Pregnancy is the same all the world over. And yet – there are differences in how pregnancy is approached from culture to culture. Some differences are stark, while others are subtle. I think it’s so interesting to learn about the norms for pregnancy and childbirth in various countries. One trivial thing that I still haven’t gotten used to is that you have to say ‘antenatal’ here instead of ‘prenatal’. I botch that one up all the time. Also, here in England, you don’t get pregnant, you fall pregnant. Very passive.
Anyway, once you’ve fallen pregnant, you need to organize some antenatal care for yourself. I thought maybe you might be interested to know how prenatal care is set up here. As with other health-related issues, the NHS entitles every pregnant person who is a legal resident of the UK to free treatment. (Well, it’s not technically free because if you’re a legal resident, you’re also a tax-payer in some form or another. So you’re paying for your healthcare, but there is no exchange of money at the point of service.) In fact, to add an extra incentive for pregnant women to have all of their health needs met, you are exempt from paying for prescriptions and routine dental care while you are pregnant and in the year following the birth.
Midwifery is at the heart of the whole antenatal care system in the NHS. I’m 26 weeks pregnant now. I haven’t seen an obstetrician yet, and if I’m lucky I won’t have to. I say ‘if I’m lucky’ because obstetricians only get involved with cases when they involve some sort of complication. If the pregnancy is healthy and straightforward, then midwives provide all the care right through to the postnatal stage. Personally, I like this orientation. I think pregnancy is a normal (albeit special) condition for the female body. Doctors are trained to diagnose health problems and treat them. Of course, pregnant women are more vulnerable to all sorts of health problems, and I am unreservedly thankful that doctors are available to treat women who need their expert intervention. It’s just that in and of itself, a normal pregnancy isn’t a health problem. I think it is a good sign that the NHS recognizes this. Midwives, on the other hand, are experts in normal pregnancies. Because they know "the normal” so well, they’re good at spotting cases that need additional attention from a doctor. Midwives are skilled at giving reassurance and advice, especially to new mothers, for whom all of the bodily changes seem so alarming. It’s so nice to hear a midwife say, ‘That’s normal.’ As it turns out, there’s a pretty wide spectrum of what’s normal in pregnancy.
I can’t say very much about antenatal care in the first trimester, because I was already 14 weeks by the time we left Texas. Once I got back to England, I made an appointment with a midwife at my GP’s office. She checked me out and referred me to the maternity hospital. I went to the hospital for a ‘booking-in’ appointment. A midwife went through my medical history with me, ordered blood tests, discussed my options for screening for genetic conditions, and gave me advice about how to stay healthy during pregnancy. I was given a set of hand-held maternity notes to carry with me when I see any medical practitioner. At 20 weeks, I had an appointment for an ultrasound. Usually the NHS provides two ultrasounds for a normal pregnancy, but I missed the first one. At the 20 week scan, the sonographer checks the baby head-to-toe for a whole range of abnormalities. If no red flags are raised at the 20 week ultrasound, then the next midwife appointment isn’t until 25 weeks. Every time I see a midwife, she writes her summary of the appointment and the key measurements (blood pressure, fundal height, results of the urine test) on the copy of the maternity notes that I keep with me. Appointments are set at 3 week intervals from 25 until 36 weeks, when they become a bit more frequent.
So far, I have been very happy with the antenatal care that I’ve received from the NHS.
