Tuesday, November 21, 2006

Preparing for birth in Britain

This will be a fairly long post today about what has happened in regards to getting ready and registered for the birth of the baby in Britain. Unless I get sick of typing, in which case, consider it part one.

I landed in Britain on Friday October 27. One of my main priorities was getting quickly into the system here, to make sure everything would go smoothly for the birth. So I went down to the local clinic (often called a "surgery" here, a term which I find most inappropriate, especially nowadays) on the following Monday, October 30, to get an appointment. I got an appointment with a doctor for that afternoon.
He was a nice and friendly guy. I showed him my little book of medical information from Germany and he was able to make out most of it. In Germany, every expectant mother gets what's called a Mutterpass or Mother's passport. It contains details of all your visits to the doctor or midwife, the blood tests you've done and their results, your weight at each visit, the position of the baby, any complications are noted in a special section, etc etc. You are supposed to carry it with you at all times so that if anything happens to you, people will know you are pregnant and your pregnancy history. After deciphering my Mutterpass with a bit of help from me, he basically asked me if everything had gone okay up to this point, if there was anything he should know. I said so far, so good; so he just did a simple exam.
It was different from my exams in Germany. In Germany, my doctor checked me from inside everytime to make sure my mucus plug was still in place and to make sure the cervix wasn't opening or anything. From that finger test, she would also rub it onto a petri dish, I assume for a simple test for any new bacteria or such. I actually didn't think to ask at the time what exactly it was for. She would give me a quick feel of the tummy, feel my ankle for any swelling and that was that for the actual basic examination. Before I saw her though, I always did a urine test, got weighed and my blood pressure taken by the assistant and also hooked up to a fetal monitor for 20 minutes. Other times, there were ultrasounds involved to measure the size of the baby and to check position, but that didn't happen every time.
Here in Britain, I was weighed, peed and got the blood pressure, but no internal exam. He felt me on the outside to check the position of the baby (head down, by the way) and for the first time in my pregnancy, actually got out a measuring tape to measure my fundus - the size of my uterus. I know that's to check that the baby is growing on each subsequent visit, but it somehow felt quite quaint and old-fashioned after my flash doctor's office in Munich.

At this point I have to go slightly off topic and comment about that. In Germany, there are hardly any practices with several doctors working together in the same offices. The most I've ever personally had were two working together. Oh wait, when I had knee problems, I did go to one specialized clinic for orthopedic injuries where there was more than one doctor. But for General Practioners, nearly always 1, very occasionally 2 together.
What also seems standard in Germany is that you go to an OB-GYN when you are pregnant, not a GP. You can then trade monthly visits between the OB and the midwife, or see one or the other more or less exclusively. You also choose yourself who these people are. It might be based on your doctor's recommendation, but the final decision is up to you. Here in Britain, from what I've picked up, your general pregnancy care is in the hands of the community midwife/wives. Nothing wrong with that I guess, it just felt kind of restrictive after my previous ability to choose.

Anyways, Mike (the doctor) told me to make an appointment to see the midwife at the clinic within the next two weeks and if I couldn't get in to see her, to come and see him again in two weeks. So out I went to the front to make an appointment. Remember it was October 30 this day.
Appointments woman: "Right, how does November 23rd sound?"
Me: "It sounds way too late. I'll be only 3 weeks away from my due date then."
App woman: "Oh! Let me see if I can you in any earlier."
After some checking, it turned out the local midwife was on holidays until Nov. 16, so I couldn't get an appointment before then. We made a provisional appointment with Mike for about 10 days later and she told me to call Wexham Park Hospital to see if I could see one of their midwives before then.

So I called Wexham Park and told them the story (new to UK, pregnant, need to get registered, blah blah blah). Here I found out that the Cookham midwife was in China at a conference! Interesting information, but didn't really help me. So they said they would arrange something and call back in a few days. That was the Wednesday, and on the following Monday morning I got a call from the midwife who said she would come and see me at the house on Wednesday afternoon. (See here for previous mention of that visit)
That seemed strange, having a medical appointment in my own home, but it was pretty straightforward. I had to give a urine sample again, blood measure and the quaint fundus measuring. She felt my tummy to make sure the baby was still downwards and took a blood sample. Even though what she said the blood was for was all tests that I had already done ages ago and had written down in my Mutterpass, but she wanted it, and so I let her have it. No need to make a big fuss I guess. I was a bit surprised when she took the blood sample without putting any gloves on or sanitizing my arm first though! Gangrene doesn't look to have set in though and I did see it was a new sterile needle, so I guess it was okay.

So that was 2 weeks ago and this week my new British records should be ready for pick-up. I can understand 2 weeks as a standard turn-around time, it's no big deal when you are in the early stages of pregnancy. But I would have thought coming into the system at 35 weeks pregnant they would have tried to get them done a bit quicker for me, as really things could get moving anytime. Ah well, the British one is a big folder that you have to carry with you, not nearly as convenient as my Mutterpass, so I should be happy that I haven't had to drag it around with me so far.

And that's it so far, until my next appointment with the Cookham midwife this Thursday. Back from China, with all the latest news from the world of midwivery. We also did a tour of one of the hospitals this past weekend, but I think I'll save that for another post.

1 comment:

susan_rn92 said...

It appears that you are experiencing the difference between a medical model and the more holistic model that is common to midwifery. I don't know how other countries give choice of health care during pregnancy and birth, but in Canada you have a choice for care provider whether your GP if they do deliveries or a referal to an OB, and the other choice being a midwife if one is available in your area (most provinces cover them with the health care plan). I like the idea that you can choose what fits your comfort zone more. Some people feel more comfortable with the scientific medical model, with methods such as electronic surveillance and interventions such as epidurals. Then there is the type of person who feels more comortable with the minimal invasive methods where there is an assumption of wellness instead of illness. I agree with you, choice is always best.

The measurement of fundal height is commonly used in Canada to assess the progression of pregnancy. The number of centimeters measured should be approximately equal to the weeks' gestation after about twenty-two to twenty-four weeks' gestation. It works well if the same person is always doing the measuring and can identify if other more invasive or expensive investigations need to be done.

Studies have shown that there is an increased association with operative proceedures in births where continuous fetal monitoring is used. It is suprising that in Germany they would choose to have routine monitoring for a normal pregnancy.

Hope you are able to navigate for what seems to be the bane of health care anywhere, red tape. Good luck.