Labor & Delivery Around the Pond

At the end of my third trimester, I put together a prenatal healthcare comparison titled “Pregnancy Around the Pond.” After spending my first pregnancy in London and my second in New York City, I evaluated the differences between the two countries in terms of prenatal medical and community support, educational resources, and preparing for the big day. Overall, while it lacked the community support, I found the United States made the entire pregnancy experience a little more comfortable with earlier, dedicated support, continuity of care, and less pressure when it came to packing for the main event. That said, I knew the actual labor and delivery would weigh the heaviest when crowning a big winner.  (No puns or visuals intended…) So here, I will take you through the final stage of my pregnancy journey Stateside, and reflect on the same event that took place in England, three short years ago.

EARLY LABOR

Now, I’ve already shared my birth story—this isn’t that. This comparison will focus on healthcare differences and specifics. See my previous Motherhood post, “A Healing Birth,” for more intimate and emotional details.

With that said, when thinking back to my London early labor experience in comparison to New York City, my body’s behavior was pretty similar. I was going through a long latent period which meant several hospital trips, only to be sent back home to relax, to not take up hospital resources and encourage the Oxytocin to flow and the contractions to progress in a more calming environment. While my first experience did come with potential ruptured membranes (there were leaking fluids, but ultimately the doctors decided my water did not break) it never turned into an emergency, or a time-sensitive situation. So what did I notice over several days of on-and-off contractions, and multiple trips to the hospital in both countries? That continuity of care is so, so important.

The United States totally wins this category. Throughout my multiple hospital trips, I was never repeating myself. My medical records were organized. The baton was seamlessly passed from one on-call doctor to the next with my OB’s practice being consulted along the way. The first night I went to the hospital, I was told to go home, I wasn’t ready. The next night I went to the hospital, not only was I told to go home, but I was told to show up at my doctor’s office at 10:00AM, that he would squeeze me in to make a plan. A plan. This is what was absolutely needed during my time in England, but I was left circling, confused, and in pain.

This is what it looked like in England. The first night, I had leaking of fluids and contractions, I was told my water may have broken, I was admitted to a room, then told it had not broken and to go home, I wasn’t ready. The next night, I had to explain everything that had transpired to the on-call doctor, was admitted to a room, told I might need a C-section, and was eventually told to go home , I wasn’t ready. The doctor said to wait until I was ready and did not need to come in for my scheduled, post-due date evaluation later that morning. So I went home with no plan other than to wait. Eventually, I was told that I still should have come in for that evaluation to be induced a day early, but since I was seen so many times by different people, the importance and the message fell through the cracks. I felt like I fell through the cracks. 

As a woman in labor, you do not want to worry about giving every small, medical detail to the professionals that should be caring for you. When I went in to make a plan with my Stateside doctor, he knew everything that had happened, checked my dilation, which jumped up to 5cm overnight, gave me a quick sweep and ultrasound, told me to pick up some castor oil, take a spoonful, go home, and come right back with my bags when the contractions were a few minutes apart. Certainty. Specifics. He knew me, he had my back. He was ready for me.

When still contracting and in even more pain I went back to my U.K. hospital, UCLH, for the third time on my own, I waited. No one recognized me, no one knew why I was there. Finally someone asked me why I skipped my important post-due date appointment. I told them the doctor advised that I did not need to come in since I had been in the hospital a few hours earlier. The woman at the front desk said I still should have come in. This made me think, what if something happened to me? Clearly no one talks to each other over there, so if a 41-week+ pregnant woman does not show for this important appointment, wouldn’t you call? I could be in distress. It’s not like missing a pap smear. It didn’t sit well. But, I was eventually back at UCLH on my own, desperate to be seen. And left wandering the halls after explaining my situation until I saw a doctor that had been there on the first night and actually remembered me. I was most thankful for him.

LABOR & DELIVERY 

While the U.S. medical staff seemed to really look out for me during my early labor, and the entire journey from my first contraction to getting into the delivery room seemed very intentional and controlled, my experience eventually seemed to flip. Actually being in labor in the U.K. was a lot more pleasant. While the birth dragged on with long, painful contractions, that led to an epidural and an induction, the environment was much more peaceful. Even though I was only in the U.S. delivery room for about 2 hours of birthing and 2 hours of getting cleaned up, I wouldn’t have wished for a minute more. The room was harsh. Harsh lights, offensive decor (and I mean that in a funny sense–like curtains from the 90s), no privacy (I felt like I was practically in the busy hallway and nurses’ station), and no space for anything! My room at UCLH, where I spent 11 long hours, was actually very spacious and pretty! It was kept dim, so my Oxytocin could flow, there were basic, solid colors of grays, whites, and light purples (no crazy floral curtains), and I gave birth in natural light with some surgical lamps. Not an oversized spotlight that would be attached to a prison. Anything necessary for a safe delivery comes first, of course, but the U.S. hospital, Mount Sinai West, felt like it went out of its way to make me uncomfortable. 

Aside from the aesthetics, the staff was very aggravating in the U.S., as well. Sure, one bad apple can ruin a whole bunch, and maybe my nurse was just that, but I cannot help but be frustrated from my entire experience. The nurse stayed in the corner of the room filling out information on the computer the majority of the time. Continuously asked my name or calling me by the wrong one. She ignored any moments I was in distress, and left my husband searching for vomit buckets and ice chips. She messed up inserting a canula (twice) accidentally dropped my entire kit for cord and tissue storage, and forgot to tell the doctor I was storing which led to my placenta needing to be retrieved from the sealed waste bucket. On top of all that, she was just annoying. (But, most people are when you are in labor.)

Francesca, on the other hand–my gentle, doting, wonderful midwife over in the U.K–was a godsend. But, midwives have a MUCH bigger role. They are like doctors and nurses wrapped into one. Francesca was the only person I saw, aside from the anesthetist, until the very end. She was my calming force, always trying to make me comfortable, and was my medical expert, monitoring the baby and me throughout. She was also the woman that caught my baby. And, she was my advocate.

As I’ve mentioned in my birth story, after a long latent labor, I needed to eventually be induced. Fifty grueling hours of trying gas and air and a diamorphine shot, all just led to vomiting. I finally opted for the epidural while receiving a Pitocin induction. The hope was that we would finally get things moving. After eight hours, I was finally ready to push. Two hours after that, doctors started coming in. They stood over me and talked over Francesca (and her colleague Gemma at this point). They were there to make “important”, “executive” decisions. They basically were the ones to decide if it was time to take me in for a C-section. This was the moment that stuck in my mind. Francesca, who should have been off work but committed to seeing my birth through, locked eyes with me and told me to ignore the doctors and push. I followed her direction and gave it my everything, knowing that I needed to cross the finish line for my baby and my body. And, then, there she was. My 7 lb., 7 oz. pride and joy.

Francesca left at this point. She did her job and Gemma stayed with me to deliver my placenta and clean me up. This was when my complications began, but I’ll get to all that in a little bit.

The takeaway from this, Francesca saw me. She knew my hopes and goals and guided me to have as little medical intervention as possible. Well, what was within her power, anyway. The nurse at Mount Sinai, did not see me. She maybe was seeing her next meal, or thinking about what she was going to watch on TV that night. I felt like a number. I don’t even remember that woman’s name, maybe Monica? It doesn’t matter.

Once things started really progressing during my second birth (and we’re talking within two hours, not within fifteen like the first time around), my dedicated obstetrician, one of his colleagues, and maybe a couple other people came in. I remember being surprised that half of the bed I was laying in came off to make for easy delivery access. I do not recall that happening in the U.K. The lights were bright, and the doctor was mean. Now, I had a pleasant rapport with my doctor throughout my entire pregnancy, but, once it was go time, he was serious. I followed his instructions and had my 8 lb., 3 oz. perfect munchkin pretty quickly after arriving!

DRUGS

Drugs, drugs, drugs. Everyone is different. Some people go into the hospital knowing they want an epidural. I was not that person. Both times, I wanted my body to be a clean, organic temple to house and push a baby into the world. But, I said throughout my entire journey, “I reserve the right to change my mind.” I did not want to be held to anything, nor feel guilty about changing my mind. I just wanted to do what was right in the moment, and trust my body.

What did that look like? Well, for my first baby, I needed all the drugs. I was in excruciating labor for eventually 60 hours (including 2 hours of pushing) that I slowly went up the drug ladder. I first tried the diamorphine shot in a holding area before my bed became available, and I vomited. I next tried the gas & air, and I vomited. I don’t know if I was getting sick due to the drugs or the pain of labor in general, but, I do know they didn’t help. (Both those options seem only widely available/mainstream in the U.K.) The only thing that really did the trick was the epidural. After 50 hours of scaling, unbelievable pain, an anesthetist (more commonly referred to as an anesthesiologist in the US) looked at me with my midwife as I was shaking and crying, and said “You’re ready.” They knew I needed one, and I knew I needed one. I really feel like I gave it the old college try, but eventually made the call that needed to be made. It was against my birth plan, but, at the end of the day, my only true plan was to have a baby. I was amazed by how the epidural completely took away ALL of my pain. I did not feel a thing. I had to look at the monitor just to see if I was having a contractions. I did stop hitting the epidural button when it was time to push. This made it painful, but gave me control in the end, and allowed me to give a little more power into the pushing process. After knowing how painful birth can be, and how much easier the epidural can make it, a lot of people were surprised that my goal for baby number two was, once again, NO DRUGS!

Now, baby number two in the US. Looking back, I realized I never had a birth plan with my doctor. I mean, I thought I did. In my mind I knew exactly what I wanted, and surely my doctor knew after almost a year of visits preparing for the big day. But, after I had my baby he said to me “I didn’t know you didn’t want an epidural!” Ummmmm. Well, you should have. You should have known every major detail of my ideal birth. My US experience got a major ding for my OB’s lack of attention. In the U.K. I was actually given a paper binder to bring to every appointment and one page was dedicated to my birth plan. Sure, it was insane being in a country that had all my records on paper, and to rely so heavily on a binder, but at least there was no question about my birth goals.

So, after another long latent period of labor, a spoonful of castor oil, a walk to the hospital, and a wait in the waiting room, I was in a room experiencing the worst pain of my life. No joke, it felt like someone was tearing my body down the middle, pulling me by each limb from different corners of the room. But, did I ask for an epidural? No. Did I want an epidural? No. But, then they started asking. My nurse asked repeatedly. My doctor called in and suggested it through a different nurse. Another nurse asked me. I was asked about an epidural about a dozen times. And, I almost caved. They kept dangling that carrot, and I was almost in enough pain to take the bait. I was so disappointed with how pressured I felt throughout my birth to have an epidural. I was strong-willed and able to say no, but not everyone is able to be the advocate for their body that they want to be in those circumstances. I’m glad I didn’t have the epidural. My body felt a thousand times better after the birth in comparison to my first experience. Sure, I had complications that time around, but I couldn’t even do an upward-facing dog yoga pose without pain in my epidural space for months following my first birth. Yes, it was SO MUCH HARDER without an epidural. But, if we have another baby, I will try to do it drug-free once again. But, like I always say, I reserve the right to change my mind!!

COMPLICATIONS

I’m going to try to not get too consumed in this section. It was emotional and traumatic, filled with a lot of “what-ifs” and unknowns, but I’m going to try to stick with the medical facts for comparison purposes. Full birth story details are available here.

My placenta wouldn’t come out, and I severely hemorrhaged after it was manually removed in a U.K. theatre (operating room) after my first birth. This complication did not happen after my second birth, so I cannot compare the two countries in this aspect of my care. I would like to point out that I made it very clear I did not want students in the room during my delivery, but the hospital disregarded that request in the theatres. In and out of consciousness, I remember a lot. And one thing I remember is way too many people. I understand that teaching hospitals need to teach, but I did not want to be a subject at that time.

The head UCLH doctor was an arrogant woman and I do not remember her fondly. I remember asking her in the end, after a surprise TWO HOURS in theatres (with doctor’s arms up my body trying to control bleeding) if I was done. She misheard me, laughed to the crowd and repeated what she thought she heard. “She asked if she was dying (haha).” It was confusing and insensitive. A few hours later, that woman stood over my bed with a team of doctors. Following a traumatic birth, U.K. hospitals have a policy to debrief the circumstances that took place as soon as possible. Studies show that by doing so, there are lower rates of depression. Facing it head-on and early, has proven to be the best way to move past and understand this type of trauma. It would have been okay if I didn’t have to see that god-awful woman again.

UCLH does offer a nice chance to sit down and properly discuss a full, traumatic experience with a doctor within six months following any complicated birth. A lot of my US friends were surprised by this, so it must not be a post-complicated birthing standard here. It really did help being able to go through my chart, ask a lot of questions, and process a lot of feelings I had from what had happened to me. This was invaluable for my mental health.

RECOVERY

I gave birth in major cities, so a private room was never a standard recovery option. NYC and London both offered a private experience, but it came with a price tag. For around $1000 you could recover in a private room, have your husband spend the night next to you and your baby, and get some better food and maybe toiletries. We sprung for the room the first time around, but, due to my complications, our room was refunded, and, instead, we were left with the most uncomfortable, loud, cramped space imaginable. Day one was spent in front of a loud nurse’s station under observation, in a little curtained nook, that was also incredibly cold. After I was in the clear, and free of a vaginal pack, uterine balloon, catheter, and compression devices, I was transferred to the general labor recovery ward. This is where people that don’t have complications and don’t pay for a private room end up. And it is just a big, open space, divided by curtains. It’s loud, since there are no windows or doors, and often too hot. There are no TVs. And there is one bathroom shared between many new mothers. Plan your showers right and don’t forget a towel! Those are bring your own. And if you read my hospital bag comparison, you’ll already know that EVERYTHING is bring your own in the U.K. I had to bring my own diapers, wipes, blankets, swaddles, clothes, peri bottles, pads, mesh underwear–EVERYTHING. It was shocking. I mean, sort of good if you’re very particular like me. But, it was a little extreme. If you want a true look at public healthcare, recover in an NHS labor ward.

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Now, in the US, during round two, I didn’t bother paying for a private room. I had a toddler at home, so just wanted to be in and out. I didn’t care if my husband could spend the night because I wanted him to rush back to my daughter. The slow, relaxing experience (that I wish I had) was really only something for my first baby. I was now a mom of two, and my relaxing days were already over! The free room at Mount Sinai West was fine. It was SO much better than the UCLH labor ward, and we feel we made the right choice opting to save a grand! The only unknown: your roommate. You could have a really difficult roommate and/or baby that is loud, rude, or has a ton of visitors all through the day. My roommate didn’t bother me, but I actually bothered her! I thought I was quiet and respectful. My husband is a considerate person in general, and visiting hours were over right when we got settled, so he left pretty quickly, anyway. I watched some TV, nursed my babe, ate a cheeseburger and tried to get some rest. But, SPOILER ALERT, newborn babies cry. My roommate didn’t like that my baby cried and asked me to send my baby to the nursery overnight so she could get some sleep. To me, this was the most ridiculous request on the planet. “Yes, stranger, let me get rid of my brand new baby that my instincts have been built to protect, so you, woman I will never see again, who didn’t want to spring for the private room, can get some good sleep.” No. Way. She is the type of person that should have had a private room. Free rooms come with roommates, and you have no right over that roommate’s new baby.

MY BABY

This brings me to the nursery. This concept was really surprising to me. Giving someone you don’t know your brand new baby. Maybe I’m just a super-protective mom, maybe I watched too many switched at birth Lifetime movies, or maybe I was just used to the U.K., but I didn’t like it. In the U.K., your baby is with you from the second it is born and never leaves your side. You do everything for your baby from the very beginning. There is not a service to bathe, change, rock, feed, whatever. I was so uncomfortable when my baby had to leave my side at Mount Sinai for an evaluation. I walked to the nursery and watched her through the glass. I hated the policy. They asked if they could wipe her down and lotion her up after the exam, and I declined. I was also frustrated when I delivered them one of my organic diapers (that BYO English mentality) to change her into after and discovered they put some diaper cream on without my permission. What type of cream was it? Was it organic? I’ll never know, and that still haunts me to this day! Dramatic, yes. But, these children are my life’s work that I had just spent a year growing. I didn’t want them out of my sight and wearing products I hadn’t vetted.

Also, even though the U.K. leaves you to care for your own child, the U.K. nurses were much more concerned with how the baby was getting on. My entire time at Mount Sinai West, not one nurse asked me how feeding was going. They did require a lot of vital checks throughout the night, and once had requested a specific time because the baby had taken awhile to fall asleep. The woman acknowledged my request, but forgot to pass it on. Someone came in and woke the baby up just minutes after she finally went down. Recounting this whole part of my experience is actually making me quite frustrated! U.K. wins.

POSTPARTUM FOLLOW-UPS 

While I criticize the U.K. a lot for not giving patients access to OBGYNs and pediatricians, I do have to say, allowing patients to stay home with their babies for the first month is brilliant! You do not take your child to the pediatrician on the first day or two of life! I think that US practice is horrible! Your body is healing. You’re on no schedule whatsoever. The elements may not be kind outdoors. And, you want to protect those brand-new immune systems as much as possible! Nope, a U.K health visitor comes to you! Not just once. Multiple times over the first month. While I wish they sent a proper pediatrician and not a health visitor, it is nice being able to stay in the safety of your own home. I do believe the U.K. also prefers the home visits to make sure you’re appropriately parenting (the U.K. is a little bit more Big Brother in that way), but my baby was well-cared for so I didn’t care. Well, I did get really irritated when the health visitor criticized the flip flops I wore to walk around the house and told me it was a tripping hazard. I was like, see ya later, bye at that point.

American friends could not believe that I was able to stay home my first month. And, after having my US-born baby, it reaffirmed that England did it right. The HV also checked my stitches, something that was not done until my 6-week postpartum visit in the US. After your health visits, however, you will only ever see a General Practitioner in the U.K. You would only see a gynecologist if something was seriously concerning and at that point you would need a referral. I could go on and on about the U.K. healthcare maze, but I’ll leave it at this: I like the U.K. system and timeline, but with the US doctors. Can’t I just have it all?

AND THE WINNER IS…

I would love to say the U.K., I really would. They have a more holistic approach to birthing that I really appreciate. But, I just can’t. In the area that matters most–the safety and wellbeing of mom and baby–the US prevailed. Continuity of care is vital. I was a testament to how vulnerable women can fall through the cracks of a public healthcare system with unreliable records. It’s been three years since I had my daughter over there, and I know changes and improvements are always being made, but with constant budget cuts, it’s hard to get a system to the place it needs to be. I am still grateful for my experience, my midwives, and the doctors that helped save my life. I would have a baby in either country again, but will definitely have my eyes a little more open in certain areas.

I hope you found this insightful, no matter where you reside. Remember, the best advocate for your healthcare is you!