pointing out one thing, each woman’s experience will vary quite a bit depending on which NHS Trust is treating them through their pregnancy and what facilities and services are available in their area. While one of the big advantages of the NHS is that a lot of the advice and care is similar, my experience could be very different than a woman living in a different NHS Trust.

I’ll start at the beginning, after taking a pregnancy test (okay, three) I rang my GP, and they referred me directly to the midwife service. Here in the UK, most antenatal care is given by midwives. For women who have no risk factors or need for any extra consultations, they may never even meet an obstetrician. This is probably the single biggest difference between antenatal care in the UK and the US. After the brief call to my GP, I called the midwife service and booked a date for an “early bird” appointment the following week.

My “Early Bird” Appointment

When I was only 5 weeks pregnant I had my “early bird” appointment. Depending on where you live in the UK, your appointments with your midwife could be at a Children’s Centre, in the antenatal unit of a local hospital, or wherever your local midwife service might be located. In my case, my appointment was at a Children’s Centre which is such a different vibe than a doctors office. I quite like it, instead of going in and sitting on an examination table, my appointments with my midwife are in a very comfy and laid back setting. This first appointment was just a 20 minute intro where I was given lots of stuff to read and the main purpose of this visit was to meet my midwife and also for her to explain to me about the Down’s Syndrome screening test, identify the section of the information packet I needed to read and to prepare me for my “booking appointment” where I would need to make decisions about what tests I wanted.

One thing that is paramount in NHS antenatal care is choice. Women are encouraged to make informed decisions and must consent before pretty much anything is done. The early bird appointment is just to make sure the mother has enough time to consider all the information and make informed decisions at the booking appointment when the tests must be ordered and scheduled. Not a single scan will be taken or vial of blood drawn without the mother being completely aware of why and giving consent.

Another thing I was given at this appointment was the NHS packet on pregnancy. This booklet was extremely informative. It would be a great tool for a woman who maybe can’t afford to go out and buy a bunch of baby books, this packet has all the information needed from a week by week guide of pregnancy, to information on different options for birth plans, and explanations about each appointment and what to expect. It is incredibly well written and illustrated and I found it great to have early in my pregnancy before investing in my own baby books, and I still refer to it as a resource along with other books I’ve purchased.

The other thing that is included in the packet is the NHS list of what woman should and should not eat during pregnancy. I found this especially helpful because there is just one list, and every pregnant woman in the UK will get this same list. I have heard so many of my American friends going around and around about the list from their OB, and I’m glad it isn’t something I have to worry about. Every OB seems to have their own recommended list of foods to avoid, and it can be very confusing for a woman. They often are left thinking “Well, my friend can eat this, why can’t I?” or else the even more worrying question “My friend has been advised by her OB to avoid this, should I be eating it even though my OB says its fine?” I don’t envy women who are left with these types of contradictions and its nice that the NHS makes this simple for women and its quite black and white.

My Booking Appointment

My booking appointment took place when I was 8 week pregnant, again with my midwife at the Children’s Centre. At my booking appointment (the name comes from a time when women had to literally book their bed in the hospital to give birth) my midwife took a full medical history of myself and my husband and asked all the relevant questions. All of this information was entered into my handheld notes. This is a binder that I will carry with me to every appointment from now until well after the baby is born, so instead of the midwife and hospital staff passing around information, I carry around one folder and they all fill in the information at each appointment to build my file. It is definitely a new concept to me, but I like that I’m in control and not reliant on the various people who I will see to communicate with each other.

After this she took blood samples (again explaining to me what each vial of blood was testing for and asking me to sign off on the tests before taking the blood) and after about an hour of questions and tests and generally getting to know me and my husband, my booking appointment was complete and I was left to await a letter in the mail confirming when I would have my first ultrasound scan.

The Twelve Week Scan

After what seemed like the longest four weeks, my husband and I finally showed up for the twelve week ultrasound scan last week. It was one of the most amazing experiences of our lives. The ultrasound scan took place in the women’s wing of my local hospital, I brought my handheld notes with me for the ultrasound techs and midwife assistants to fill in all the necessary measurements and sign off on tests that were run after I had blood drawn. We were also given the expected due date of January 25, 2012! And of course, we got to take home the first photo of our little one.

After about three months now in the NHS antenatal care system, I’m left with a few conclusions. First of all, the approach to antenatal care is a very natural one. For women who need extra care it is there, but for women who have low-risk fairly typical pregnancies, care consists mostly of regular appointments with a midwife and very little time spent in a hospital or doctor’s office.

Also, pregnant women are very well taken care of through both the NHS and other government agencies. During pregnancy and for a year after the baby is born pregnant women receive free prescriptions and NHS dental care. Also, policies regarding pregnant women in work are excellent and go to great lengths to protect women and their jobs, and maternity leave is also excellent, something I’ll touch on more in later posts.

I’m really looking forward to sharing my experiences with you over the coming months!

Comments

  1. avatarEva says

    Congratulations!! What an exciting time for you both. Wishing you a great pregnancy, a painless delivery and the very best for the future!

  2. avatarclare says

    The NHS approach to pregnancy and childbirth is fantastic. I began my pregnancy in the UK and moved to the US at 18 weeks. Even though I have top of the line medical insurance here, it doesn’t make up for the over-medicalised approach. I’m due in one week and will deliver in a NYC hospital but would rather be in the UK with a midwife.

    • avatarLisa says

      Yes, so far I am really enjoying the experience. When I talk to my friends in America they report back a very different experience, especially when it comes to procedures and taking blood. They often tell me that they just get poked and prodded, nobody really tells them what for. I feel very much in control of my care and I like that its a bit more “hands-off” and treated as the natural process that it is.

  3. avatarSue says

    Congrats from me in sunny Saltburn, just down the road from Hartlepool. You will be looked after well, I am sure, by our fabulous, free at the point of delivery, (excuse the pun) NHS.

  4. avatarDixieBrit says

    Glad you are having a good NHS experience. I have had two children, one in the US and one in the UK. I still think of my NHS experience as a nightmare, even though it was over 13 years ago now. The NHS works well as long as you play within their system and don’t deviate.

    When I found I was pregnant (don’t you love that they say, “fell” pregnant, like it is an accident), I met with my GP to arrange for care with the midwives. The main hospital in our NHS trust was foul, a real dirt magnet and I had had way too much experience of it to want to go there. I had been caring for my often-ill mother-in-law and knew too much of the place. Plus, they had a very understaffed maternity section.

    The other hospital nearby, about the same distance, and within my choices, was a teaching hospital for midwives! I had visited and found it clean, bright and friendly. I knew this was where I wanted to have my baby. My GP was great, booked me in and the next thing I knew, the midwives were ringing to arrange appointments. My first appointment was in my GP’s clinic. I came in to meet with them and, since this wasn’t a first time for me, I expected things to be rather straightforward.

    The midwives interviewed me, gave me literature and then wanted to do the standard weigh and measure stuff. While they were doing so, I mentioned that I was planning on the teaching hospital as our hospital. The mood in the room changed immediately. Now it was hostile. These midwives were from the main NHS trust hospital and did not take kindly to my choices. They practically shoved me out the door and complained at me for wasting their time. Hey, I didn’t make the appointment, they did!

    Turned out I was supposed to meet with midwives at the other hospital. This was an error somewhere down the line, but these local midwives took it upon themselves to call my husband!! and tell him that they thought I was depressed. I was furious, not depressed, and swore never to darken the door of that hospital for any care, ever.

    Eventually, I did meet with the midwives at the other hospital, but because I was coming from an outside of catchment trust, there were many communication hiccups, not least of which was allowing me to go 3 weeks past my due date. Still, I am glad I chose the hospital I did. Once our daughter was born, we had very good care and it was, indeed, a lovely place to have a baby.

    The main thing with the NHS is, you MUST speak up. The British have a very combative relationship against companies when demanding their statutory rights, but when it comes to the NHS, they often just roll over and take it. You cannot do that if you want decent care. The best care there only comes when you demand it.

    • avatar says

      When I first “fell” pregnant I was doing some googling and found a wide range of accounts. I found a particular blog where one woman had a pretty traumatic experience while living in one NHS Trust and then after moving to a different area having an amazing experience with her NHS antenatal care. Definitely why I said that experiences vary depending on where you go.

      It seems to me that when there is one person who has had a bad experience with their midwife service, there is usually a long line behind them of people with similar experiences. You can pretty much tell by talking to people what to expect, and from talking to other people in my area I’ve heard nothing but good things which is a positive indication that this is one of the “good” NHS Trusts!

  5. avatarzoe says

    really enjoyed reading this lisa, its interesting to see someones experience of the nhs, especially from someone who knows what its like to not have the nhs. =] im looking forward to more blogs you do on this subject
    zoe
    X

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