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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To really hate OBEM USA?

154 replies

VanGogh · 11/09/2014 01:02

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?

OP posts:
minifingers · 12/09/2014 08:58

"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."

I don't take the responses on mumsnet to be representative of the national picture because they're not. I take my evidence from the Quality Care Commission surveys. MOST women have a choice of birth setting. MOST women get the pain relief they requested. MOST obstetric led units have 24 hour anaesthetist cover.

Obviously only a fraction of the amount of money which is spent on your average US mother is spent on a mother in the UK, and this impacts on the quality of care - you are much less likely to get one to one care in the UK from someone you know, and this is a HUGE problem. You also have less control over birth setting and who is looking after you, and this is a problem too.

On the other hand, if you're willing to spend some cash, as you would in the US, you can have a gold standard service - one to one care from a private midwife all the way through pregnancy, birth and the postnatal period with the back of of NHS obstetric and neonatal services should things become complicated or dangerous.

Would add, that for all the many faults of NHS maternity services, it gets a big bang for its buck in health terms - better clinical outcomes overall than the USA for a fraction of the money which is spent per head.

minifingers · 12/09/2014 09:01

"Maternity care here is at breaking point".

In some areas.

Not everywhere.

LittlePeaPod · 12/09/2014 09:01

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.

Well done you!

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

Based on my experience this doesn't seem to be the case.

  1. Close friend wanted a hospital birth and was guilt tripped into going into a MWLU and the care was so poor her DD nearly died and was transfered (air ambulance) and placed on an ECMO machine in Leicestershire. She was released after 10 weeks before spending a further 3 months on oxygen at home. Part of the problem was the lack of communication and over stretched MW. The Trust has accepted liability. I had a thread on here last year about this.

8 NCT women and only four got the birth they wanted and asked for. Myself and three other women. Below is a brief overview of the other four.

  1. First woman wanted a water birth and was pushed into a hospital. Good thing really as she ended up having an EMCS
  2. Second woman wanted an ELCS because she had been told throughout that the baby was big. She felt pushed into a VB. This too ended in an EMCS with her been placed under general anaesthetic. She has been left traumatised and has said she will not have any more DC. She has also been left with an awful scar.
  3. Third woman had a breech baby however her baby was measuring small and she felt pushed into trying for a VB by the MW. She ended up having an EMCS. She had wanted an ELCS because baby was breech originally
  4. Fourth woman wanted a home birth and this was also refused. Good thing, she too ended up having an EMCS.

Based on my limited experience, the vast majority of women don't seem to get the birth they want.

Surfsup1 · 12/09/2014 09:07

I don't understand the argument about CS being "natural".

They're an extraordinary medical advance and I personally wouldn't be here to discuss this if it weren't for the option being available (having been born by CS as well as having given birth by EmCS) but IME there wasn't anything natural about it at all! Anaesthetic, surgical procedures, antibiotics etc etc.
Wonderful but not at all natural.
Vaginal birth is "natural". Dying in childbirth is natural (although happily less common these days). Caesarean sections are not natural - that's simply a fact not a value judgement.

Annarose2014 · 12/09/2014 09:27

Can't bloody believe you're encouraged not to take Paracetamol at home - what on earth do they think its going to do to you?? And how is it their business if its at home and outside of their liability?

I was at my Antenatal class yesterday and they were positively encouraging we pop a couple of Panadol when contractions start. Seems completely sensible to me.

Tbh, no wonder things escalate quickly when women know that their only pain relief is either an opiod or an epidural.

FiftyShadesOfGreen4205 · 12/09/2014 09:27

I've never been treated with less dignity and compassion than under the 'care' of NHS midwives. I'd take the US system over it any day.

soapboxqueen · 12/09/2014 09:51

I thought this was more about the show than the health care systems.

However, I've had two children on the NHS and both were great experiences. Especially seeing as both were prem, one needed special care and one was breech. While not everyone has a great experience no matter which country they give birth in, statistics show that the majority of women using the NHS have a good experience and have choices.

The NHS always ranks higher than the medical system in the US.

ScrambledSmegs · 12/09/2014 11:50

To be fair I think this thread was originally started with the intention of discussing the show, and the differences in maternity care between the UK and US.

I had a quick look at the show and it is quite hard to see the differences between the births. Unlike OBEM UK, where there seems to be great variation in the way labour progresses with each mother, all of the ones I've seen so far seem to progress in exactly the same way (as the OP has described) . Everyone seems happy, babies and mothers v healthy and nothing goes wrong, it's just very... samey.

The thing is, from what's been written here it's only one facet of the US maternity system. It's a shame that the show is limited but I suppose it's the way tv works.

Oh, and no gas & air? You guys are soooooo missing out. It's amazing stuff. I remember trying to get my DH to have some as well, with the words, 'Go on, it's good shit' Blush Grin

BravePotato · 12/09/2014 12:17

I had my baby in a US-style setting, lovely epidural at the right time (did not slow down birth), lovely care from my OBGYN (who promised to be at the birth whatever the time of day, so reassuring), very good stitching and recovery, very good experience all round.

I always look at the UK OBEM and think : " Thank God I was spared that!"

LOL, guess we are all different.

Thurlow · 12/09/2014 12:45

I was at my Antenatal class yesterday and they were positively encouraging we pop a couple of Panadol when contractions start.

I remember our NCT tutor basically saying "fuck it, take paracetamol AND crack on with the wine". She pointed out that many women, when they finally get to hospital, will opt to have morphine or pethidine, which is an opiate akin to heroin, so one glass of red wine isn't going to do too much damage right at the end Grin

mathanxiety · 12/09/2014 15:54

Annarose, I believe it's so they know what you have and don't have floating around in your system if you end up getting more pain relief in the hospital or needing a CS. Also, I suspect because they fear you might lose count of how many you take.

As well as that, they need to gauge how your contractions are feeling without pain relief so they can tell when you might need to start thinking about heading to the hospital. One of the ways a doctor or MW can judge how you are doing is by asking about your level of pain and hearing how you speak over the phone - whether your voice is affected by contractions, etc.

And there is also the fear that well meaning friends or relatives would dig into their pain relief supplies - including prescription pain relief - and prevail upon a woman to take something effective that might not be good for the baby. If there is an interdiction on even acetaminophen then it's easier for a woman to refuse to take the codeine her well meaning friend has in her medicine cabinet.

Minifingers --On the other hand, if you're willing to spend some cash, as you would in the US, you can have a gold standard service - one to one care from a private midwife all the way through pregnancy, birth and the postnatal period with the back of of NHS obstetric and neonatal services should things become complicated or dangerous.

Or you can get gold standard service while on Medicaid and not have to pay one cent for it -- one to one care from your own personal MW or doctor all the way through pregnancy and delivery and afterwards as you recover in the hospital, and all the neo natal care you could hope or wish for including an examination by the hospital pediatrician as a matter of routine, or neo natal specialists if the need arises....

And as I mentioned before, clean, clean, clean hospitals -- clean room and clean ensuite shower and loo, clean furniture in your private or semi private room, clean sheets daily, clean floors and doors and windows and TV remote, all the supplies you could hope or wish for all laid on, for yourself and your baby...

And I know we are not talking about Ireland here, but I know someone who had to have an EMCS and was on the trolley being taken up to the next floor (terrible hospital design) where the theatre was; she and her MW and her DH waited and waited and waited for the lift, everyone getting more and more frantic as ten minutes passed and no sign of it. When it finally arrived and opened a bloody meal service crew emerged from it. There is no way on this earth they should have been using that lift. It's a well known fact that your chance of receiving even passable care in Dublin maternity hospitals is slim to none if your due date falls between April and October, the busy baby season.

CheerfulYank · 12/09/2014 15:59

I know plenty of women who took Tylenol during labor so again, that's probably not representative of a lot of places here. :)

Annarose2014 · 12/09/2014 16:40

But those are crazy reasons! Paracetamol doesn't impact on how fast your contractions are coming and their duration which is surely a more clinical way of assessing dilation.

And pain is so subjective - somebody might be howling down the phone after the first half an hour! Doesn't mean they're at 5cm!

And taking Paracetamol doesn't stop you getting Pethadine!

Not getting at you by the way, not shooting the messenger! But am faintly horrified by the paternalistic attitude that a woman can't be trusted to take Paracetamol at home. Like its a gateway drug that can lead to labouring women mainlining opiods in the kitchen! Hmm

HibiscusIsland · 12/09/2014 16:41

I think giving birth in the US would have suited me very well by the sound of it. My "care" I got when I gave birth to my eldeat in the Uk was absolutely appalling. Bit better with my younger child. I changed hospital for that. Wasn't going back to the other place

HibiscusIsland · 12/09/2014 16:42

The care I got

mathanxiety · 12/09/2014 16:57

Paracetamol really wouldn't do much good anyway imo -- it barely makes a dent in a headache ime, and I am allergic to aspirin and all the aspirin family so I am stuck with it, which sucks.

A lot of people wouldn't have paracetamol/acetaminophen at home anyway simply because it really doesn't work too well for many. They would just have aspirin or Advil or Ibuprofen, etc, which can affect bleeding and blood clotting.

It's possible Tylenol isn't as strong in the US as paracetamol brands are in the UK. My mother always swears paracetamol sends her to sleep. There used to be just one Tylenol strength available but now there is regular and extra strength, possibly because regular really wasn't much use, but of course it could be just a gimmick. I don't find the extra strength works too well either.

Annarose2014 · 12/09/2014 17:04

Sorry to be so obsessed with the Paracetamol thing, lol.

It is pretty good here though - in my hospital on the general wards our first response to bad pain is 1gm Paracetamol orally, and if its VERY bad pain then its 1gm of Paracetamol IV. Tbh, that honestly usually does the trick.

Then if somone is absolutely writhing in pain we escalate it - Pethadine or Codeine or something. But 2 X paracetamol can really work here. Depends on the person of course.

CheerfulYank · 12/09/2014 17:08

Yes I don't really have Tylenol lying around either. I have Aleve, Excedrin migraine (or generic) and children's Advil.

Maybe it is stronger there. I do have Tylenol PM as it makes me sleep.

Annarose2014 · 12/09/2014 17:11

Also, post-C section here you get a Difene suppository. Do you get that in the US?

mathanxiety · 12/09/2014 17:30

I haven't had a CS but what I have heard from others is the wonder of having a pump to manage your own opioid pain relief via IV. I know women who have had a duramorph shot after CS deliveries too - but they would have children aged 8 and up at this point.

Want2bSupermum · 12/09/2014 18:57

annarose I had two CS's. No suppository for either. They give you stool softeners and black coffee, sugar optional. A jug with a lid and a straw in the top was filled with warm water and lemon slices and left on my side table. The nurses filled it up everytime they came in. With my 2nd it was a planned CS so they have me a stool softener upon admittance and my obn instructed me to take one the previous day.

They don't want you taking anything before you arrive at the hospital so they can track the progress of the baby. My obn explained that tylenol can subdue the activity of the baby and result in their tests not identifying issues.

sunnybobs · 12/09/2014 19:03

Oh my days I'd bloody love an American birth! I've done water birth at home and induced birth with pitocin and I'm now pregnant with number 3. When the midwife asked what I wanted this time I said "one of those American births where when they ask for an early epidural they get one and then they have to actually be told when to push!" They were not impressed and I know it will be the usual NHS battle of "no you're not ready for an epidural, no the anaesthetist is busy and then oops well you're too far gone now so all you can do is push" lies lies lies that every midwife tells Hmm wish we could properly choose in this country rather than midwife dictates being dressed up as women's choice

PicandMinx · 12/09/2014 19:14

Great post sunnybobs.

minifingers · 12/09/2014 19:26

"Or you can get gold standard service while on Medicaid and not have to pay one cent for it -- one to one care from your own personal MW or doctor all the way through pregnancy and delivery and afterwards as you recover"

It seems to me like much routine care given to labouring women in the USA isn't evidence based.

How can care be considered 'optimal' when it is not evidence based and when it drives drives a coach and horses through the medical concept of 'first do no harm'?

mathanxiety · 12/09/2014 20:04

You need to define 'harm' there Minifingers.

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