Life

Pregnancy Around the Pond

April 10, 2019

Pregnant at the top of St. Paul's Cathedral

 

Becoming a mom for the first time is quite the experience. It comes with a lot of questions, concerns, and the scary unknown. The second time around, it’s old hat, and you have a better handle on what’s normal, what’s not, and what to expect when you’re expecting! I obviously can’t speak for everyone, but everything has been easier in this second pregnancy. My weekly journal with number one has been right on the money with number two. The days go by so much faster since my focus is not on a 40-week countdown, but, instead, a growing toddler, and, as a stay-at-home-mom, if I don’t feel like leaving the house, I generally don’t. There are some differences I’m navigating through, however. With my first daughter, I gave birth in England, and everything I know and learned about childbirth was taught to me in that country. Being American was my first language in life. American-English, American schooling, American customs, healthcare, foods–every aspect of me was American–until I found myself pregnant in London. Pregnancy was never something that I had to learn in the US, so I was a blank slate learning it all in my new country. This past year, my transition back in New York City, and navigating maternity life as a foreigner in that aspect, has been eye opening. 

 

Here are some key differences between the two countries, including what I have found to be pros and cons in this private vs public healthcare experience. This is a pregnancy opinion piece, and I expect to have a much more rounded out view once I get through labor and delivery! Also note, I am speaking from a London to NYC, urban experience, where there are many hospital options to choose from. I understand that rural experiences are different, having come from working in the medical field and covering a large territory throughout New England, New York State, and Southern England, U.K.

 

WHEN YOU FALL PREGNANT. (See, a very English phrase right there.)

 

 

Hands down, the US wins this one, just due to the separation of Women’s Health in general. From a young age, women see dedicated gynecologists, and discussing sexual and reproductive health is far less taboo than in the U.K. Pap smears begin earlier, girls are offered more education and information, and the entire experience is far more comfortable to navigate. For this reason, you probably already have a specific doctor you can call as soon as you get your first positive pregnancy test result. You’re not going to the GP on call that you may have never met before that does not even specialize in any part of Women’s Health. You’re calling the same person that may actually deliver your baby. I find this a more personalized, comforting experience. The initial appointments are also a lot longer, answering any questions you may have. You leave when you’re ready, instead of cramming it all into a ten-minute slot. I felt very heard and cared for in my early Stateside appointments.

 

Baby Number 2 in NYC

 

 

YOUR PREGNANCY COMMUNITY. 

 

UK ALL DAY. Joining the NCT community was beyond special during my first pregnancy in London. The National Childbirth Trust is an organization throughout the U.K. that offers reasonably priced childbirth/parenting courses, provided by qualified practitioners, and matched to you by your post code, meaning that the moms you meet are the same ones you will go on walks with, grab coffees with, and join at endless baby sensory classes!

 

My initial NCT course in London cost around £250 for 6 classes and a two-hour, post-delivery reunion. In these classes, located in the instructor’s home and occasionally a community center, my husband and I learned about absolutely everything Baby! This covered when to head to the hospital, pain management, tips for a smoother delivery, how to change, bathe, and swaddle a newborn, breastfeeding advice, sleep expectations–literally EVERYTHING. I felt so prepared for childbirth and motherhood after this course. But, beyond all of the helpful facts (provided to us from a midwife that had given birth to four children of her own right in her home’s basement) it was the sense of belonging the NCT provided. My husband and I were paired with seven other couples, all first-time parents, that equally had no clue what they were doing. We looked forward to getting to know these people each week, and celebrated each birth announcement through a group WhatsApp chat that we still use to this day. Originally, it was a chat about baby kit and pregnancy woes, then later to show those just-born photos, a place to ramble when we were all up breastfeeding during the wee hours of the morning, and to share those first-year milestones. Now, many of us have moved away (and we cover a vast area of the U.K., Australia, the US, and the Netherlands!), but we still check in to celebrate our two-year-olds’ birthdays and share news of our new pregnancies! Without the NCT, it would have been a much lonelier experiences being in a faraway country, away from my family, and being the first in a group of U.K. friends to experience motherhood.

 

I know there is a slight animosity between the NHS and the NCT–the NCT business model is thriving whereas the free National Health Service course is always struggling. There are also differences in content, with a lot of people feeling pressured in NCT courses to breastfeed, and follow a certain level of parenting guidelines. Having taken both courses, I do not think the NHS course was thorough enough, nor did I find the teacher as passionate about motherhood. The money spent with the NCT was extremely worth it in my opinion. As for the content and pressures, I am 100% someone that wants to learn the “ideal way” to do something first, and then find alternatives or make modifications after, if necessary. What do I mean by the “ideal way”? I am a statistics-based, science person, when it comes to these sort of things, so if science shows that breastfeeding is best, I want that education. If I cannot breastfeed when the time comes, I will make sure my baby is fed, period. In my experience, I found the NCT simply informed me of best practices, and that type of information is invaluable. I feel the same with swaddling education, C-Section avoidance, and, hell, using cotton balls for the first month of newborn diaper changes instead of wipes. If these are deemed best practices, I want to know it, and why. Then I’ll decide if I want to go that route as a mother in charge of her own body, baby, and choices. 

 

Swaddle Practice at an NCT Class

 

So, that said, I loved my U.K. pregnancy community. What have I found in NYC? Nothing that knocks my socks off. There are versions of everything I am talking about available in New York City (I mean, it is New York, after all), it’s just on a much smaller scale, you need to know where to look, and it’s a lot more expensive. From what I have seen, there are three types of groups available in the NYC area:

 

Private Childbirth Courses 

 

This is in line with the NCT classes that I loved. The main problem: there isn’t one large organization that everyone uses. This means the classes vary so much in terms of price, accessibility, and information. Wealthier people may opt for certain courses or, often, host an in-home private event (which can cost $300 per couple for one 3-hour session) while less-wealthy individuals may just focus on the hospital childbirth courses (if available) or comparison shop meaning they are not necessarily meeting people close to their home-base. The NCT was so reasonably priced and accessible to all, that it really brought together a sense of local community. The U.K. is all about that. I obviously didn’t do a full-on childbirth course this time around, but for my research, looked into what was available for my area and what I would have chosen. I would have opted for City Births, a high-rated company with several locations, and one very close to me. Their price per couple for a basic childbirth course is $395, and that is for a 6-hour session. The site does not give details about how small the classes are, or their range of due dates, but that is also important to note, as NCT kept everyone within a few weeks of their due dates and the classes were pretty small, making for a very intimate and relatable experience. City Births is about double the price and a third of the time than my expat experience. 

 

Hospital Tours/Information

 

Some of the New York City hospitals offer free childbirth courses, such as New York-Presbyterian, but those courses are again, not as long, not as intimate, and not based on location. You can expect 20 couples instead of 7. Since expectant parents may pick their hospitals based on health insurance, the location of their work, or their friends’ recommendations, your hospital class may include parents from all different boroughs, and, let’s face it, once you have kids, the odds of staying in touch when there is an hour+ commute between the two of you are very slim. My experience was the opposite. Everyone lived within a small radius of each other, but we were all giving birth at different hospitals around London. My US hospital, however, Mount Sinai, does not offer free courses, and instead charges the same amount as the private one mentioned above. Their tours, however, are free. 

 

My Mount Sinai hospital tour was miserable. The tours run a couple times a week and you basically just show up, which made for a very over-crowded experience. My husband stayed home with our daughter and I went stag, which turned out to be very strange. Out of 70 attendees, there were only two of us without partners, and I was the only second-time parent! But after giving birth in another country, I wanted to see what this American hospital was all about, know where to go, and make my final decision on a private room. The two-hour experience covered some basic childbirth information (like when to finally make your way to the hospital) and provided actual access to each type of room (delivery, private rooms, shared rooms) which was nice to see, but miserable to get through a line of 70 people to get a glimpse. My U.K. hospital tour, at UCLH, was coupled with a few-hour (FREE) Saturday birthing course, but did not include actual room access. This was due to not wanting to spread the flu and other viruses in vulnerable areas, which I almost prefer despite not being able to see anything ahead of time. The public recovery area is so poor in the U.K., (which I will get into in my post-delivery post) that even the shared room at Mount Sinai looked like something out of a hotel. For this reason, I have decided not to opt for a private room following my New York City delivery, and spend the money elsewhere. 

 

Social Events

 

The last area covers social activities offered around the city. These are your meditation classes, prenatal yoga, baby trade shows, etc., which are exactly as you would expect in both countries. Reasonably priced, full of info, and not too much of a time commitment. I do have to note that the US reserved time for pelvic floor work in muliple prenatal yoga studios, whereas I thought that was lacking in the U.K.  

 

New York City also has a lot of expectant mom meet up groups, which I found fills the NCT void in this country. Between absolutely nothing, and full-on expensive private birthing courses, you can get social fulfillment meeting some other expectant moms. In theory, I love this idea. Especially as a pregnant mom in a new city.  In reality, these meet ups actually made me extremely uncomfortable. The problem: unlike through the NHS or even the NCT, the hosts of these meet ups are businesswomen that happen to have children of their own. They are not qualified to answer questions beyond their own experiences as parents, and I do not think that is always very clear. Since I was the only second-time mom at the few events I went to (I would not have joined if I wasn’t new to the city and had just lost my mommy crew), I watched a room full of information-hungry pregnant women who were so desperate for insights into childbirth and child-rearing, ask endless amounts of questions. I remember being in that position. The unknown is SO SCARY. And I was fortunate to have advice that was coming from professionals who were trained in providing information. The hosts of these meet up groups should have been nothing more than facilitators with the venue and a way to connect moms together, but, naturally, they assumed more of a power position when the twenty moms began asking them their plethora of questions. And, frankly, I was not happy with the answers. These women were advocates for having wine every night, co-sleeping, and not freaking yourself out about having some blue cheese. A mom can choose to ignore best practices, but, when opinion-based (not scientific) information comes from a “power position,” that information can sometimes be confused as best practice. I know someone who has fetal alcohol syndrome, another that lost their child to SIDS, and another that was born premature due to complications of listeria. These are serious topics and should not be taken lightly, in my opinion. They were so laissez-faire about parenting in general, that I found the entire meet up a hindrance to unsuspecting parents. These hosts also provided me unsolicited childbirth advice about seeking a doula to prevent doctors from pushing me too far medically, which I take very seriously following what was classified as a traumatic birth with my first. They also tried to play off their older children that were against sleep, eating, and potty-training as just how it is. If this sounds familiar to any of you, let this be a reminder that hosts like this may not know exactly what is right for you or your baby. 

 

 

PRENATAL CARE AND YOUR BIRTH PLAN.

 

A New York City Ultrasound

 

This one is a tricky one. I really had a positive pregnancy in the U.K., and was very happy with the care there, but I also didn’t know what I was missing. Now, I prefer going through pregnancy in the US, as I feel much more in control of my care, my birth plan, the decisions being made, and the unknown. For example, in the U.K. you obviously do not have one dedicated doctor (or a doctor in general, in most cases) and you may see a completely different midwife every time you go. I NEVER had a repeat midwife, nor had I ever met the two women that delivered my daughter. It was no big deal to me (despite having a couple appointments with midwives I did not care for), as the maternity binder UCLH provided included a lot of detailed information, a record of all my prior appointments, and an area to fill out my birth plan details at my leisure. This folder was to come with me to every appointment, and, as my due date approached, stay close to my body at all times. This little fact baffles a lot of US folks. Having to hang on to any paper records, not rely on any electronic storage, and to put the responsibility in the patient’s hands is pretty frickin’ crazy. Post-delivery, I combed through an inch-thick stack of papers to try to piece together some information alongside a doctor, as part of UCLH’s post-traumatic birth debrief. And then over a year later, I spent months and months trying to get photocopies of that same stack sent to New York City to give to my new OB. A tattered envelope came with these sensitive docs. But, aside from the archaic paper system, I kind of liked having it all in my hand as it was all very transparent, not like that Seinfeld episode.  And, I thought it was a good thing being seen by a lot of midwives, as maybe more eyes were better to pick up potential issues and whatnot. So, the U.K. was fine.

 

But, fast-forward to the US. Every single appointment is so thorough. The doctor really seems genuinely interested in my mental and physical state. I do not feel like just a number. I know what to expect. My birth plan is something he continuously discusses with me and provides continuous information that he wants me to just sit with before making any decisions. In hindsight, I felt like Google was actually the lead midwife in my U.K. care. I do have to point out that following my previous complications, I am now with a “High-Risk” group, so their care may just be so thorough because a more sensitive pregnancy requires it. Not sure, as I only, personally, have these two pregnancy experiences to go on. All I know is I feel really in control this time around.

 

All the options available to me are also laid out and available right from the doctor’s office. Group B Strep is a perfect example of what I’m talking about. Mothers are automatically tested for this common infection during a prenatal appointment around 36 weeks. In the U.K., I would have never heard of this bacterium, nor its ability to spread from mother to baby had someone from my NCT group not shared it with our chat. I independently located a private clinic that could perform the test at an out-of-pocket cost of about £50. Other offerings in the US, that may or may not be covered, but have at least been brought up to me: NIPT tests, amniocentesis, and induction requests. 

 

This sort of open communication has made me think so much more about my birth plan. My UK plan was more focused in two areas: Birth Centre or Labor Ward, and No Drugs or Drugs. They do offer more drug choices which include a pethidine or diamorphine shot, gas and air, and an epidural (the latter disqualifies you from the Birth Centre, anyway), whereas you really only find epidurals in the US. But those are really the big decisions. You’re expected to go past 40 weeks, then can start having membrane sweeps, and eventually a planned induction. This time around, in New York City, my doctor is talking to me about when I want to have this baby, not just the hows and the wheres. Since new studies have shown that inducing anytime after 39 weeks could potentially lower your risk for a C-Section, this conversation is giving me more choices than I had expected. I always knew I could induce in the US, but having someone really weigh the pros and cons, and speak to my situation personally, has been very helpful. After delivering nine days late and having 50 hours of latent labor before an induction, previously, it’s really giving me something to think about. My goal is to have minimal intervention, but I also do not wish to have this experience go quite like my last… 

 

 

PACK YOUR BAGS. 

 

And since it’s almost go time…

 

As I pack my hospital bag based on my old U.K. list (with notes of what I did use and didn’t), it’s pretty clear that I’m overpacking. You need to bring basically everything for NHS post-delivery care in England. It’s amazing you do not need to bring your own forceps. I’m talking pads, disposable underwear, towels to take a shower, diapers, baby clothes–it’s pretty much all on you. And I’m still packing it all because I cannot believe my hospital, my doctor, and my New York City friends that say IT’S ALL PROVIDED HERE. You really only need to bring going home outfits. The hospital will even pack you a little take-home care package. And, someone told me that Mount Sinai surprises you with a post-delivery cake and Cornell gives you a Chanel gift bag! Obviously we’re talking private insurances vs public healthcare, once again, but let me tell you, my U.K. taxes were high. Since I am a wee bit of a control freak, I do like having my own brand of organic emergency formula, natural diapers, and my own baby clothing, so those I’m still packing, but maybe I’ll leave the sanitary pads at home!

 

 

 

 

AND THE WINNER IS…

 

Too soon to tell. Obviously the United States has stood out in a few more of these categories, but what does it all really come down to? A smooth and safe delivery with a healthy mom and baby at the end. So until this little lady is out, I won’t be handing out awards just yet. I hope this information is insightful and I would be interested in hearing feedback, thoughts, and comments on your own experiences. Cannot wait to complete this series with “Labor and Delivery Around the Pond”!

 

 

 

 

 

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