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Childbirth

Share experiences and get support around labour, birth and recovery.

Giving birth in the USA, what is normal compared to UK?

25 replies

oopslateagain · 22/02/2011 14:37

I gave birth in America and really didn't get a chance to talk to anyone else about what is normal/expected there. Hoping MN can come through!

This is all long-distant (dd is 13 now) but it came up on another thread and now I'm really curious.

Quick snapshot of events:

I had told MW that I didn't want an epidural (I was very emphatic!) and that I'd like as natural a birth as possible, able to move around etc.

I gave birth at 39 wks, went into hospital at 7 a.m. with contractions every 2 1/2 minutes. The nurse said she didn't think I was in labour as I wasn't in pain, and to walk about till my midwife came in. MW arrived at 8.30am, checked me and said "ooh you're 6cm, you'll have this baby today!" She then broke my waters (and THEN got me to walk to the delivery room Hmm wouldn't it have been nicer to NOT make me waddle down the hall with fluid dribbling down my legs?)

She then put me on a Pitocin (sp?) drip, saying now the waters had gone there was a risk of infection so baby had to come out. I asked her to drop the bed rail so I could get up and she said that as I was on Pitocin I had to stay on the monitor so I HAD to stay on the bed.

From the moment she confirmed I was in labour I was not allowed anything to eat or drink except 'chips' of ice (think of a slushie with no liquid) eaten with a spoon. The drip had a saline bag so she said I wouldn't get dehydrated.

She checked me at 11.40am and said I could push. I had no urge to push but (first time mum, very timid Grin how times change!) did as I was told. Had baby at 12.01pm, 20 mins of pushing. At no point did she tell me to slow down or anything, I had a horrible tear (only 1st or 2nd degree but it went right up my labia and through the clitoral hood, sorry TMI!!!)

She pulled on the cord to get the placenta out which bloody hurt 'inside', then said I was bleeding a lot and had to knead my tummy very hard.

TBH it was all over so quickly (and dd had health problems so it wasn't the first thing on my mind) but looking back I would like to know:

Did she really need to break my waters? Wouldn't they have 'gone' on their own?

Once my waters were broken was it really necessary to put me on Pitocin?

Was I actually ready to push even if I had no 'urge'?

Don't they (in the UK) get you to slow down as the head crowns so you DON'T tear?

And I was bloody glad I had the baby so fast because I was starving! Also very thirsty despite the drip.

I've only had the one dc so I really am clueless here, just over the years listening to other people's stories has made me think Hmm about mine.

OP posts:
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nailak · 22/02/2011 15:29

have you seen rikki lakes documentary on this it will explain a lot to you.

CBear6 · 22/02/2011 15:30

The US system is so different to ours in the UK, a friend of mine had to try three different hospitals before she found one that would even let her deliver without an epidural. One of my MW's did part of her training in America and she said that she and the nurses would work their backsides off looking after their ladies and then the doctor would swoop in a few minutes before delivery and get all of the glory :)

Your experience does sound a lot different to what we would get over here, although I'm basing that on the hospital I delivered at, my own experience, and that of friends.

The waters don't need to be broken unless it's to speed labour, if labour is progressing at a normal orate and baby is fine then it's not a requirement, some babies are even born still inside them. My waters didn't break until I was 9cm dilated. It's also not a requirement to go on the pitocin once they break. Yes, there's a risk of infection but generally you're fine for a while before the risk becomes too great, some people even leak for ages before delivery and my SILs leaked for two days before she went into labour, the hospital sent her home and said she was okay for up to 72 hours.

I tore with DS, 2nd degree, but I didn't get a chance not to, he turned his head before it was fully out so even though I had slowed down and was doing that stupid puffing-panting thing just the act of him turning his (huge) head in such a confined space caused the tear.

barelyutterly · 22/02/2011 15:46

Second time today I've recommended this blog (I've recently come across it and am a huge fan of it as you'll see from my other posts Grin) but I think it's worth a read. It's written by an Aussie midwife for other midwives but in such a way that laypersons can understand it too. Lots of references and research links.

midwifethinking.com

I'm cringing at the description of your DD's birth actually, and I think from reading that blog you'll find most of what happened to you was unnecessary. Sad Especially with regard to directed pushing, breaking your waters (unnecessarily? would they not have broken on their own?) and this concept of "instant" risk of infection.

Haven't ever given birth in the UK so can't answer that but from what I've read the no food/drink thing is outdated. And pulling on the cord sounds really bad!Shock

God help the midwife/consultant who tries any of the crap you described on me. So glad to have discovered MN myself so I can read stories like yours and prepare myself for every eventuality! (thanks for sharing it btw).

oopslateagain · 22/02/2011 17:03

nailak - thanks, I will look at that.

CBear - ouch that sounds painful!

barely - thanks for the link. I am definitely thinking that a lot of the 'intervention' was unnecessary but far too late to do anything about it now. I'm sure it's completely different now anyway (fingers crossed) Grin

OP posts:
barelyutterly · 22/02/2011 19:11

A friend's wife recently gave birth in Canada and he told me that because they forced her she'd had to be induced with oxytocin for her first child, they automatically made her have it for this birth too, even though she literally went into labour on her due date and was labouring otherwise normally. Hmm

I actually think North America is miles behind Europe/UK with this stuff (and I say this as someone who spent the first 30 years of my life there and only moved here a few years ago). For instance, otherwise intelligent and educated friends of mine didn't even consider not circumcising their baby boy when he was born, they considered it routine and the medical community encouraged it. They looked at me like I was nuts when I asked why they had it done, as if I'd asked why they'd had the cord cut or why they breathe air!

Not to start another thread on THAT issue, but just saying that society in general seems to view pregnancy and childbirth much more clinically there than here. A homebirth there is virtually unheard of and I'd be under extreme pressure from everyone I know if I was living there but wanting the birth I want here to "just go to the hospital and have it the regular way". Makes me very glad I'm living here (even though I know the NHS has its own problems!)

AppleAndBlackberry · 22/02/2011 19:24

I'm not a medical professional but based on my experiences in the UK:

Did she really need to break my waters? No

Once my waters were broken was it really necessary to put me on Pitocin? No

Was I actually ready to push even if I had no 'urge'? Not sure about this one

Don't they (in the UK) get you to slow down as the head crowns so you DON'T tear? Yes

oopslateagain · 22/02/2011 21:07

Wow barely I just read your link. She is an amazing MW.

I am now fairly pissed off that I was obviously railroaded into the kind of birth that the hospital/MW wanted.

But I have a happy fairlyhealthy 13yo dd and no resulting physical problems so I will chalk it down to experience and not endlessly complain about the fucking bitch with her idea of the perfect birth Grin

OP posts:
berri · 22/02/2011 21:18

God I'm moving to USA soon so DC2 will inevitably be conceived & born there, your post has made me feel sick with nerves!

Doesn't sounds like a good experience at all, poor you :(

EdwardorEricCantdecide · 22/02/2011 21:29

I gave birth in the uk, midwife did break my waters but immediately before pushing so would have been 10cm anyway.
Thing that concerns me most is that they pulled your cord. In the uk they offer you a hormone injection after baby's born to deliver placenta quickly, u can refuse this though.
AFAIK if you pull on the cord it can cause severe bleeding or hemorrige (sorry bout spelling) and if you don't deliver whole placenta can cause infection.
I was told to stop wen head crowned but wanted it over and done with so didn't listen!

oopslateagain · 23/02/2011 02:12

berri bear in mind this was 13 years ago and it was my first baby so I had NO idea what to expect.

I'm sure that you will be fine. Just TELL them what you want - and make them stick to it.

They'll probably mark it down to the crazy English lady cultural differences Grin

OP posts:
fridakahlo · 23/02/2011 02:21

Berri, just do your research, know what you would like to happen but expect the unexpected and have someone with you who can question/ advocate for you. And be prepared for the lack of gas and air over here!
Do your research and find a midwife/obstetrician who you trust to be on your side and not just do things because "your at ten centimetres so now it's time to push!"
Good luck, hope it all goes well.

MadamDeathstare · 23/02/2011 02:49

This reply has been deleted

Message withdrawn at poster's request.

berri · 23/02/2011 11:20

DS was prem so that one didn't exactly go to plan either :o

Yes think I'll have to do a bit of research before ttc....

petelly · 23/02/2011 15:31

I had a brilliant experience in US with my second. I chose midwives who also do home births so hospital that they worked from was also (relatively) easygoing. I loved the one on one care that I got and I knew who was going to be at the birth (out of a group of 3 midwives - all of whom I got to meet beforehand during prenatal care). There was no gas and air as they don't use it in the US. Also, I was pushed a bit to consider a c-section because baby was big and I know in UK they don't do c-sections just because of size. But when I said I didn't want one (based on NICE recommendations), everyone was fine with it. Fantastic experience. :)

ihearthuckabees · 23/02/2011 15:54

I had a pretty rubbish time too OP, and it was my first (and only, partly due to the damage done by the birth!!). Haven't got time to post the details right now, but will try to come back and fill you in. Agree about intervention being over the top - wish I'd been more savvy too.

mathanxiety · 23/02/2011 16:20

Your experience doesn't sound typical at all.

You seemed to be progressing naturally and had got to 6 cm. My doctors and MWs wouldn't have broken the waters unless labour was showing signs of being slow, not progressing (it would be done to jump start things and not for no reason at all as the baby needs to be delivered within 24 hours of waters breaking due to infection risk). They wouldn't have set you up on pitocin as you were afaics progressing nicely and your waters had just been broken so they would have waited to see how you took it from there once your waters broke. And you probably didn't need the drip either. What your MW did sounds really bizarre and not explainable from a medical pov. Pulling on the cord sounds downright dangerous. Are you sure the person who attended you wasn't a janitor?

I had 5 babies in the US, 4 in one hospital with the same group of doctors attending and one in another hospital with a MW group. The first hospital (a university hosp) delivered 500 babies a month in summer, and doctors were trailed around by groups of medical students; I had a big audience for the delivery of DS (a midafternoon arrival) so some students could see a ventouse in action. Nice in a way to have a room full of genuinely happy people all staring at my rear end when he finally saw the light of day, but strange too... The second (a community hosp) delivered a smaller number but was close to a very deprived area so lots of sick and premature babies Sad, lots of CSs and a big NICU. MWs tended to deliver a lot of the care for 'normal' pregnancies and deliveries there.

I think getting a canula in for a drip is done in a lot of US hospitals, whether the drip goes in or not. They don't let you eat anything once you're admitted to L&D mainly in case you need general anesthesia for a CS or any other problem that might arise. My Drs and MWs also said no nail polish or makeup and this is for anesthesia purposes too, to enable visual monitoring. The saline drip might be needed for a long labour, just to keep you hydrated.

Shaving, enemas, etc., are all ancient history now I know someone who asked for an enema in early labour because she was mortified about pooping while pushing, and the nurses were very surprised. And a lot of women arrive at the hospital with Brazilians they have inflicted on themselves nowadays a friend who is an L&D nurse reported this to me (we are both a little old for this sort of malarkey, we feel, but many young mums arrive at the hospital bald as eggs).

One good thing about prenatal and L&D care in the US is that you will usually be attended at delivery by someone you have seen during your prenatal care, and even if you are primarily attended by hospital nurses, the doctor or MW will be there or thereabouts and will be reported to. Most hospitals have one on one nursing care while you're in labour. How good this is depends on the person involved. You can choose your medical professionals too, depending on insurance of course. Your choice of doctor essentially means you go to the hospital he or she has admitting privileges in though, so ask what hospital they have admitting privileges in before picking a doctor or MW.

A good few hospitals want constant monitoring during labour but this can be negotiated, as can things like your position during labour and delivery, what sort of pain relief you want, etc. You get the chance to talk with your med team before the delivery and it's important to discuss the whys and wherefores of everything that might happen, because things can change during labour, and a good deal of what your body does and what your baby's body does is outside of your control. DD1's birthing suite birth plan (with the birthing ball, pool, etc) changed when her heartbeat began fluctuating wildly and meconium appeared in my waters..

Go to prenatal classes in the hospital you'll be delivering in, not elsewhere, because the instructor will be familiar with protocols there and you can then discuss things knowledgeably with your medical team. Depending on risk factors, you can negotiate what you want. Ask especially about pain relief and whether an epidural will be available if you want one. (There is no shame in having pain relief during labour, and no shame in changing your mind either. You will not receive a medal for endurance. You will feel exhilirated and wonderful afterwards no mater what even if you have a CS).

Please remember if you don't want any particular medical procedure, you don't have to assent to it, and included in the definition of medical procedure is having a drip, having an epidural, etc. It's a good idea to have a birth partner who knows your preferences and will speak up for you, not just nod dumbly when the staff want to do various things. Your partner can dig in his/her heels and 'just say no'. The staff can't force you to have anything done that you don't want.

It's important to ask little practical questions like availability of valet parking when you go on your hospital visit. The woman who shared a room with me after DD3 was born hadn't known about the valet parking service, where you just wheel up to the emergency entrance, hand your keys to the valet and then they take your car off to park it, while you and your partner get taken into the hospital. This woman had ended up unable to walk any further on the 8th floor of the carpark and had to be rescued by paramedics with a stretcher -- her DH had to leave her and run off to find the carpark emergency phone near the lifts, and it all sounded horrific, as her baby turned out to be breech.

I have to say I don't get this 'US birth is over-clinical' thing, except in the case of the shunning of homebirths. My sister who gave birth in Dublin had a horrible experience from mean, unkind and over-stretched nurses who had a chip on their shoulders against women in general and new mothers in particular. She had a crowded and dirty ward, horrible loos -- I had two experiences of sharing a room with one other mother and baby, three private rooms with just myself and baby, and a clean and private, or shared by one other person, shower/loo each time.

With the exception of one psycho nurse, I found nothing but kindness and professionalism among the medical staff I encountered in the US for L&D with all 5 DCs. Practices vary among doctors -- mine had a horror of overdue babies and induced me based on calendar dates and estimated size, for DS, but I persuaded them to leave me to go into labour naturally for DD2.

pointythings · 23/02/2011 22:05

All I know is that I have a friend who was working on a US airbase local to me who chose to have her baby on the UK system because she didn't want to be railroaded into anything unnecessary - but I suspect there is a lot of variation in the US as there is here.

With DD1 I had my waters broken at 5cm because nothing was happening - it speded things up.

DD2 the waters still hadn't gone by the time I was pushing, the midwife had a look, told me breaking them would make the pain worse, I said no thanks, she poked gently with a gloved finger and they went, 90 seconds later DD2 was born. So breaking waters not always necessary.

petelly · 23/02/2011 22:19

The thing about the US is that you get more choice usually. I chose the midwifery group that I used because they were very non-interventionist and they worked at a hospital which was comfortable with their philosophy. They did ask me to put a canula in but I was happy with that as I think it can be life-saving if something goes wrong after the delivery like a post-partum haemorrhage.

And, yes, the facilities were wonderful. Private, clean room. Nurses who can't do enough for you. Edible food.

Although not so great when you get the bill at the end of it all....

Alimat1 · 23/02/2011 22:20

pulling on the cord is routine. controlled cord traction (CCT) is always used after you have been given the syntocinon/ syntometrine inj in your thigh immediately after delivery.
The vast majority of women opt for this. After the injection, you wait a small time - 5mins or so, and guarding the uterus with one hand, gently pull on the cord to get the placenta out.

some women opt for a physiological 3rd stage whereby the cord is left until it stops pulsating, and maternal effort is used to expel the placenta - this can take up to one hour.

If the midwife was pressing your tummy it sounds like you had a heavier than normal bleed/ PPH and she was trying to 'rub up' a contraction. this can be uncomfortable but is first line treatment for excessive blood loss.

apart from that - your care does not seem normal at all compared to the UK

mathanxiety · 24/02/2011 17:36

If she had no injection of pitocin to deliver the placenta then there would have been no indication for CCT though. The OP didn't mention having the injection.

My Drs and MWs encouraged immediate nursing partly in order to help boost oxytocin, induce afterpains/contractions, and deliver the cord (and partly for bonding), and did a little kneading and a lot of waiting for the placenta -- there was no hurry. CCT wasn't done my my doctors or the MWs unless there was an inordinate delay in the delivery of the placenta.

It meant you spent that time in the delivery suite waiting and no-one else could hop into your bed until you were completely delivered, placenta and all. Maybe speed in turning around the room was a priority for the OP's MW?

Alimat1 · 24/02/2011 17:49

Then if she did not recieve the syntocinon for the 3rd stage this could dangerous practice.

It is absolutely fine not to give it in a normal, spontaneous delivery. (ie no ARM/syntocinon drip)

However, when labour has been interfered with by performing ARM and using syntocinon for induce contractions, why would you expect your body to naturaly deliver the placenta following.By inducing you have taken away all of your body's natural hormones and influences and replaced them with artificial hormones. To then expect your natural hormones to expel the placenta is basically waiting for a PPH

In the UK our guidelines are to recommned syntocinon/syntometrine for 3rd stage if there has been any 'interfering' with the labour, to reduce the chance of PPHs
Obviously this is the womans decision and she should always be fully informed of both options and must give consent to whichever decision she choses and this is documented

mathanxiety · 24/02/2011 18:27

I received pitocin with DD1, DS, and DD4 (3 out of 5). With DD3 I went into labour with cervidil and didn't need any augmentation.

With DD1 I went onto labour spontaneously and pitocin was used to speed labour up when DD1 became stressed (heartbeat/ meconium) instead of opting for a CS as my doctor tried to avoid CSs as much as possible. I needed constant monitoring. She was born and the placenta was delivered within half an hour iirc, and no further intervention.

For DS, cervidil had no effect and I was induced with pitocin. He was born almost exactly 8 hours from time of induction, and the his placenta arrived about 20 minutes later, again with no intercvention.

DD4 -- cervidil didn't 'take' even after two insertions and induction with pitocin took place. Again no intervention to deliver the placenta, which arrived some time after half an hour, maybe 40 minutes after she was born.

No mention of PPH any time, and the immediate nursing was felt to be sufficient to induce contractions to stanch bloodflow plus encourage separation of the placenta.

'Why would you expect your body to naturaly deliver the placenta following. By inducing you have taken away all of your body's natural hormones and influences and replaced them with artificial hormones. To then expect your natural hormones to expel the placenta is basically waiting for a PPH' Not so. The body produces its own oxytocin in response to breastfeeding. Induction does not take away all your own body's natural hormones and responses. Depending on when it is administered, pitocin may just supplement the oxytocin. My doctors' and MWs' practices were to wait because failure to deliver the placenta and PPH are not 100% guaranteed consequences of induction.

As well as a prolonged third stage, risk factors for PPH include being Asian or Hispanic (Latina), aged over 30, having a bleeding disorder, having a forceps delivery following failed ventouse and a multiple birth.

Alimat1 · 25/02/2011 11:53

As I said earlier - it is not normal practice in the UK

oopslateagain · 25/02/2011 15:22

I know for certain I didn't have an injection after the birth but I still had the drip running - could they have put it in there?

The MW definitely did pull on the cord to get the placenta out, and it really did hurt - I guess when it 'separated' inside. Then there was mild panic with the MW and the doctor both kneaded my tummy - she mentioned heavy bleeding (she never used the word 'haemorrhage') and she said the kneading helps to stop it.

I also found it very very odd that they never once mentioned my 'bits' by name - vagina, vulva etc. The first time the nurse came into my room after the birth she asked if she could 'check my bottom' - I must have looked Confused because she asked me to roll on my side and lift my nightie, I did so, still Confused as to what my bum had to do with things. Then she went behind me, pushed my legs forward towards my chest and checked the stitches in my fanjo!

Bottom. Grin

This is the same hospital that tried to put an IV in my 2-day-old dd and blew veins in both arms, one hand and both ankles before giving up and putting the cannula in her HEAD, sticking it on with vast amounts of white tape. She went through her first week of life with what looked like a jaunty little white sailor's cap on her head.

I didn't have a choice of hospitals. We were with the military and had to put up with whatever we were allocated.

OP posts:
mathanxiety · 25/02/2011 15:29

Military hospital or one allocated for military use explains a lot.

My exMIL, for all that I loathe her, had an experience that sounded like hell on earth in one in Texas many years ago. She actually got puerperal fever while in the hospital.

If you ever have a chance to go to a 'civilian' hospital, take it, even a public county hospital.

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