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

If we really want to improve outcomes, then tackling social inequality would probably make a much greater difference than changing much by way of NHS antenatal provision.

I'm 36 weeks into my second pregnancy and I live in NI. I'm Consultant led due to thyroid issues. I can honestly say I cannot fault my care so far - in either pregnancy.

I've had appts every 4-6 weeks and they've been exemplary in their attention to detail. Perhaps it depends on the hospital you attend?

The better US results may be to do with younger average age of first time mothers? Also, much of their healthcare is employer-funded so presumably the employer has a strong interest in getting the employee back to work fit and well.

I thought the UK system was very inefficient for the patient (one example - all care provided in your home area around lunchtime even if you have a long commute and there seems to be no option to access care near work), however, I don't have anything else to compare it to and it was at least free.

I think it does vary very much by hospital - which is wrong in a nationalised system, isn't it?

Every screening test has to consider the sensitivity of the test and specificity of the result. All screening tests are introduced following strict guidelines set by the national screening committee, based on evidence. Yes cost is a factor, which in a public service health service is absolutely reasonable, but it is one factor of many.

Further tests are always available privately should people wish to persue them, but as always, the interpretation and consequences of the results need careful consideration.

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

I suspect these results may be from 2 polar opposite groups of people though. I have good insurance, and took every test going, so I probably fall into the first section. However, many people do not have adequate insurance and their maternity care may be minimal or non-existent. I suspect those are most likely the people who suffer the poor outcomes.

suspect these results may be from 2 polar opposite groups of people though. I have good insurance, and took every test going, so I probably fall into the first section. However, many people do not have adequate insurance and their maternity care may be minimal or non-existent. I suspect those are most likely the people who suffer the poor outcomes.

That is certainly a factor, but heavily medicalised medicine is harmful in its own right. The trouble with the "test for everything just in case approach" is:
a) some tests can be harmful e.g. amniocentesis, CT scans
b) many tests produce inconclusive results and trying to treat inconclusive results can harm patients. A classic example of this is thyroid cancer - the rate of "detection" in the US has skyrocketted because of "just in case" testing, but the death rate hasn't changed. So "testing to be on the safe side" hasn't saved anyone's life, but it has exposed many patients to the risks of unnecessary surgery. There are many other examples.

I had my DS's 10 and 30 years ago now and I can say my Ante-Natal was absolutely top rate, probably as we were looked after by a high-risk pregnancy unit.

I had blood flow scans even with DS1 in 1986 as this was a specialality of the team looking after me. I was surprised when doctor in charge of the team said.."we've looked after you before, haven't we ?" and got my dusty 20 year old records bought to him within 5 minutes (they keep their own records on the unit)

I know a lot of people who have 'normal' care at my hospital moan about the care

Phineyj The healthcare insurance structure has no impact at all. What does make a difference is the liability insurance requirements. My obn practice lost an obn last year because she had two stillbirths and a mother died on her. The liability insurance was so high she now only does gyn work. It is a huge shame as she is a fabulous doctor who is extremely dedicated to her profession.

In my area at 35 I am below average for having my 3rd. The average age for having a first child is 38 at my local hospital here in North New Jersey. There seems to be a much bigger issue with infertility because of the older average age. In poor areas you will find more teenage pregnancies but on the whole women tend to be 35+ having their first if they have been to college (and about 60% of the female population is now graduating college).

I will add that I was shocked that kick counts were not mentioned to my friend in the UK in 2012. My obn uses an app and monitors the time taken each day for the 10 counts. If she sees a pattern that worries her you are sent to the hospital PET unit for a detailed scan to check everything. Its is cheap to do kick counts yet it is not done in the UK. The whole notion that cheaper is better scares me with the NHS. There is a balance and costing less doesn't mean better care. Kick counts don't actually cost the NHS anything yet in 2012 at least women were not told to complete them and call the midwife if less than 10 kicks in 2 hours.

Also for those who don't know how the US system works.....

Medicare steps in the covers all pregnant women in the US who don't have the assets to pay for care. You get exactly the same treatment, same tests and same doctors that you would get if you were pregnant with private insurance. It is one of the areas they have right here with regards to healthcare and I am very thankful to Hilary Clinton for driving through that change.

The UK assesses things on a cost/benefit basis. In other countries, tests are done because it makes money for the insurance companies, and plus people like the idea of tests - it tends to make them feel safer - so why not?

In fact most of the tests are unnecessary - for example the GBS test doesn't give better outcomes than the UK approach which is to treat anybody who is high risk. It's NOT the case that the NHS only takes the cheapest approach, but that it needs to see a clear benefit if it's going to pay out for testing. If the outcomes with the test and the outcomes without a test are similar, then it doesn't make sense to put money into that test - because it doesn't improve outcomes.

I was told about kick counts when I was pregnant with DS in 2008 and everyone I knew who was pregnant knew about them.

I do agree the UK has a shocking track record for stillbirth, and this needs to change. But aside from that I think our maternity care is among the best in the world.

I had the same community midwife from booking in through to signing me over to health visitor care 2 weeks post birth - she explained she could carry on seeing me a bit longer if I wanted, but everything seemed fine. I did see other midwives/hospital consultants too, but she was the main person I saw.

I felt very happy with the care I had throughout.

I had wonderful care here in the US for my pregnancy (anecdata I know). I agree with previous posters that the issue here is that blanket statistics hide a gulf between women with good health insurance who are getting the level of care that that buys versus women with no health insurance (and in the case of undocumented women no access to publicly funded care like Medicaid). There are also significant racial disparities I believe.

Having had two DC outside the UK, I've been appalled by reading stories on MN about the many women who seem to have had traumatic and mismanaged births. The worst cases end up with 'bad outcomes' (which seems to be a euphemism for either mother or baby dying), but there are so many others where babies suffer birth injuries, or women suffer grave physical or psychological damage which leaves them permanently scarred - and the way these births are described so much of it might have been avoidable with better care (primarily higher staffing levels).

I've listened to a fair number of birth stories in the country where we live (from friends and baby groups etc) and only ever heard of one woman who was unhappy with the treatment she received (and in her case it was because she chose the wrong kind of birth for herself). Everyone else has seemed reasonably happy with the level of care. Obviously this is anecdotal and not in the least statistically valid, but I think antenatal care and care during labour needs to consider much more than levels of neo-natal death and still birth.

I've looked at my notes from my births, 17 and 13 years ago, and can't decipher half of them, but I definitely had a toxiplasmosis test as standard in both. I also had a rubella test in both (what are you supposed to do if you're not immune - run away from any small child you see who might be infectious?). My iron levels got checked several times. A Kell antigen test was done. Several antibody tests called Coombs tests. And a test for Treponema pallidum, which I've just seen is a diagnostic test for syphilis! Good grief, glad that one was negative. Can't see a B strep test mentioned, but that might be a more recent innovation. It sounds like a lot, but I only remember having blood taken 3 times during the pregnancy.

I think I had about 7 scans throughout each pregnancy, including the high-definition one around 20 weeks. The first scan is the first time you go to the gyn, so might be as early as 6 or 7 weeks. That's when they confirm the pregnancy, and check that it's not ectopic, and whether it's a singleton or multiple birth. Does that mean in the UK you don't find out you're having twins etc until 12 weeks?

The extra scanning means that they have a good idea of the baby's weight close to birth, and a large baby and smallish first-time mother might be recommended to have a C-section. It also means they can be sure before the birth that it's not breech (but surely this would be known in the UK beforehand too, no?). I was never worried or anxious about the scans or tests - quite the opposite, it reassured me that any anomalies would be spotted beforehand and gave the the confidence to go for a midwife-only birth in an independent birth centre.

Actually illegals have full access to medical care as they are considered American from conception onwards. I think one of the reasons why the Republicans lose it around Hilary Clinton is because she turned the Republicans points on abortion against them to argue that the illegal is carrying a US citizen therefore care must be provided to both the mother and child. Quite a clever lady and I think she should have been awarded the nobel peace prize for her contribution to healthcare for women.

I know I haven't read the whole thread but I'm pregnant in Belgium at the moment and there are only two hospitals in the whole of Brussels that offer gas and air. So despite all the tests etc, there's still a fair few things I'd change!

My sister is a UK midwife and was very impressed with my pre-printed booklet of blood tests, scans and screenings each with a numbered week that was given to me by my family doctor as soon as I found out I was pregnant.

I just rolled up to the hopital or local surgery at the relevant time with the relevant page. The prenatal system was set up and doctor or midwife intervention happened at least every three weeks. There were also prenatal courses and support groups. All free on the national health system, including elective or medical abortion.

I'm in a PIGS country with one of the highest rates of caesarian section births in the world.

I've mentioned this before on MN. My daughter was stillborn in March. Nothing wrong with her, or the placenta etc, no infection. I was 40+5 and considered low risk becuase I'd had 3 healthy pregnancies and births, so I was given the bare minimum in antenatal care, I even had reduced appointments. The amount of times the hospital staff said 'it is more common than you think' to us. The bereavement midwife informed me than there were three women, in that hospital, who had suffered stillbirths before us, that month already. My daughter was born on the 12th. If you work that out that was one every 4 days. In just that one hospital. I joined a sands support group and it is full of other women like me, who lost their baby for no given reason, or because the placenta stopped working, or because they reported something that they were told were just normal niggles of pregnancy. Another mother who actually asked for the group B strep test, was refused and then whose baby died from a grup b strep infection.
I am pregnant again, and receiving very good care. I am anxious beyond belief though, and they keep telling me not to worry becuase this time they are taking good care of me. Well why couldn't'they take good care of me last time? Maybe I would still have my tiny daughter. Maybe the other mothers would still have their precious children too. There was a documentary on last year I think. And they valued the extra Doppler scans at a cost of £12 per woman per pregnancy, I think my friend said the strep b test cost £38 even if these were things that we were given the option of paying for and adding to our care. I would have done that for my child.

I should say my first two children were born in Turkey. I had very regular growth scans throughout and doppler scans towards the end. The births were horrific, flat on your back not even gas and air type births but I had living children to show for it. I would opt for the good antenatal care and crappy birth anytime. That pain at least has its limitations. That pain of losing your child is with you every second of every day and no matter how hard you can't escape it

It also means they can be sure before the birth that it's not breech (but surely this would be known in the UK beforehand too, no?).

Not always, as I can attest from personal experience!

Sorry for your loss 3littlebadgers

I had a late missed miscarriage in the US and dd1 was born there. Dd2 and Dd3 were born in the UK. I would choose US care over UK every time.

My US missed miscarriage was very well and sensitively handled and I was scanned to make sure there was no retention of products. A friend in a similar position in the UK had "precautionary" D&C and went on to be treated for infection. The level of staff sensitivity my friend received in the UK was way below my US experience.

I am unconvinced by arguments for not testing for strep B.

My neighbour had an emergency C section last month because the midwife staff had not noticed the baby was full breach - late scanning would have picked this up and was routinely done in the US.

When pregnant in the UK I did not see the same midwife more than once and did not receive dedicated care during the delivery phase, despite delivering a month early.

It is not true that good insurance pregnancies are necessarily over medicalised in the US. I had no interventions. Also the newborn care and checks and breastfeeding support were far superior in the US.

YANBU - the UK could and should do better and a lot of it is organisation and mismanagement rather than cost imo

I think steady care from 2-3 well trained and not overworked midwives would help an enormous number of women have a better pregnancy and better birth outcome.

it doesn't solve the medical problems which need to be tested for an picked up on, but never seeing the same midwife 3 times running can't help the mother's mental state at all. A steady, supportive, available midwife or three would give a sense of security and maybe confidence to speak out when there is a worry. Just a better experience overall.

Don't confuse testing with better care or safety.

Testing means more interventions and you have to be careful to get a balance. We test for GBS when risk factors are indicated in the UK

I've seen Belgium mentioned, so have to weigh in.
The guidelines for pregnancy management here are based on Nice guidelines. It's just not followed very often, because gynaecologists are paid every time you see them and extra if they do an ultrasound. When I did a rotation on gynae, every single patiënt was given an ultrasound. For no reason whatsoever other than they were there and it's fun to see the baby. So yes, pregnant Belgian women can and do get lots of ultrasounds, but that doesn't mean the care is better.
Regarding CMV, it is tested for here, but the guidelines say not to, because if you've never had it before you need to make sure you wash your hand really well and we can't predict what will happen if you catch it during pregnancy, but if you have had it you still need to make sure to wash your hands well and we also can't predict what will happen if you get it a second time during pregnancy. So there really is no point in testint.
We test for HIV, hep B and syfilis at the beginning of the pregnancy, so that those can be treated and not passed on to the child (or the midwives). And then it's urine tests and weighing every month or so with three ultrasounds and glucose testing.
We do have lovely 'mother books' which I get to hand out to pregnant patiënte in which we keep track of all test results etc and the mother can read about what's happening with the fetus and write down any questions or observations. (once the baby is born there is also a child book).

Not all tests that exist are good tests.

I had my first earlier this year, and couldn't fault my antenatal care. I was however consultant led due to a pre existing condition. I had fortnightly appointments, at least monthly scans and continuity in the professionals I saw.
My issues were more with the post natal care which was pretty poor in my experience.