Birthing a baby across the pond: part one – the technical stuff
Slightly pissed at 2-3 weeks pregnant.
Is it ok to fly in early pregnancy?
How do I verify this bun in the oven when I don’t even have a doctor in this country? (I paraphrase, but you get the gist)
Such was my google search history in the hour after getting the first positive pregnancy test. As I waited for my husband to return from work, sat amidst the debris of packing for a three-week trip home for Christmas and ever such a slight hangover from drinks the night before (you don't have to guilt-trip me, I still feel it now...), I did as many modern mums-to-be do, and took to the internet. The ClearBlue Digital prophecy had spoken and I needed answers, fast. And so began a devoted nine-month relationship with the search engines, in which I sought to furnish myself with all the information that What to Expect When You’re Expecting didn’t tell me – the stuff that is assumed prior knowledge for anyone who has grown up in the country they will be giving birth in, but leaves those of us recent joiners a little in the dark.
Below are some of the key questions I had about handling the medical side of my pregnancy, and the rough responses I deduced from all that googling. (It goes without saying that I am no expert, and this information is based purely on my own limited experience. If you had a different experience and info that other mums would find useful, please get in touch!)
How do I confirm that I am definitely, definitely pregnant?
Having only been in the States for four months by the time I fell pregnant, I hadn’t yet forayed in to the world of medicine. In the UK you have a GP who is your first point of contact for anything medical; in the US you basically see a specialist as and when you need to and (if you’re sensible and not blinded by the British mentality of only bothering the doctor when you’re at death’s door) schedule annual wellness checks for a general once-over. I had no assigned gynaecologist, so had to work out who I wanted to see (see below) in order to confirm that there was, indeed, a bun in the oven. As my husband so helpfully said, ‘let’s not jump the gun – all you’ve done so far is piss on a stick.’ Once I’d selected someone, it was quick and easy to get an appointment, but even then there were no further tests involved – apparently OTC pregnancy tests are so accurate these days that if you’ve had a couple of positive results, you can pretty much guarantee that this is happening. Cue lots of waiting and almost (but not quite) hoping that the morning sickness will kick in for reassurance that there is definitely something there before the 12 week scan when you can actually see something conclusive for yourself.
Who am I going to trust to befriend my nether regions for the next nine months?
Back in the UK, if you’re fortunate enough to have a complication-free pregnancy, you will likely be seen for monthly check-ups by a midwife or your GP (or some combination of both), and then select somewhere – typically a birthing centre or hospital – for the big day itself. In the US you’ll pick a provider who is covered by your health insurance from the outset, and the idea is that their practice will see you through your pregnancy, birth and all the way to postpartum check-ups. Most mums-to-be opt to be seen by one OB-GYN (obstetrician-gynaecologist) – a specialist doctor who will see you for scheduled appointments in their clinic, and then works with a team of others to cover the shifts on the delivery ward at their affiliated hospital. It’s a great option if you want to build a relationship with one person who gets to know you and your pregnancy really well for nine months, although the downside is it’s pot luck as to whether your doctor will actually be on shift to deliver your baby.
I opted, instead, for a model that was more similar to what I guess I would have experienced at home and signed up with a practice of midwives (less common in the States – only about 9% of women here deliver with a midwife instead of a doctor). They approached things a little less ‘medically’ than I think an OB-GYN might have done and were supportive of my wish to try for a low-intervention birth. All the midwives in the practice saw women both in the clinic and on the delivery ward where they shared shifts between them, so I took up the option to rotate who I saw for each appointment. It meant I didn’t have a consistent relationship with one clinician, but by the time I came to deliver I knew there would be a high chance that the midwife on-call was someone I had already met at least once. It worked for me – feeling like the women who admitted me, delivered my daughter, and then came round to check up on me later in our hospital stay actually knew me, was brilliant – especially being so far from home and without family around during and immediately after the birth.
When will I see this little nugget?
Whilst the monthly opportunity to hear your baby’s heartbeat and get the ok after pissing in a plastic cup is reassuring, what you really want is to see that little peanut, right? If everything runs normally, you’ll just have two ultrasound scans during your pregnancy – one at 12 weeks and another more detailed scan at around 20 weeks. Just like at home, you can pay to have an early scan if you have any concerns, and a 3D one further down the line, but you’ll probably have to look beyond your regular clinic for that. Clinic appointments, by the way, may be scheduled more frequently closer to your due date: for me, monthly check-ups became fortnightly in the third trimester, and then I was seen every week in the last month (which I think is a little more frequently than most people are seen in the UK).
Everyone at home I know has done NCT classes: what kind of preparation is there here?
Most of my friends who’ve had babies have done NCT courses and I loved the idea – getting a bit more prepared for what was in store with the birth whilst meeting other new parents to hang out with / late-night-desperate-text during the early months sounded like a win-win to me, and being away from home without a really developed friendship circle made the social side of things particularly appealing. Unfortunately, I couldn’t find an exact equivalent here in Philly so – much to my husband’s joy, and in the true geek form of someone who always loved a colour-coded revision schedule during exam time – I kind of constructed our own course. The hospital ran a few different things – a one-day course on labour and delivery with a chance to visit the delivery suite, a couple of evening classes on the basics of newborn care and – my husband’s particular favourite – a breastfeeding seminar (he did later admit this was the most useful of them all, but I still had to drag him there like a reluctant teenager). I also signed us up for a three-session series run privately by a doula (see below) focusing on preparation and comfort measures for those hoping for a low-intervention birth. ‘Conveniently’, my husband ended up having a business trip that clashed with the last, and most hands-on, of these classes so his sister who was visiting deputised as my birth partner. I’m telling you now, you have not fully explored your relationship with your sister-in-law until you’ve had her massaging the backs of your thighs in a move sensitively dubbed ‘milking the cow’, whilst you lean against a wall alongside seven other heaving pregnant ladies experiencing the last uncomfortable weeks of pregnancy in the midst of an East coast summer heatwave. Forever in your debt, my lovely!
How am I going to cope with the pain of labour?
It turns out us Brits are pretty bad-ass when it comes to birthing babies. The general consensus amongst the childbirth educators (I know, w*nky name, but that’s what they’re called over here) we met was that British practice has evolved so we are less likely than Americans to view labour as a ‘medical’ process, with the associated drugs and procedures, and more inclined to favour a low-intervention approach to getting those little buns out of the oven. Cue a degree of basking in patriotic glory (complete with silent fist pumps at the side of my chair where my fellow educatees couldn’t see) on my part at how hardcore we as a nation are. Bear in mind that I hadn’t experienced a single contraction yet – oh how much I had to learn.
In practice, what this means is that the epidural rate in America is somewhere between 60 and 70%, compared to about 40% in the UK. The caesarean rate is also higher – about one in three in the US, compared to one in four at home - thought to be (and obviously this is a generalisation) partly because many American doctors are concerned about being sued for letting women labour for too long and so are more likely to step in with medical intervention sooner. My plan – based on little else other than that it’s what my mum had done 30+ years ago and it had turned out ok for her – was to try for a lower-intervention birth, which I thought meant seeing how far I could go with some gas and air. My one close friend at home who already had kids had done that and said it was enough to take the edge off and her husband benefitted from the calming effects of the odd puff too. I soon learnt, however, that America doesn’t ‘do’ gas and air. The educators (ugh, I hate myself) I spoke to said it’s because anaesthetists make too much money from epidurals and fear losing out on this if women have other options for pain relief. This seems counter-intuitive to me in a system that is supposed to be built on consumer choice, and there are some lobbying efforts amongst midwives and doulas to change this – but for now, the medical pain relief options are basically epidural or nothing at all.
What the f*** is a doula?
If you’re a slave to the pregnancy bibles like many mums-to-be find themselves becoming, and those bibles are American, you may come across discussions of a ‘doula’. A doula is basically an additional birth partner – someone who doesn’t necessarily have medical qualifications (although many do) but has attended lots of births and can provide help with positioning, breathing and comfort measures to alleviate pain, as well as moral support to both you and your partner. Most doulas receive some private payment from you – although there are some that offer their services voluntarily – and many will also visit you at home after the baby arrives to check up on you all, help with feeding and answer any early days questions you have (something I found a really appealing option in the absence of both NHS health visitors and having my mum on the same continent). The process of deciding whether to have, and then selecting, a doula warrants a separate post which I’ll endeavour to do in the near future.
What is my hospital stay going to be like?
I’ll be honest – this is where it gets really good. I understand why the NHS needs to turn new mums round as quickly as possible, and if I had given birth at home I may well have wanted to escape the madness of the maternity ward and get back to our house and the awaiting masses of admirers of the new bundle pretty pronto. Having now experienced labour and delivery though – albeit a relatively straightforward one – the thought of being sent home mere hours after giving birth, as so may at home are, is completely unappealing when I compare it to the experience we had here. In America, it's standard practice to have a two-night hospital stay after the birth. If your hospital is anything like the one we were at, you’ll have a private room, en-suite bathroom and a futon on which your partner can also stay so they don’t have to miss out on any of the middle-of-the-night fun. Both you and the baby will receive regular check-ups, there’ll be the opportunity to see a lactation consultant for help getting started feeding however you choose, and there are plenty of nurses on hand for all those first-day questions that might otherwise send you in to a panic.
- What does the green line on the nappy mean? No biggie - she’s just had a wee.
- Jesus, why does her poo look like that? That’s meconium – it’s a good thing that it’s working through the system.
- Err, how come I’ve woken up looking like Dolly Parton? Don’t panic! That’s the milk coming in.
The hospital stay gave our new little family some time and space to get going on this new way of life with the safety net of experts just outside the door for help when we needed it. My husband mastered nappy changes and swaddling whilst I had a few hot showers, time and plenty of supplies to concentrate on my healing (which, even if you have a straightforward birth, is so important). When my husband and I emerged from the cool comfort of our hospital room in to the stifling summer heat to walk our daughter home for the first time, we had a grand total of 60 hours of parenting under our belts, and the beginnings of a partnership grounded in enough confidence to wait at least an afternoon before we turned back to google with our next slew of questions. As the nurse said, eyeing my porn star-esque boobs as she signed our discharge papers: ‘Now the fun can really begin.’