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?

Puntastic -- my late exFIL was a neurosurgeon and paid either the highest or the second highest malpractice premiums of any medical specialty. Right up there with him were obstetricians. They were number 1 and number 2 as far as cost of malpractice insurance went. This is because both specialties carry with them the risk of quite catastrophic damage if doctors make mistakes.

While the result of doctors wishing to err on the side of caution may be more tests than British women get, and perhaps more medical intervention than them too, as an Irish woman I would prefer to see the litigation-inspired situation that exists in the US than the shameful situation survivors of symphisiotomy face in Ireland on top of the brutality of the experience itself.

I know there's a happy medium someone upthread said what she would like was US money thrown at the NHS maternity service but I think if anything is shown by this thread it is that kindness, responsiveness of nursing staff and a clean hospital mean a lot even in the face of lots of monitoring and the potential to end up with a CS.

I don't think either the American or the UK system addresses the immense spiritually transformative element of the experience and failure to do that results in a feeling of insult or deep hurt or profound disappointment. ('Spiritual' in a non-formal-religious sense).

Downamongtherednecks -- your OB/Gyn must have had some huge judgements against her to warrant $1m in premiums.
'For ob.gyns., malpractice insurance is most expensive in the New York counties of Nassau and Suffolk, where women’s physicians will pay $227,889 in malpractice premiums this year. But in Central California, ob.gyns. will pay just $16,240.' www.obgynnews.com/single-view/malpractice-premiums-steady-in-2013-vary-widely-by-region/7ab6e2e266fbe026bede4c41133b9227.html. ExFIL paid about $100K annually as a neurosurgeon.

I laboured under monitoring with all of the DCs despite foetal heart deceleration, even with DD1 when my ability to push a baby out was unproved, though I was moved to the theatre for the last two hours of labour just as a precaution and exH was asked to don surgical gear including a hairnet, but DD1 was born vaginally all the same.

I had a very experienced OB/Gyn. I think a lot rests with the individual doctor. What one doctor would play by ear, another might see as reason to operate immediately.

.......
No G&A, and I remember being advised to use no aspirin or paracetamol in labour while at home -- you can try breathing techniques or hypnosis or effleurage, massage or lamaze, but basically what you have is epidural or opioids in your IV or in a shot.

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.

Pitocin is not standard.

gah posted too soon
I don't think one episode of a highly edited programme can give you an adequate snapshot of normal maternity care in the US..

The idea that 'there is not the understanding of how best to care for a woman in pain' is not borne out by any of my own experiences or it seems by the experiences of many other women who have posted here.

Pitocin is not standard

No, but it is pretty common if you have an epidural since it slows labor down.

Good to know about the length of short term disability payments for CS, I was wondering about that the other day.

There is 12 weeks mat leave in the US, where your job remains open for you, if you take a day over that, you may lose your job. I think the main issue of women returning very early is that there is little mat pay and people can't afford the time off. I've just told my dept manager I'm pregnant and she didn't say a thing when I suggested the minimum I will take off is 6mths. She's updating her staffing with that in mind. However we live in a booming city that is crying out for decent workers in my field, but we shall see next year how it all works out.

This is my third baby, I've had one in UK and one in Canada. UK was fine although I did find lack of information a concern. I was on a drip fter birth and in hospital for 4 days and have still no idea why. I had a partial epidural where I could still feel the actual birth after being in labour for 2 days. On open labour ward which was a nightmare for so many days, I was glad to go home!

In Canada I had an obgyn who was so overbooked I would wait between 2-4hrs with a toddler for my 5min appt with him in a room heaving with women. Thankfully I only saw him for my last 6wks. He had a record of attending every birth, I was told I couldn't push until he arrived. They soon changed their mind when DS2s heart rate started dropping. Oh how I wish I'd been the patient to break the arrogant sods record. Epidural there, but completely numb and had to use stirrups. We paid about $200 for a private room.

So far my care in the US has been great. I've had some early issues and have had 5 scans so far. I've seen a consultant due to my age (41). Compulsory testing here in include HIV, STDs and drug tests. I have some ongoing worries and my obgyn has said I can call her every day and go in if it helps. Very reassuring actually. I have received bills so far of $7400. Thankfully mostly covered by insurance. I have no idea how much the hospital stay will cost, but our out of pocket is $5k per year for hospital visits. I won't think about that yet.

I figure if a medical professional gets my baby and me home safe and well after a birth, that's all that matters to me, whether it's VB, CS, with drugs or none, no food, shit food, dorm room or private room, I don't much care.

Keep in mind that many people in the US do not have good or even any health insurance and in these cases they do not get private rooms, lovely food, water births or even the option of midwifes.
I had my daughter on Medicaid (albeit 18 1/2 years ago) and was assigned to a midwife without asking my opinion on the matter. It's the cheaper option.

I also had private rooms, though no water birth option - that had more to do with the setup of the small, rural hospital than anything insurance related. The same would have applied to any woman giving birth there.

One of my nurses was in the process of training to be a Doula, and was the most useful person in the room in my opinion. She'd actually gone off duty about 40 minutes before Daughter was born, but asked to be allowed to stay - and was most welcome.
The OB/Gyn did turn up at the last minute, after 36ish hours of labour, but only because Daughter needed to be pulled a bit (her dad said the vacuum thing looked like the device they use to pull the dents out of cars) and that's considered a 'surgical procedure' and requires a doctor.
But even with an epidural and intervention, they tried to keep me from being on my back at any point.

Things like home births, midwives (and the rules for their qualification), cesarean rate, medications, vary not only (widely) from state to state but from hospital to hospital. I don't think there is a "typical American birth experience" frankly.

Soap box queen it was dull

Weirdest comment. Birth is not a spectator sport!

personally I wouldn't dream
Of having my twat on display for anyone's judgement.

I wanted medicalised births for my 4 And didn't get that here in the UK.

Equally if I choose to give birth in a pool with singing dolphins while my doula hugs a tree that's equally valid.

Choice choice choice.

Not here in the UK.

No, but it is pretty common if you have an epidural since it slows labor down.
I only had an epidural because they decided to give me pitocin. Both of which I am most grateful for I nearly offered to marry the anesthesiologist because my only other alternative at that point would have been a c-section.

I think the system here is barbaric and lacks choice with the treatment you receive based on the mood of the midwife. It's as if the ones I've met don't get paid and are doing me a favour?? I had to ask one to stay with me whilst I gave birth and even then she stood in the corner of the room and dh had to catch the baby.

I chose to give birth in hospital because I'm wanted medical attention readily available. I would have given anything to give birth in US or Aus.

due to 'insurance' reasons - an explosion risk??? Strange how that risk doesn't exist over the border or in Europe, huh

The risk does exist in the UK. When the gas and air was delivered to my house for a homebirth the fire brigade were notified.

From what you describe, I think the program you are watching is not really representative of the birthing process in the US. I think a far better program to watch is 'A Baby Story'. You really can have everything and anything you want when delivering a baby in this country. The best is getting your own room with wifi afterwards. I loved that I could call my family and friends on skype and send DC to the nursery while I slept.

I'm in the US and had state insurance with DS and still had a lovely birth.

We weren't stuck with paying for a lot either as it was a Catholic hospital and they took up a lot of the slack. The state paid for most of the rest. Still had a big private room but had to share the bathroom with another person. Never saw her though so I didn't mind, and she didn't want the tub so it was all mine. :)

With DD I had private insurance but it wouldn't have mattered if I hadn't...there is only one place to give birth in our tiny town (besides home, I mean) so the poor and the wealthy would be in the same place.

I loved DD's birth because it is such a small town. There was only me and one other mother in the whole birthing wing and she left before I did. The nurses were so excited (because they don't get a birth every single day) that they fought over who got to care for us. They also said they'd arrange a signal with me to come in and demand visitors leave if I wanted. Also, I can't have gluten and the dietician called me from the grocery store to ask which bread I preferred. :o

Room was huge, bathroom was big and the tub had lovely jets in it which felt wonderful on my back in labor. The only thing wrong with it was that the internet connection was rubbish and I'd wanted to do a "live American birth" thread on here! Ah well, next time.

And it's not either/or...I had epidurals and "medicalized" American births with my two and used water sound CDs, baths, and scented calming oils at both of them.

Keep in mind that many people in the US do not have good or even any health insurance and in these cases they do not get private rooms, lovely food, water births or even the option of midwifes.

It's simply not true that underinsured or those who do not have private insurance get different care or food or options from other women.

You still get all the same treatment in the hospital in the states regardless of insurance status (well, other than obvious situations like celebrities and such I suppose - not a celebrity, so didn't have that experience!).

Private rooms, good or poor food, water births and so on are simply available or not depending on where you're giving birth. In a hospital in a small town, there may not be as many birthing options as perhaps in a larger city with a birthing center. I never saw a midwife (or heard of one actually practicing) until I got to the UK. I do prefer it, however, that's simply my choice.

When I was in labour with dd in the states, I had to argue with the nurses to allow me to walk around while I was in labour, whereas in the UK I was encouraged to do so. Just little things like that IMO made a big difference.

Safe birth. Hmmm.

The USA spends more per birth than any other country but is way way down the list if developed countries when it comes to maternal deaths.

Would recommend this film:

"Birth in America is big business. Medical decisions are being made for monetary reasons."

The argument is that what's primarily driving the increasing medicalisation of birth in the USA isn't the search for better outcomes for mothers and babies, but the focus on defensive medical practice, and the profits of insurers.

It's a great film - really interesting!

Personally I think women are pretty invested in defending their birth choices - of course they are, if they are treated kindly and come through it in good health and with a well baby.

But if we're assessing how good a maternity system is overall, I do think you need to look at clinical outcomes ask - is the colossal quantity of intervention in labour in the USA actually necessary and is it improving the health of mothers and babies? If not, why is it happening?

"Choice choice choice.

Not here in the UK."

The vast majority of UK mothers have the choice of a home birth, a birth centre birth, or a birth on a labour ward with an epidural.

If 95% of women in some US hospitals are having epidurals, and midwife care isn't available, would you really argue that they have the free choice to have an unmedicalised birth if that's what they want?

"Personally giving birth is simply a means to an end. I don't get the whole 'it's a wonderful achievement' thing."

No - it's quite understandable that you wouldn't get it if you have only had surgical births. But speaking for myself, going through labour and birth under my own steam did leave me with a feeling of huge strength and euphoria and self sufficiency. I appreciate that's not everyone's experience, but it is how I felt.

minigingers it's simply not true that you have choice in the UK. You don't. It's a post code lottery and a midwife lottery.

In the vast majority of cases

Sorry. . In the vast majority of cases women give birth in units where they have never met their midwifery team and have pain relief based on where the anaesthetist is In the hospital and,Ike me, being denied an epidural 4 times as basically they could t be arsed.

The good was vile, the bath wS covered In blood so my dm cleaned it herself.

After care and help to bf is generally appalling.

How is lack of care/choice/ empowering for Anyone.

The USA birth existences and Canada sound like paradise.

the vast majority of UK mothers have the choice of a home birth. A birth centre birth or birth in a labour ward with dm epidural

With respect that's just not the case.

Countless threads on mumsnet for years disprove that.

I Am a nurse so do know the score.
Maternity care here is at breaking point.

cheerful yank that sounds absolutely fantastic.

We can only dream of that level of care/cleanliness and attention here.

The main US-based birthing program I remember watching was all set in a midwife-led water birthing centre, so there must be a flip-side to this coin!?