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Would there be more medical intervention over here if the NHS had better funding?(41 Posts)
I'm watching a US show about delivering babies and it never ceases to amaze me how routine medical intervention is over there. It seems rare to go through labour without an epidural and c-sections seem a lot more common. Also they start induction earlier than we do and don't like women going overdue at all. I'm not sure how wide spread this kind of care is across the US but from what I gather the rate of intervention is much higher over there.
Do you think it's literally just a funding issue that means the NHS push for natural delivery with limited pain relief? Personally I'm glad they do because I feel where possible an intervention free birth is ideal and after being pushed to have an epidural with DS1 simply because of raised bmi I have experience of how this can lead to more intervention (epidural stopped contractions and they had to induce my labour with a hormone drip/break my waters to get things going again). Obviously I'm not suggesting intervention is a bad thing in all cases as it can be life saving but I feel watching this show they really over use it.
I agree with bun. The NHS gets knocked too easily. In practise it is excellent. I had a smooth home birth with excellent care before, during and after. My pal had an emergency ceasarian- (baby apcar score 1). All cared for brilliantly.
Its sad that there is a political agenda to bash the nhs, because it makes losing it easier. Why fight for a crap service? The reality is that it is excellent and we are privileged. We should be proud of it and fighting to keep it.
Oh no *there is likely to be a bed for me, not bactereimia lol!
I find it really interesting that no one on this post has mentioned how lucky we all are living in a country with free at the point of access world class healthcare. The safety and quality of maternity services in the UK is excellent, and what is more it is constantly being admitted, assessed and having evidence based changes made, which is more than most places in the world can say. In the UK our healthcare has a much larger focus on evidence based practice than the US whom unfortunately due to the insurance system are very financially motivated into providing more intervention.
I'm not for one moment saying that the NHS is perfect, it is really important that midwife staffing levels are improved, and that services continue to strive to improve. But when I go into Labour I will have the reassurance that I will be cared for in a state of the art hospital, by midwives and if needed doctors who have all had world class training and work within stringent regulatory bodies, I will know that there is likely to bactereimia a bed for.me, there will be cleaners to keep the rooms hygienic, there will be access to a wide range of evidence based medicines and interventions should I need them, myself and my baby can be monitored using safe modern equipment if needed, and although nothing in birth is guaranteed both myself and my baby are very likely to live through Labour and return home safe and well. If something does go wrong there are specialist itu teams who can care for my baby or myself who can be bleeped at a moment's notice around the clock. I wonder what percentage of women in the world can go into Labour with these assurances.
My granddad lost his baby sister because the family didn't have the money to call out a doctor. We are so lucky to have an Nhs and I hope more funding would be used for more midwives and not more intervention, fortunately unlike America we have nice and the care quality commission who rigorously assess where money can be best spent to provide evidence-based quality healthcare.
i think ultimately the question is 'is medical intervention a good thing or a bad thing?' and I don't think there is a clear cut answer when it comes to maternity.
No medical intervention causes unnecessary risks, but then so does 'too much' medical intervention.
As to what is too much or too little? well, theres the problem. If you leave it with the mothers then those who don't want any medical intervention might be seen as putting themselves in unesserary danger, as would the other extreme of wanting all intervention possible (and we have both problems in the uk)
Who is best to decide what the right level of medical care is? and should that be decided on money?
I dont think there is an answer..
Nah, don't worry, I totally get it - I've thought about it and I think it's a bit like comparing apples and oranges, e.g. doing smear tests is just part of the job description there because that's how the system is set up and is a main part of a OG/Gyn's duties, whereas there are other systems in place here and other people are qualified to do it.
Both approaches make sense in the framework of their healthcare system.
I've read up a bit more on some German maternity and midwife blogs and there are lots of mothers saying how they preferred the approach to pregnancy in Scandinavian countries and the UK because it felt so much more relaxed.
Sorry BEE x posts there. Looks like I am replying a bit harshly to you but was actually to Stevie
Well yes it is about what you are used to but just because you are used to more 'routine checks' or a Dr to do your smear doesn't mean it is actually of benefit to you.
You can opt to get more in the UK. It is fairly easy as long as you can afford it, you just pay and go private.
I really don't believe that we get substandard care in the UK. Our mortality stats and other hard indicators stand good comparison with other systems. A lot of what people from other systems are telling me they miss I really can't see how it is necessary or helpful. Some of the 'customer care' aspects I admit the NHS doesn't do well. Crap hospital food, long waits at clinics, general lack of customer focused service (I am told some US hospitals have valet parking!) but when it comes to the actual care offered I really think it is good and the data bear that out.
10 years ago waiting times were too long but that was because the NHS was woefully underfunded by Thatcher and her successors. I am not a massive fan of Tony Blair in most ways but for Increasing NHS funding to European avg levels (and for the minimum wage) I have to applaud him.
I believe very strongly in care being free at the point of use and in access not depending on ability to pay but that is an ingrained ideological position for me. I can't see me ever changing my mind about that.
The Current administration is privatising the NHS slowly by the back door so I think you are wrong that it won't change. It already is.
Mammadoc, I found the nuchal test helpful for me (had to pay for it myself) but found the results of the accompanying blood test confusing and after some research actually irrelevant so I agree there.
My GP didn't listen to me/ignored my info about likely conception date and I ended up having my scan at 8 weeks instead of 12 weeks and I wouldn't have had another until 20 weeks, I wasn't really happy with that (neither were the midwives & doctors at the hospital), another reason to book the nuchal. A lot of the care, no matter which country you are in and the health system there, seems to be a box ticking exercise.
Mamadoc I completely understand where you're coming from but I think NomDeClavier summed it up well in her last sentence. To that I'd like to add, it's down to what you're used to - whilst I salute NHS workers, the UK population has been accustomed/trained to believe that very minimal (sometime substandard) care is the right way. But let's be honest, it's all about "cost effective", the standards for which are dictated by lack of financial resources rather than patient benefit.
I have endless examples from the country I come from which operates a part state-funded, part private funded system similar to France and Germany. We won't go into it because it's beside the point. Yes, it is against the ethos of the NHS and maybe that ethos could cope with post war healthcare, but it cannot with the needs of a vastly changing population and 21st Century medical advancements. IMO, the whole system needs a rethink, but that will never happen as no politician has the balls to stand up and tell the truth as it is too emotive an issue for many people.
There is a lot of thought put into what the NHS offers as an expected standard of care. The NICE guidance is based on best available evidence and an intervention is recommended if there is evidence of benefit and if it is cost effective.
There are lots and lots of screening tests and interventions that could be offered but for many of them there is no evidence that they are helpful or the chance of finding something is so small that you would have to screen thousands of people to find anything. False positives do occur and cause a lot of distress.
My DD1 was born IUGR despite final trimester US being reassuring and my DS was then said to be growth retarded but was over 8lb. The test was too inaccurate to be much use and I worried very unnecessarily about DS.
There are endless threads on here about the triple test and the anxiety that a high (or even not very high) probability result causes.
It really is not as simple as more tests mean you are safer. If you are a false positive then you will get unnecessary worry and interventions for no reason.
I'm also in France, DS was born here in 2011 and DD is probably on her way now <loving the distraction that is MN>
In general I like the system here if you shout loud enough and choose your hospital well In general it is medicalised and I dislike the pushing on your back assumption that OBs have (MWs are different!) but you can get round it.
Midwifery has undergone a massive shift to become a more autonomous profession in recent years and there is a fairly strong natural birth movement in the public sector.
I like that we get a routine 3rd tri scan plus one at term to check amniotic fluid and placenta function. GBS testing is standard, monthly blood tests for toxoplasmosis are standard. You can choose to see a paed with your baby, or your GP. In fact there's a lot on offer that if you don't want you don't have to have, although maybe I'm just difficult to bulldoze! The default assumption might be medicalised but that's easier to get out of than it is to access more medicalised care in a country which doesn't systematically provide it.
id rather a doctor be over cautious than risk still birth though. Ultimately its decisions like the one your descirbing that bring deaths down. Constant monitoring is imo a good thing and they would never move at the 'smallest thing'.
mamadoc, there are no practice nurses in Germany - nurses here would object greatly but I am used to a specialist doing it and that's what I feel more comfortable with. Midwife care is something that has to be requested but some people don't, even though it is covered by your health insurance (including 1 hour check up visits every day for about 2 weeks after the birth).
The routine check ups seems sensible to me as they check for things like hip problems and then later on correct development.
Mamadoc, not always, but sometimes. It brings to mind the fact that continuous monitoring results in more emergency Caesarean sections than intermittent monitoring, because a little blip might cause a midwife or doctor to overreact at the possibility of foetal distress when there might well not be any problem at all. Perfect example of more checks being detrimental!
Do people really think that more checks and more specialists equals better care though?
Why would a highly qualified obgyn be required to do a routine smear test when a practice nurse can do it just as well? That really does seem like an insane waste of resource to me.
Similarly a routine check up in a normal pregnancy seems to me best suited to a midwife. Check urine and BP, discuss stuff. Why wouldn't a midwife do this as well or better than a Dr? Lack of continuity is a valid complaint but could be solved by having the same midwife (as always used to happen when they were attached to GP practices).
I just had a routine 2 year check for DS. I struggled to see the point of it at all. He is fine, I have no concerns. If I did I would go see the health visitor or GP. Waste of everyone's time I thought. The idea of scheduling in 7 of these makes me shudder. Okay I know that I am not the target audience and some unsuspected problems must be found but really there is a cost vs benefit issue here.
Sometimes cheaper can be better as well.
I work for the NHS and "natural" non or little medicalised births are a target, because simply that fewer interventions are seen to be less risky. I also believe that if the NHS had more money services would be better. Of course if we had a system in the US model with insurance etc it would be more medicalised.
Interestingly enough I've just started reading a blog by a German midwife and the consensus when reading the comments is that most women regret being seen as a 'patient' and not just a pregnant woman, and that they would prefer a more relaxed approach.
A friend of mine had too much amniotic fluid and now has to go to her gynae twice a week for a CTG - even after the hospital said everything was fine after her next check up and said the CTG can be reduced to once a week, her gynae refuses so she still has to trudge in twice a week and work up the time at work in the evenings.
I'm from UK but going to be giving birth in France in March. Did a lot of research thinking I'd be in UK system, and had to re-learn how different it is here; there are some US parallels, although the health system is a mix of state-funded and private, most people have to get top-up insurance because state doesn't refund everything.
Traditionally France has also been highly medicalised, with something like 90% epidural rate at many hospitals. But it's usually for lack of other options, despite some recent improvements in choice. Gas & air still not available in some places due to fear it might damage the baby, neither pethidine, and you would be VERY lucky to have a water-birthing centre near you.
This means women are still sometimes left the choice of epidural or no pain relief at all, which clearly might lead people to more medicalised outcomes, especially as the traditional birthing 'style' is often "flat on your back + stirrups" (they still apparently try to do this during pushing stage).
My hospital is very proud of the fact it encourages movement, has birth balls, music and aromatherapy, but they still want to do internals every hour, physiological 3rd stage is frowned on, the labour room is very clinical-feeling compared to many UK places, and I've been told that pushing will mean lying down (that's what THEY think!).
Also, homebirth here very rare because the midwives have to get their own insurance to do it, too expensive.
Personally I would like to at least have the choice of trying for a non-medicalised birth, and I think this is where the UK is right (at least in policy if not practice).
Stevie I completely agree. I'd happily pay a supplement for more services. I'm sure lots of us who can't stretch to full private care would pay extra to move a step above the close to minimum that's offered. I just want an option that's neither the baseline nor full privatisation. I want more choice and I want options presented to me so I can make informed decisions- not to be told what I'm getting like I'm a child.
I'm from Germany and I prefer the specialist system we have - you have a family practitioner and see him for day-to-day niggles and aches and sometimes he would refer you.
But you don't need a referral, you can make an appointment with the specialist if you need to. If I lived back home I'd have a OB/Gyn that I am familiar with because I would go for my smear test with him once a year, and he'd be the one who would do most check-ups during my pregnancy - not like here where I'm only 4 months along and have seen about 3-4 different midwives by now because you get sent from pillar to post.
Once baby is born there are a few more standard things that get checked for every couple of months just to make sure baby's development is ok - there are 7 examinations running up to 24 months and then 4 more until the child is 6 and starts school. Most of the time you'd go to your child's paediatrician for that.
All this doesn't mean that there's necessarily more intervention during birth, though - Gas and Air hasn't been used since the 70ies and in general it is all about childbirth without too much intervention and pain relief. You can get a PDA/Epidural, and walking epidurals are now available, but a lot of woman choose what we shall call 'natural' for the sake of the argument.
I do believe it depends on what system you're used to, though...
SaggyOldClothCatPuss - no personally I certainly wouldn't want more. I loathed the intervention I was pressured to have as I feel it just leads to more. This time I want a home birth with limited examinations and to be left to get on with it. I was just curious as to whether in the US they genuinely believe intervention is the safest way and if so would we end up going down the same road.
Stevie77 - as always discussing childbirth is an emotive subject I apologise if the language used has offended you, it is difficult to know what terms to use to encompass a certain type of birth. What I was trying to say is my choice of language was not meant in a judgmental way.
You've got a very good point there about lawsuits I guess dr's over there are less likely to have a wait and see attitude for fear of things going wrong.
I think I'm coming to the conclusion that we have a different approach over here that's not just based on funding. Hopefully better funding would be used in the way mrsannekins listed.
I hadn't even thought about the differences in healthcare for children and babies. I'm not really sure how I feel about those differences. I do think the GP's are under a fair amount of pressure to be the front line with such short often rushed appointments. Although I'm not sure I'd want to see a specialist straight away either.
I'm a specialist Dr in the Uk so clearly I need to acknowledge my bias but I really don't think patients in the UK get a bad deal from seeing a GP rather than a specialist routinely. A GP often has a relationship with a patient or a family over a long time which is really invaluable.
GPs do have paediatrics training of course which is quite adequate to a routine development check. My paediatrician friends don't want to do routine checks on a lot of normal babies and children either. It would be a waste of their skills. I don't quite get why children and pregnant women are a special case but people with other conditions can be seen by a generalist.
In my own field I don't want to be swamped with people with minor illness who could easily be treated by their GP. It's more cost effective for me to just see those people who are more seriously ill or fail 1st line treatment.
I really don't think our system is all about saving money or doing things on the cheap. For one thing it's not very cheap. It costs a big proportion of the total budget and we spend about European avg on healthcare ( way less than US though). That is spending from all sources public and private. The last Labour gov Increased spending on healthcare and although I don't agree with all their policies they did dramatically cut waiting times which were bad in the past.
Having lived in the states, it's not just all specialists, I had a family doctor (GP), and if I wanted a specialist I needed a referral. Aside from paeds anyways.
In Canada it's similar. I saw a paediatrician until I was about 13, not a GP, and their system is similar to the NHS in that it's free. And it's also common to be under the care of an obgyn during pregnancy, though midwives are around, just not as common.
thecakeisalie but the language is the issue as it conveys so much.
Anyway, the issue with the states is totally different and I don't think you can conclude, based on it, that if the NHS had more money to spend on this part of it it would lead to more intervention. One of the reasons for higher rates of intervention in the US is, as has been mentioned, the structure of the health system and the involvement of insurance companies. Hospitals have a clear financial gain to make if they carry out more procedures, use more resources. Second, the higher rate of intervention is also due to medical lawsuits. Doctors would try to avoid a situation where they could get sued if something goes wrong, hence more intervention.
I don't think that if the NHS had more money, any of the above would happen here unless things would change dramatically i.e. how the health system is run.
Mamadoc I don't prefer the UK system over the US system (I'm not US but have a fair knowledge). Things have gone too far the other way in the UK. Actually, kids SHOULD see paediatricians and not GPs. Children are not mini adults and medically, are totally different. There is a very good reason for this medical specialism. There should be more developmental checks here but due to funding there aren't. Not because it's not needed. Big difference. Just like there is no recommendation for vitamin D and Iron supplements for babies because if they do they would have to subsidise it.
Also, the way some GPs are here - not up to date with advances and medical research/recent knowledge, is far from ideal.
The system in the UK is far from perfect and far too driven by cost cutting (understandably) and penny pinching. Personally, I'd rather pay the NHS a supplement and get a better funded system then not and have to put up with a third rate system which drives many people towards private medical services.
It's a whole mindset. It's not just confined to obstetrics. Things are culturally completely different in the US and the fact that it makes money for health insurance companies is a big driver.
Eg after your baby is born they would automatically have a whole programme of checks with a paediatrician for the next 3+ years which would only happen here if something was actually wrong. They don't have much of a GP system in the states. You see a specialist for everything.
Personally I prefer the British way but that might be because I am British! Having lots of checks and investigations of healthy people is basically screening them for disease. There will be a certain false positive rate which adds up to a lot of unnecessary investigation, cost and worry over a whole population.
The outcomes of US healthcare vs the expenditure show it is very poor value for money overall. There is definitely such a thing as too much medicine. Unnecessary intervention has clear harms. I am not in the least bit jealous of US drs or patients. I genuinely don't think that most UK drs have their treatment decisions affected by funding apart from maybe some very specialist cancer drugs.
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