To really hate OBEM USA?

[VanGogh]

Don't get me wrong, beautiful safe deliveries. Wonderful.

I had OBEM set up to series record and now I see my magic box thing has recorded the USA series too.

How different can labour and delivery be in two developed countries? All I seem to see is women on their backs, epidurals, "you can't deliver without your OBGYN" it seems so... So... Well, medical I guess. I dislike it. All I see is drips and close monitoring and beds.

Why???

Please tell me I'm not alone?

The very plush hospital I delivered at doesn't charge more than other hospitals and you'd be accepted and receive the same treatment if you're on Medicaid or don't have insurance. Nowadays with obamacare and expanded Medicaid especially for pregnant women it would be unusual for a woman not to be covered for prenatal care and birth. The system here is bonkers but it's not THAT bad

I would like to see the birthing experience of poor Americans or people without insurance. I'm sure that would not be shown on OBEM

Poor people get medicaid. Pregnant mothers are automatically given insurance, and if they can't afford insurance they're given an income based hospital bill to pay (sliding scale fee). They're the most "protected" class as far as insurance and health care goes.

So, they would have the same experience as everyone else.

The food was bad both in the UK and the US for me! Particularly bad was my first meal in 36 hours post DC2 in the US, labelled vegetarian, and containing turkey sausages. DH brought food in for me after that, much as he did in the UK, which was equally as dire.

The policy results from an immature understanding of what actually constitutes the biggest risks to mother and baby. More intervention does NOT always equal lower risk.

You can bet your bottom dollar that some office full of actuaries somewhere has calculated to the nth degree what the risks are in specific circumstances.

The assertion that there is some 'immature understanding' of risk here is off the mark.

I would like to see the birthing experience of poor Americans or people without insurance. I'm sure that would not be shown on OBEM

That was me for the birth of DD4.

I had had four previous births to compare my experience with. My pregnancy with her was complicated because of GD and anemia, and perhaps because I was 37 at the time, and I was induced on her due date. The only difference between the four insured experiences of pregnancy and hospital delivery and DD4's was that I chose a midwife practice for my pregnancy and delivery care. I got a private room with bathroom ensuite for labour and delivery, and another for my post natal recovery. Food was great, staff were kind and very knowledgeable and responsive, hospital was so clean you could eat your breakfast off the floor in both cases.

I think what I'd really like is the UK approach (midwives, more emphasis on giving natural birth a go) with the US levels of money applied. However I realise that probably wouldn't happen as it's the US funding system which leads to US birth being medicalised.

Several of my US friends had exactly what you describe. They chose a midwifery led practice and it was funded by their insurance.

'Poor people get medicaid' is a loaded statement for sure......, and its true that Affordable Care Act will go a long way to protect people.

However it is not true that people on Medicaid get the same options as those with private heath insurance - it varies state by state and in many less progressive states private hospitals will not treat people on Medicaid.

Also what about the access to care - many lower income areas do not have "plush' hospitals - people on low incomes often do not have the access to the top OBGYN's and subsequently the fancy hospitals they work at.

Then you have the working poor - those who hold down a job but can't get time off to attend appointments - or who just don't bother because they cant afford the co-pays. They have insurance but the deductible is so high they are left with a $15,000.

There is a reason the United States has the highest first-day infant death rate out of all the industrialized countries in the world.

I can't do links but my source is CBS News & Save the Children.

Having had a baby in the states and two in the UK, I can say I preferred the UK experience. I have to agree it was less medicalised (for lack of a better word) and seemed to focus more on what I wanted (within reason obviously) and what would help me get through the labour.

But I do think there's always the huge matter that often your birth experience is quite affected by the medical professional helping you through it. If they are focused on your (and the baby's) needs, it's generally better IMO. If they are not, then it's a more stressful experience.

mathanxiety I know from other threads that you are normally bang on the money in these matters but sorry, I'm not convinced. In general terms (ie not specifically talking about maternity) the US spends a great deal per head on health-care. Yet results are not as good as they "should" be in comparison with the situation in other, comparable countries. It suggests that even if medical decisions are largely determined by actuaries (and are they, really?) they sure aren't getting it right all the time, in terms of bang for buck.

The report here talks a bit about this:

"... These procedures and the use of expensive diagnostic tests are all subject to physician opinion on whether they are desirable or not. The fact that U.S. physicians decide that more procedures and tests are desirable compared to their peers in other countries could be due to a few different things, such as:

A fear of litigation that sees physicians test for everything so that they cannot be blamed for not having covered all bases

Payments that mean that physicians get paid more if they do more interventions, regardless of medical necessity.

Because patients ask for more tests and services. It is often comforting to feel that medical problems are being diagnosed or treated, regardless of whether they are medically necessary. As these services are often paid for by insurance policies, the immediate cost of extra treatment for a patient is often zero or very low..."

"...two things are apparent: U.S. physicians get higher incomes than in other countries and the U.S. uses more expensive diagnostic procedures. More generally, with so many different kinds of insurance, no one organization has a strong incentive to cut out wasteful practices and ensure that all Americans get value for the very high levels of expenditure incurred when they are sick."

Not sure if the business of being born film on YouTube has been mentioned, if not it's very interesting.

If a heavily medicalised labour is followed by the post natal care Shakshuka described, then I'd choose that every time. Sounds fabulous!

littlepeapod I had an antenatal appointment last week... had to fill in a form about my previous births and the form definitely said "natural" or "Caesarian" (as well as asking about interventions). Some people definitely call a vaginal birth a natural birth.

wobbly good point. I was born in the US and that's what my mum had. I get the impression it's rare though, but that may be due to patient choice?

America does have higher rates of medicalised births - most likely linked to the insurance industry.

They also have higher rates of interventions. I like the choice we have in the uk and the fact you usually aren't pushed in to a choice unless necessary - not to say it's perfect at all. I loved all the birth shows us and uk when I was pg but I would choose to give birth in the uk.

Plus no gas and air - wtf!

There was one (Canadian) Dr in the US hospital where I had DC2 who was trying to introduce gas and air but he'd apparently been repeatedly told he couldn't, due to 'insurance' reasons - an explosion risk??? Strange how that risk doesn't exist over the border or in Europe, huh? Actually, come to think of it, the nicest health care professionals I met during my US hospital stay were that Canadian Dr and a Canadian nurse. I think there was a real difference in bedside manner.

I had one baby in the US, and one in the UK. In the US, my obgyn told me she had to pay a $1 million malpractice insurance premium PER YEAR! So she didn't make any money at all until she had reached $1 million dollars. I had a doula as there are no midwives - still ended up with an emergency section, as they do one at the first sign of foetal heart deceleration to avoid being sued. (But it was better than the NHS in London, we ended up at the Lindo Wing as the local hospital looked like a war zone)

Actually, come to think of it, the nicest health care professionals I met during my US hospital stay were that Canadian Dr and a Canadian nurse. I think there was a real difference in bedside manner.

Gosh, our birth practices are bad, our doctors and nurses aren't nice, I guess living in the US is the worst. I'm so glad to be enlightened.

steff - not sure why you're picking up on my comment, that was my experience. What I mean by nice is less abrupt, actually took the time to speak to me as a human rather than treating me as a medical case and nothing more and made me feel cared about (which is how I felt when I had DC1 in the UK).

No Gas & Air?? Not even Paracetamol??

The horror!

So when you arrive in to a labour ward in the US, whats your 1st, most basic option for pain relief? Pethadine?

The term natural birth does not make sense and should be banned.

Babies are expelled through the vagina of the stomach. Both are natural.

Can you imagine this conversation if men gave birth?

Why do we put up with this shit lottery in the UK.

I've only seen one or two episodes of OBEM USA, the one described above. Agree with the comments about how the woman who used a Doula was treated. What I particularly remember was a woman who had an epidural that didn't work. I thought the way the nurses treated her was quite barbaric, they had no understanding of how to calmly help her through a labour without pain relief, she was shouted at the whole time she was pushing. I couldn't watch another episode after that because I found it so distressing that they were not supporting her in the way she needed. So, for me, the highly medicalised births where picotin and epidurals are standard means that someone who doesn't have those, for whatever reason, gets substandard care because there is not the understanding of how best to care for a woman in pain.

And as for the so called fantastic aftercare? I'm sure I'd need a lot of help to get back on my feet after birth if I knew I had to return to work in a few weeks. i know I'd far rather be in Europe with up to a year of maternity leave than in one of thhe few countries in the world with no statutary maternity leave. Maybe the reason so many Americans want a CS is to increase the time they get at home with their baby?

I loved birthing my babies in the US. Two of my children were born in hospital, one in a birth center. I chose my midwife and ob/gyn. I saw only my practioner, I was never handed off to a doctor I didn't know. My doctor and midwife were both respectful of my birth plan. My husband stayed overnight with me in a private room for every birth. I cannot imagine what it would be like to be on an open ward with other postpartum mothers. I was able to rest and have my baby with the entire time.

I get what the op means by the difference in the obem shows. I only watched a few of the US ones and got bored. In the UK one you'd have women on beds, women in pools, women walking, women on all fours, women with gas and air, women with epidurals, women using hypnosis, whale song, tens, paracetamol etc

The American one was, woman on a bed with a drip, woman on bed with a drip, woman on bed with a drip, a section, woman on bed with a drip. It was dull.

Woman should absolutely have the right to give birth how they choose. However for the vast majority of women, child birth needs no interventions. Interventions come with their own risks. Sometimes interventions are unavoidable for the safety of both mother and baby. The trick is to know when they absolutely are needed and when they are not.