Since PregTASTIC is gaining more and more international followers, I thought it would be interesting to share some of my observations!

Babies are born all over the world and while it is obvious that pregnancy and birth in Somalia will differ very much from the US or India, we expect the Western world to have comparable standards of care. While the US and the UK share a language (well, sort of…) and Western health care standards, the one big difference between the two is that the UK has a National Health System (NHS)!

This means that expecting mothers will not pay anything out of pocket for their pregnancy care – including blood tests, ultrasounds, amniocentesis etc – or their birth (including all anesthesia, the hospital stay etc). In addition they get free prescriptions for the duration of their pregnancy as well as free dental work until the baby is 1 year old. In the US most people are insured through a plan at work or privately. Regular co-pays are the norm and while most doctors do not charge every time you come for a pregnancy check-up, you certainly get a bill for an amino or the hospital stay. Depending on you insurance plan, the birth of your baby can cost you as much as a month of groceries to a semester of college!

In the UK pregnancy care lies completely in the hand of midwives. You only see a doctor if there are complications. Ultrasounds are carried out by technicians, but you would see an anesthesiologist if you get an epidural or a surgeon if you need a C-section. I was sent straight to the midwife when the pregnancy test was positive and I don’t expect to see a gynecologist at all. In the US most women sign up with an OB-GYN, which they see for their check-ups and certainly for the delivery (even if a nurse coached you during labor and the doc just breezes in to catch the baby). When I was in the US, I had to search for a doctor that worked with a midwife and had to travel 30 min to their associated hospital! All other hospitals in the area did not allowed midwives. And while I was signed up with the midwife, I had to see the doctor at least twice during my pregnancy, since he was the main responsible care giver for insurance purposes.

While the NHS system sounds pretty wonderful from a monetary point of view, there are certain draw backs: in urban areas with big midwife teams, you might not see the same midwife for your visits and therefore have no idea who might deliver you. It is hard to develop a personal relation with your care giver that way and it is a bit worrying if you have a very specific birth plan you want them to follow. Pregnant women are seem MUCH less frequent here than in the US, which does not bother me since this is baby No3, but if I were a first time mother I’d be slightly worried if the midwife said “See you again in 6 weeks” after a 15 min consultation! There are less tests than in the US, too – if the NHS does not consider it essential, you don’t get it! For example, there is no routine glucose test unless there is a family history of diabetes. While some people find these test annoying or even invasive, for me they were always reassuring that somebody was keeping an eye on me and my baby!

The biggest draw-back by far this time for me is the fact that you only get two ultrasounds your entire pregnancy in the UK – week 12 to determine the due date and week 20 to check the organs. That’s it (unless there are complications)! And the ultrasound technicians are less than forthcoming with information about the gender. I totally expected to be able to ask whether it was a boy or a gilr at the 20 week scan, but a grumpy technician said that it was not her job to check for that, but only for the health of the organs! So we actually booked a private ultrasound at week 27 to check for the gender and assure us that everything is all right – which will cost us £100 ($160) for the cheapest package! (There is a whole industry here that covers services the NHS deems unnecessary, but people feel they need or want!). I really miss my US doctor’s office that had its own ultrasound machine and you could have a “quick peek” at the appointment!

In the UK, you have three official options for birth: at home, at a midwife-led centre or at a hospital. (A midwife-led centre is a birthing centre without doctors for low-risk women who want a natural birth). If you opted for a home birth or a midwife unit and you change your mind and want an epidural or need a c-section, you will be transferred to a hospital by ambulance. (There was a recent study that many first time mom needed such a transfer and the NHS was worried about this rising cost factor…). I was amazed that a home birth was officially offered to all low-risk women and was an adversised option in all the brochures and books! In the US it is only legal to hire certified professional midwife (CPM) in 27 of the 50 states. CPMs who continue to attend mothers in the 23 states where it is illegal, and can be arrested and prosecuted. (However, no state prosecutes mothers for giving birth outside a hospital, which sometimes happens unexpectedly!). Most insurance companies will only cover your birth if you are officially registered with a OB-GYN office. So most women in the US deliver at a hospital and only rarely are the births attended by a midwife!

When it comes to pain relief during labor, the UK has a couple of options that are very unique: before the epidural women are offered a TENS-machine that stimulates nerves with small electric shocks or “gas&air”, nitrous oxide (also know as laughing gas) mixed with oxygen, that women suck out of a  gas tank during contractions. Finally there are also shots of pain killers offered (pethidine or diamorphine). So there is a whole spectrum of things to try before the epidural, if you want to! In the US, I always found the decision very harsh – nothing or epidural!  On the other hand, in the US you have the option of a selective C-section – only last month did the NHS begrudgingly and with much protest from the midwives allow the possibility that women without medical indication could chose a C-section. You are really expected to birth naturally with a midwife if you can – it’s so much cheaper than a c-section with a doctor!

(So which option will I chose? We will try to go for a home birth. More about that in a future post!)

So we signed up for the Bradley Method, a husband-coached natural childbirth class. During this class our birth plan emerged – waiting until 42 weeks if necessary, no artificial breaking of water, no interventions (IV, pitocin, epidural, episiotomy), no constant monitoring = ability to move around during contractions, no early cord clamping etc. When I presented this to my OB/GYN, he flat out laughed at me: He always induced women at 41 weeks, hospital policy demanded 30min of monitoring on my back when I checked in as well as an IV “just in case”, if labor didn’t not progress he always gave pitocin and broke the water, if the baby seemed stuck he cut and – in any case – he had never seen a woman go through with such a birth plan, “they all want to go natural but scream for the epidural within an hour!” I was horrified.

My husband and I discussed our options for another week – should we take on a doula to help? How about delivering with a midwife? It turned out, the big hospital I was signed up with didn’t even allow doulas or midwives in the hospital, even if you hired them yourself (never mind did they provide any). One nurse watching up to 4 patients via the fetal monitor data at the nurses station and a doctor that came in only for delivery – that was it. It was a tough decision, but in week 36 we changed to the only hospital in the area that allowed midwives (a 30min drive away) and found a wonderful midwife named Doris that was fully supportive of our birth plan and encouraged us that natural child birth was possible.

We delivered our first son with Doris and with her expertise of various positions and (unfortunately, but necessary when labor slowed) a shot of pitocin we were able to achieve a natural child birth. It was a very empowering experience. So there was no question that, when we fell pregnant again 2 years later, she would be our midwife. That our second son ended up being delivered by a doctor was a surprise for all of us!

What happened? On my due date I woke up at 1am with contractions, but waited for a while to see whether they were regular. Then I woke my husband and called the midwife to meet us at the hospital. A friend came over to watch our first son and we took off at 2:15am. During the 30min car ride, the contractions were right on top of each other, every bump in the road almost unbearable. We checked into the hospital at 2:45 and while my husband was parking the car I felt the urge to push. My midwife hadn’t arrived yet, but the baby was coming! A rather panicked call by the nurse caused a doctor to come over from next door to deliver my son – just 17 min after check-in. Doris arrived about 10 min after the birth and took over (and the doctor went back to his still laboring patient next door). Even though it was not with a midwife, I had achieved another natural birth – and my husband was back home in time to make our son’s breakfast!

Now I am pregnant with my third child. We have moved to England in the meantime and I don’t even have the option of a doctor (not that I would want one). All vaginal births here are delivered by midwives. But we will try to go one step further and have a home birth! Because if labor is even faster than last time, I might not make it to the hospital anyway…

I know they say the third time is the charm, but with kids, anything goes. Before even becoming pregnant with this one, I wondered if I would be pressing my luck with another delivery. I’ve experienced two natural births that have been quite low on interventions. And I’m very pleased with that fact. Still I can’t help but wonder how this one will go. Will I be able to once again avoid the interventions I fear? Will I make it through this delivery without a c-section?

Part of my fear comes from #2’s positioning. I had horrendous back labor because she was sunnyside up until minutes before crowning. Thankfully my midwife knew a move that corrected her position. Back labor ended and she was born. I know that once a woman labors with a baby in that position, her likelihood of that happening again increases. If so, I hope that same maneuver convinces this one to flip as well. But who knows; this one might never be in that position. This one might be ready for an even speedier exit than #2…an exit that nearly happened before my midwife made it to the hospital. Which brings me to fear #2.

What if this one comes too quickly? With #1, my labor stalled the minute I walked through the hospital doors. Now I have a better understanding of the progression of labor and the sphincter law (as Ina May Gaskin calls it), which is why I waited to go to the hospital with #2. I know the longer a woman labors in a hospital, the more likely interventions will be. So, when hard labor started, I got out the exercise ball and bounced through them in the comfort of my living room. When the breaks between contractions were becoming non-existent, we left for the hospital. It’s a good thing we didn’t wait any longer; she was born within an hour from the time we entered the hospital.

Having experienced back labor with both kids, my midwife says that if this one is in a good position, I might not have back labor. And then I might not even know I’m in actual labor. While I do enjoy the thought of not experiencing that horrible back pain, I’m not sure how I feel about an unexpected home…or car…birth. Perhaps my husband should start looking into birthing techniques.

So what do I do about these fears? The only thing I know to do. Read and research. Throughout the years I’ve taken in a plethora of birth stories, talked to doulas and midwives, listened to countless podcasts, read a fair amount of books and attended a birthing class. I’ve come up with my personal birth philosophy thanks to the knowledge I’ve collected, so perhaps the most important thing I’ve done was to find a care provider that will respect that. I have a midwife I know and admire. I have confidence in her abilities. But more important than her abilities are my own. I know I’ve done this twice before. I know things can always happen or go wrong. Twists in the journey can pop up unexpectedly, but I believe self-confidence goes a long ways.

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Listen to PregTASTIC, Episode 230 to learn more about the Top 10 Labor and Delivery Fears many women experience.

I swear the moment I became pregnant, my belly just gave up and popped out. With my first, I began showing somewhere in the fourth month. It happened a bit earlier with number two. But number three has made it difficult for us to keep our pregnancy a secret through the first trimester. I have been doing my best to camouflage and suck it in, but when we finally began making the announcement official over the weekend, we were the ones who were surprised. The responses we heard from several family and friends were, “I knew it!” or “I thought so!” or as my mom said, “I noticed you were getting a belly.” Gee, thanks, Mom. So the “surprise” was actually on us.

We have always preferred to wait until the end of the first trimester and after my first midwife’s appointment to tell everyone. I’ve seen couples share their news early, have a miscarriage and then have to deal with a whole different sort of announcement. Call us cautious or superstitious, but that’s why we’ve waited. My first appointment was last week, at which time I asked the nurse practitioner to make sure she heard only one heartbeat. With the way my stomach was popping, a part of me wondered if our family of four would expand to a family of six…or more. Thankfully she said I was measuring fine and she was pretty certain there was only one heartbeat. Fingers crossed, that will remain the same during future appointments.

I must say that hearing that “whoosh, whoosh, whoosh” of the heartbeat really did make this pregnancy more of a reality. Honestly, before that it just felt like I had eaten one too many cookies. But alas, there is purpose behind my changing physique thanks to the little one growing inside—news that has Jonas, 4, and Kenna, 2, very excited. They have been talking non-stop about the baby and asking to touch my belly (which is still weird at this stage).

We decided to get Jonas in on the announcement and had him draw pictures for the grandparents. He drew five stick figures and labeled them, “My Family: Dad, Mom, Jonas, Kenna and Baby.” And, yes, my figure was also a stick figure, giving me hope that in time my body will once again be mine.