to wonder why the UK is so far behind with ante-natal care?

[hairbrushbedhair]

Just that really. The UK doesn't seem to test or worry about things that other countries take more seriously. I know we have a NHS and it's down to cost probably, so it's likely I am BU

The UK doesn't seem to test or worry about things that other countries take more seriously

Such as?

Yes it is undoubtedly down to cost.

But living in a country which does do all the checks and tests, I think it's probably no bad thing.

Really?

Group B infection, for example.

Id say our midwifery care is one of the best in the world! Behind who exactly?

What tests do you have in mind?

We have one of the highest stillbirth and neonatal death rates in the developed world!!!

Most other countries do placenta scans during late pregnancy as well as other tests which clearly do make a difference.

I'd rather give birth here than in the over-medicated US.

However, my community midwife care has been atrocious.

Yes, what tests are you specifically thinking of?

Group b strep isn't countrywide (some trusts do, some don't) or CMV

Off the top of my head as they've come into my personal sphere of awareness

And behind say Belgium as an example, they seem to test for a zillion things and do a lot more scans

Presumably it's based on the frequency those conditions occur, and whether the cost of testing for them is justified given the number of occurrences. I have to say I am shocked at some of the things that are not routinely tested for in the UK (like Group B strep). I heard from UK friends that their midwives were advising them to pay privately for a test kit you send away as it wasn't offered on the NHS.

What's CMV?

YANBU. I've lived all over the world and ended up receiving some emergency ante natal care in the UK whilst we were on business, it was pretty shocking. We live in a country where healthcare is free for everyone and is extremely good, I supposed we've been spoilt so have a lower tolerance.

The NHS has done a careful cost/benefit analysis of GB Strep screening for all and decided the costs outweigh the benefits. The greatest cost is not money it is the increase in women and their babies being exposed to antibiotics and the impact of birth choices.

More scans have been found not to actually help for most problems and can increase anxiety. Some people also worry about the effect on the baby of scanning.

What's CMV?

Good question. You'd be forgiven for thinking it's rare in the UK but it causes more problems than Toxoplasmosis for example yet relatively unknown about by pregnant women. I think it's a leading cause of deafness but also can cause other problems such as stillbirth and birth defects

Cmv action UK has some really good info on it

I'm 37 weeks pregnant and have been spectacularly unimpressed with my care to date. No one listens, no one bothers to read my notes, appointments getting cancelled left, right and centre. And I have a high risk pregnancy.

I saw an obstetrician the other day and her opening line was 'so, Mrs Pops - this is your third pregnancy'....err, no - it's not. It's my first.

*Yes it is undoubtedly down to cost.

But living in a country which does do all the checks and tests, I think it's probably no bad thing.*

Why do you think that Sushi?

Belgium as an example, they seem to test for a zillion things and do a lot more scans

I think you'll find that, in healthcare systems where doctors and midwives get paid per test, more tests get done. This has nothing to do with good care. The US has the most medicalised, test heavy, antenatal care in the world and some of the poorest outcomes amongst developed countries.

The US has the most medicalised, test heavy, antenatal care in the world and some of the poorest outcomes amongst developed countries.

We're still ten(? If I just looked up that figure correctly) places behind the US in terms of stillbirth rates

I suppose I still feel for people who face horrible things happening, it would be easier to know that at least the care they received tried to prevent it. Imagine having a preventable loss because of cost (Group B for example)

Be nice if the NHS didn't leave awareness up to charities so that in some cases women would be routinely informed and able to pay privately if they could afford it. Even awareness costs money though doesn't it - time with anxious patients, printing costs for leaflets etc

It is not always about the cost or not wanting to raise awareness though. Sometimes it is a decision not to inform women about private tests because this information causes so much worry which is more damaging that the very slight chance of bad outcomes from rare events.

I agree that the NHS needs more midwives so they have more time to listen and care for individual women.

I thought about having group B strep screening, but a paediatrician I know said that even if you test positive when tested, the evidence isn't entirely clear on what the best course of action is.

I think that there will be a move towards more Doppler scans of placental blood flow. As technology gets cheaper and more portable it should filter down more into community settings. Perhaps adequate training will be the biggest cost.

Where do you get the idea that we have the highest neo natal deaths and still birth rates in the developed world? A quick look at WHO figures shows that is not true. Our global rank is 29th out of 195 countries, which is better than countries like Switzerland, or France which is 33rd in stillbirth rates. Of course we could do much better, but we need to understand what the reality is.

I beg to differ about the US. To people in the UK its too much but I think they have the right approach. If in doubt they test for it and after having issues I am very thankful they have that approach.

The Harmony test has been available here for a while now and I was shocked it is only just coming into the UK now after a trial basis. Every single women should have the Harmony test IMO. When I had DD 5 years ago, there were some mothers in the UK who went private to have the nucal fold measurement. I was just shocked that this wasn't done as a standard procedures. Also, the step b test is given as standard here. I just can't imagine the cost benefit analysis discussion of 'So its going to cost us GBP5 million a year to do the test and if we don't do it we lose 2 babies every 3 years. Well that is alright, I mean it is probability so we should be fine.' My other issue with the UK approach is that you don't have one person overseeing your care from discovery of pregnancy through postpartum. Here in the US my obn manages my care from week 8 of pregnancy through week 8 of postpartum. All issues go through my obn and my medical notes are in held by the office in digital format so they can be emailed to doctors if necessary.

Also, US outcomes are not that poor. The rate just after childbirth is good. The problem is the rates in the first year. The government have really tried to make a difference with the WIC program and Medicare program for all children. The issues have been around parents not taking the sick child to the doctor when first sick and the living conditions not being great. Through the charity work DH and I do there is a big problem with young children living in damp houses with black mould in the southern states. Habitat for Humanity do a lot of work to try and fix this but it is really hard.

I think that tests like NIFTY/Harmony will also become more routine. It's likely that they will become cost effective soon.

The US does better for stillbirth rates, but has much higher neo natal rates of death.

I've had 8 scans so far this pregnancy and have another in 2 weeks. I haven't found the care lacking at all. I kind of wish they'd back off a bit and stop worrying me.