Pedram and I walked to the doctor’s office when I first found out I was pregnant. We had just moved to England and Brighton, and needed to find a doctor, who could refer me to a OB/GYN. I have now had a few different gynecologists in three different countries, so I was even bold enough to ask for a specific type of obstretrician for my care. Because I am crazy and ask alot of questions, and need someone who can handle that (doctors love me).
I didn’t do any reading about the healthcare system in the UK before this appointment, and since I was in denial about the whole pregnancy, I just figured it would be similar to Belgium, Luxembourg or Canada and nothing like the US. Meaning it would be free, I would probably have to wait a bit longer, there would be more paperwork, etc. And that the quality of care would be less, cause paying for care = better care, therefore free healthcare = not as good. USA for the win!
So, back to last November. We walked up to the GP office, and he told us we needed to see a midwife. Which was fine by me, but I was curious when I would see a medical doctor. And he told me…never. The British system is much different than in Canada, or Belgium, or the US. Basically, I never see a doctor, only midwives, who have more specialized training than midwives elsewhere. Unless you have a special issue, pregnancy is only ‘treated’ by midwives. The approach to pregnancy and labor is refreshingly different here — it is not seen as a medical condition, but rather as a natural development with support to guide you through it. The pregnant woman is not considered ‘sick’ in any way, she is going through a process (like growing teeth!) and will have people available to make sure she goes through it safely. I really really liked that assessment of pre-natal care. It was comforting to hear pregnancy presented this way, and I felt confident with the midwife level of support, and knowing that if I needed it, I could get additional medical care. I’ve heard about midwives from friends and imagined alot of womanly support and understanding, which sounded excellent.
After all that reassurance, we made an appointment with the midwife and showed up to a children’s school, rather than a clinic. That should have been my first clue that things were different. I entered the room, and promptly started looking for a place to take off my pants. Cause that is how things usually go. But the midwife had me sit down, and looking around, I noticed that there are no medical equipment around. We talked for 15 minutes, and then she sent us home. This is how all my appointments have been — quick and conversational.
I never took off my pants. In fact, throughout this pregnancy, I have never taken off my pants. Other than occasionally peeing on a stick or taking my blood pressure, there is no other medical assessment. There has been no cervical examination or any probing. No one confirmed my pregnancy with a urine test or blood test or ultrasound. No one has weighed me to see how much weight I am putting on. In my third trimester now, I have no idea what the position of my baby is, how big it might be. No one has talked to me about swollen ankles, bloating, hormonal changes, diet, pre-eclampsia or its symptoms, or any other related pregnancy issues.
The midwife goes through her checklist of questions, writes some notes down, and then asks if we have any questions. We stump our midwife with our questions everytime we visit — they are constantly asking us why we are interested in specific things. They are perplexed at Pedram’s presence (most women come alone). They ask Pedram if he is a scientist because of his questions.
There are many many questions they cannot answer, and instead they constantly try to reassure me that things will be fine. But I am not asking because I am nervous or worried, I am asking because I am curious. And would like to know.
When I ask: ”should I be careful of what I eat?”,
She responded: “limit alcohol consumption to two units a week. stay away from soft cheeses and raw eggs. Don’t worry about it, your baby is resilient.”
When I ask: ”should I take any vitamins?”
She responded: “there is no need to if you are healthy. Don’t worry about it, your baby will get its nutrients”
When I ask: “should I be careful about exercise? The way I sleep? The pain I feel here and here?”
Always: “don’t worry about it”
I completely understand the approach here — it is very laid back, very calm and reassuring and don’t worry, this is all natural, everything will be fine, etc. But I quickly found out I don’t work well this way. I work best when given all the information I need, especially from a professional in the field. One who makes me feel confident about the process and the research. One who will quote medical studies and explain to me exactly why folic acid is important for development, where I can get some from plants, and whether or not it makes sense to supplement with a vitamin.
For example, no one has talked to me about the birth process. When I ask about it, they say “don’t worry, you have time. Don’t even think about it, it will all be fine. You will have a lovely baby”. But that is not my worry. I am curious about the process and the system. And I have been told repeatedly not to worry about it. At the same time, they ask me which hospital I would like to deliver at. And when I ask the difference between the hospitals, I was told that they are the exact same. Which is not true. One has a neo-natal unit, one does not. To me, that is a big difference. To them, the fact that I think about this is a form of paranoia.
More than once Pedram has turned to me after an appointment and said, “wow, that was completely useless.”
In my first appointment, I made it clear that I had anxiety issues. I was told this is common. In my second appointment, I tried to explain how I am positive about a blood test, so it might not be necessary for me. The midwife was perplexed, annoyed and dismissive.
I have been reading tons of literature — much of it focusing on how wrong the US process is — pregnancy is seen as a medical procedure, women have no choice, it is a business, etc. And in alot of ways, the UK process is much better. But I don’t feel like I am given much information and empowerment. I feel almost pushed in the opposite direction, that pregnancy is completely natural and instinctive and that I don’t need to know more than that. But I like medicine and science, and am aware that there are many complications involved in pregnancy, so why should it be so hard for me to learn as much as I would like about it?
Women can die due to complications in pregnancy. Babies can die. It is a reality, maybe not as evident in first world countries, but there are reasons for that. Shouldn’t we know them?
Pregnancy has left me isolated as a woman — I can’t help but think how different everything would be if men had to be pregnant. There is such peer pressure for women to prove themselves during pregnancy and labor — to show they can do it naturally, or that they don’t need medication. Those who have elective c-sections are shamed by those who don’t, and vice versa. To what extent will women go to in order to show they are in touch with their maternal side? I support any woman’s quest to give birth however she wants, given of course, that she feels inspired and confident in her choice. Not bullied. This is not always apparent to me. And in this way, the US systems and the UK system are painfully similar.
I do have anxiety issues, and the more control and information I have, the calmer I am — telling someone who has repeatedly mentioned her anxiety “don’t worry about it”, does not help. I have actually had some face time with an obstetrician — once at a private ultrasound that Pedram and I paid for (he was out of town when the public one was scheduled, and I was freaking out going by myself, so we purchased one — which ended up paying for itself in advice). That doctor gave us plenty of information, and patiently listened to our concerns, and most importantly, explained to us the answers of our questions. He encouraged us to take pre-natal classes to help with my nerves, told us the differences between the hospitals in Brighton and was very reassuring.
The second time was while I was in LA, I tagged along for my sister’s post-op appointment, and actually scored another ultrasound and some quality time with a doctor. Who, explained to me in detail about the difference in having a two vessel cord vs. a three vessel cord. A question my midwife told me I shouldn’t worry about.
I should make it clear that ‘my’ midwife is a loose term, as I have seen more than 5 different midwives. They are interchangeable, some more pleasant than others, but all have tried to reassure me by being incredibly short with me. It is not at all the type of feminine care I was expecting, it is someone who is checking off a list each time I see her, and not making an effort beyond that. I have been told that the midwives in Brighton are some of the best in England, and that their hands are tied by the National Health System in Britain. Sadly, the NHS is currently cutting costs as a part of the country’s larger austerity measures, and in alot of ways, care is not improving for women, especially in their options. Birth centers are being closed, and midwives are being overworked.
I am demanding, and I must be the most annoying patient ever. But I feel like I have to be persistent in order to get a full picture of this process. And why should I be apologetic about that? It is my right.
There is a fourth-time pregnant mom in my yoga class, and I envy the amount of confidence and peacefulness she exudes — she is a resource of knowledge and understanding about all of the anxieties of a first-time mom. She helped me acknowledge that there is a definite feeling of vulnerability as a pregnant women, which is not always calmed by ‘motherly intuition’ or’googling symptoms at 2am’. She reassured that she felt many of the same feeling I have when she was pregnant the first time, including a disconnect from the midwives. And although I appreciate the midwivery system of maternal healthcare here and their approach towards a pregnant woman, I don’t always feel supported.
Sadly, I would imagine that other women around the world may feel the same way.
