Posted by admin at March 8th, 2007

So I thought I’d just write a bit about some of the choices I’ve made in terms of my ante-natal care so far. When I first discovered I was pregnant, which was about a day after my period was due - so only about 4 weeks pregnant - I called my GP and was told that I shouldn’t bother coming in until I was at least 7 weeks pregnant. This is apparently to prevent those who may suffer an early miscarriage (estimated at about 1 in 5 pregnancies)from ‘bunging’ up the system. Nice huh? This was an early indicator of how exactly pregnant women are viewed by the NHS - it seems that we are very much at the bottom of the pile in terms of care. OK so pregnancy isn’t an illness and it’s a natural process but when it’s your first time and you feel like your guts are on a permanant spin cycle, and there are weird pains in your pelvic region, it would be nice to feel that there is at least some sort of care on hand.

Anyway, I got through the 7 weeks and duly saw my GP after the Christmas break. Now from what I had read in the great dictionary of pregnancy factoids, ‘What to expect when you’re expecting’, I was expecting an examination of some sort, maybe a urine test and some blood to be taken. What I got was - well nothing really. I went in and told the GP I was pregnant, he took my word for it, took my blood pressure, asked me which hospital I had chosen, filled in the form and sent me on my way. Now there are a number of things that bothered me about this:

 I know that the home pregnancy kits are pretty good - in fact they’re much the same ones as the doctors use - but I was kind of surprised that he just took my word for it and rolled into action. I mean I could have been a complete loon (I’m not - well, most of the time I’m not except when I’m watching that repeat of ER where Mark Green dies in Hawaii and I spend the next half-hour on the living room floor weeping inconsolably).

I was 7 weeks pregnant - I was still dealing with that fact (it kind of took us by surprise) and really hadn’t done much research into hospitals. But there I was having to make a choice about where I would be spending the most vulnerable and, probably, agonising, hours of my life - but there was no advice on offer from my GP - no recommendation as to which was the best bet in terms of care.

The total lack of any sort of check up other than blood pressure was a worry. It’s hard not to be neurotic when you’re pregnant and the few minutes that it would take a GP to draw some blood and do a urine test would save an awful lot of worry in the next few weeks.

There’s this weird dichotomy in attitude in the UK - on the one hand you’re told that pregnancy is perfectly natural and that you should just get on with it. On the other hand there’s an emphasis on the negative, on the problem pregnancy - the number of times you’re reminded that there’s a good chance of miscarriage before 12 weeks has to be heard to be believed (oh and then there’s the charming reminders about how you may turn up at your 12 week scan to find that the baby has died but you didn’t actually expel it. This is VERY rare by the way so please ignore anybody who tells you that it isn’t.)

So I get to about 9 weeks in and I start thinking - yes, it took 9 weeks but hey, it’s true what they say about pregnancy melting the brain. I also had the good fortune to be invited to a dinner party where one of the other guests just happened to be a consultant obstetrician. After about 5 minutes of trying to rein myself in, act casual and not ask the poor man any questions, I gave in, stuck my belly out and fired away. Luckily for me, the lovely obstetrician was full of good advice which he was happy to impart. The first thing he recommended was that I book myself in for a private nuchal scan at the Fetal Medicine Centre on Harley Street. This is run by Professor Kypros Nikolaides - the man who essentially invented and developed the nuchal scan procedure. It’s not cheap (£150 for the scan and a blood test called the triple blood test) but you are assured of getting scanned by a highly skilled doctor and, perhaps more importantly, you will get a scan at the right time. What do I mean by the right time? Well put it this way - at this point I had been booked into St Thomas’ Hospital and had been sent a scan appointment for the end of my 14th week - this is on the very cusp of when you want to be having your nuchal scan. Why call it a 12-week scan if it isn’t?

Anyway, the consultant obstetrician then went on to recommend that I transfer to King’s College Hospital - the antenatal unit there is also run by Professor Nikolaides and is highly rated. So I did - especially after getting rave reviews from my sister-in-law who had her first child there - in the Olympic size birthing pool! I also made an appointment for a 12-week nuchal scan at the Fetal Medicine Centre for 9th February (the results of this are in the posting entitled ‘The Wriggler Wallis’.)

By this time I still hadn’t seen a midwife.

My forms arrived from King’s. I had an appointment for a booking-in session with a midwife on the 19th March. I would be approximately 18 weeks pregnant by this point and so far I hadn’t had one check up - nothing. For all I knew I could be growing a giant toad inside me.

I wasn’t terribly happy. To be honest, as far as I knew, everything was going OK - there was no bleeding and the morning sickness was manageable (as was as my new-found amazing ability to fall asleep whilst still walking down the street)but I still felt that there was a distinct lack of support from somebody, anybody, who had even a modicum of medical training. Comparing my treatment so far with that of my friend Lucy’s, in Paris, I was frankly a little envious - and pissed off. OK, so maybe the french method of blood testing, weighing, pee testing etc…from the minute you announce you’re pregnant could be seen as overkill but personally I’d rather have the reassurance than the resounding silence and complete disinterest that I was receiving from the NHS ’service’. So I started looking into independent midwives…

First I called my sister-in-law - she had her second child at a birth centre in Tooting, run by independent midwives http://www.birthcentre.com and had found the whole experience very positive. She gave me some numbers to call but unfortunately her midwife was already booked up for August deliveries (it turns out that August is going to be a busy month in Clapham labour wards - was November really boring or something?!)

So I checked out this site http://www.independentmidwives.org.uk/?node=556 and found Melody Weig. A few days later Melody came to our house for a chat. Immediately I felt calmer, more rational - more like a human being rather than a wrung-out rag whose brain had been left in a wheelie-bin somewhere. We swiftly booked in with Melody and a week later she came back to the house for my first ante-natal visit. Melody spent 2 and a half hours with me that first time (and if anybody knows the parking wardens in Clapham they will know that this speaks of real dedication!)and answered all my questions from ‘I have this weird twinge sometimes in my right side - is it an ectopic pregnancy?’ to ‘When will I stop having to get up 5 times in the night to pee?’. She also explained that by choosing an independent midwife, I had automatically given myself a choice. At this stage (and still now) I am planning to have my baby at King’s College Hospital but if, when it comes down to it, I decide that I’m happy at home then I can make that choice at the very last moment - Melody will come to the house in the early stages of labour with a full birthing kit, including a pool, to hand just in case.

Choice…how nice. Isn’t that what we’re supposed to get without having to pay out a couple of thousand pounds?Ah yes…here it is… a statement from Patricia Hewitt:

http://news.bbc.co.uk/1/hi/health/4771661.stm

Total Bollocks. Really. And I will explain why.

As I quickly discovered it is almost impossible to get an appointment with a midwife before your 12 week scan. If you do manage to finally book in with a midwife you will then be treated by a pool of midwives - you will have no idea who will actually attend you at the birth and if, at the end of the day, there are no midwives available to come out to a home birth then you’ll be forced to go into hospital where you’ll be put on this conveyer belt system - the 4 or 5 (if you’re lucky)midwives on duty will be spread between you and the 20 other women giving birth at the same time. You won’t be able to have a water birth because hospital policy dicates that you must have a trained professional with you at all times and guess what? They’re aren’t enough trained midwives to go round so chances are you’ll find yourself in an antiseptic room, on a bed, strapped to a fetal monitor and wondering just what the hell happened to your birth plan.

None of this is down to the midwives. I repeat - none of this is the fault of the midwives. As most of you are no doubt aware, this government has been systematically stripping the maternity care system of midwives for a good few years now. This has culminated, acording to The Independent on Sunday (4th March 2007), in a 21% increase in deaths. Yes deaths. That is women dying from childbirth. Now last time I looked, we were living, in the 21st Century, in a highly developed country. How are women still dying from childbirth in such high percentages?

Here are just a few articles I found on the subject:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/12/nbirth12.xml

http://women.timesonline.co.uk/tol/life_and_style/women/families/article1273054.ece

http://www.guardian.co.uk/medicine/story/0,,1985892,00.html

Scary isn’t it? So you would think that what with the whole midwife shortage over at the NHS, the government would actively encourage the Independent Midwife movement. I mean here are trained women (in Melody’s case with over 20 years of midwife experience, combined with a range of other skills)who can provide a continuity of care to a mother that can only be dreamt of by those working within the NHS system. You would think….

Turns out that as of now the government are actively trying to force independent midwives out of business. Basically it has to do with the government’s policy on independent midwives and professional idemnity insurance - the government plan to legislate that no midwife can register to practice without it but at this point in time independent midwives aren’t able to get professional indemnity insurance (this is why, when you have a hospital birth, your independent midwife will not be allowed to ‘run’ the birth and will act more as a doula than a midwife). Now I understand that this insurance is supposedly there to protect patients from unscrupulous quacks but as far as I can tell the independent midwives are currently propping up a maternity care system that doesn’t work and without them…

What are the government afraid of? Looking bad? Too late matey-chops.

Anyway, the whole thing is explained much more eloquently here:

http://www.independentmidwives.org.uk/?node=8766

OK, so I suspect there are some of you sitting there thinking - well that’s great for you, Mrs Pampered Middle Class Wifey of Clapham but I can’t afford an independent midwife and I can’t afford a private scan. And I say, all the more bloody reason to start DEMANDING some treatment. And by treatment I mean a basic standard of care. I’m talking about:

-Treatment by professionals who don’t make you feel stupid for worrying about those early aches and pains.

-A level of care that includes blood and urine testing for the early detection of any problems and early appointments with a midwife to ‘book in’ your pregnancy.

-Nuchal scans on the NHS by properly trained operators for EVERYBODY and not those who happen to live in lucky postcodes. And for those scans to be at 12weeks and 20 weeks, not whenever the hospital can squeeze you in.

-Treatment by professionals who aren’t so over-stretched and worn out that they can barely hold a civil conversation let alone provide reassurance and advice.

-Treatment when and how you want it.

-Midwife-led care that encourages a normal pregnancy and birth rather than over-medicalised obstetric-led care.

I really don’t think that this is too much to ask for and quite frankly I resent the fact that we are now in the position of having to pay out approximately £3000 for a basic level of care that we should supposedly, according to government hot air and statistics, be receiving for free on the NHS. But the truth is that if people like us didn’t opt out then there would be an awful lot more mothers depending purely on the NHS to deliver, and I don’t really want to think about the consequences of that.