I had one baby in UK and one in Canada AMA

[zhaviva]

Just that really. I went though prenatal care and delivery in two different countries. I found it super interesting comparing the systems. If anyone else if interested, feel free to ask!

What was the best and worst aspect of each system for you?

UK:
Best. Giving birth in the comfort of a birth centre but with the peace of mind of being inside the hospital if anything went wrong. A had a fantastic midwife in the birth centre who delivered DC1 with much support and encouragement.
Worst. Nighttime antenatal care in hospital. DC1 was poorly so we stayed in hospital for five nights. Although we had some truly exception caregivers during that time, we also had some who were rude and uncaring. Multiple of these incidents (refusing help when requested, yelling at DH for doing something the day shift had instructed him to do -- and then doing it themselves two minutes later w/o apology when it became clear DC needed this particular care, etc) were at night when I understand the midwives/nurses might be on lower paid contracts.

Canada:
Best: antenatal care in hospital (only 36 hours with DC2) but I was totally shocked when the nurses were incredibly friendly and would do things like bring me a glass of water or a snack without asking (I wouldn't have dreamed ask for these things in the UK, as the hostility around asking for basic things, like help breastfeeding or checking DC1s responses was evident).
Worst - getting pushback on parts of my low intervention birth plan which no one had blinked at in the UK. I had opted for a doctor-led hospital birth in Canada due to convenience of location and had to advocate for things that I think would have been more expected if I'd 'opted' for a midwife led birth centre (you need to choose doctor or midwife care here). Also, being weighed at every antenatal appointment

Best of both: high quality care provided for free!!

Is is a bash Britain thread?

Not at all. I was really happy with the care I got in both places and I am incredibly lucky to have had access to high quality free public healthcare for two pregnancies.

I just found it interesting the differences in processes and care on the two countries. Why did I have to wee in a cup at every antenatal appointment in the uk? Why was I weighed at every antenatal appointment in Canada?

I though others might find it interesting too but I guess not. Oh well!

Did you see any C-Section after care? I have had two c-sections and was truly shocked after my first at how I was left straight after my section, in agony and on lots of morphine, to care for newborn twins. I did receive some help after asking (and when it became clear I could hardly bloody move) but I had to ask- it was not offered, or seemingly anticipated that I would need support. I am wondering how this is dealt with in other countries!

Did you find the frequency of appointments differed based on the country?

Was the Canadian system more in favour of intervention and maybe more cautious than the UK? (Maybe closer to how I’d perceive the US to be?)

Was your Canadian delivery completely free/covered by health insurance or did you have to make a contribution? Were there “extras” you chose not to pay for?

How long ago did you have these experiences? Because I don’t recognise the UK experience at all.

Uk was 2016. Canada was 2019. Both fairly recent.

The appointments were slightly more frequent in Can

Oops! Baby hit the post button :)

The appointments were slightly more frequent in Canada -- every two weeks in the third trimester and every week from 36 weeks.

Will come back to answer further once kids settle down

As far as more medicalized in Canada, I think that is right. The default here is family doctor or OB led care. Some jurisdictions have the option of midwife-led care, but culturally that might be considered 'alternative'. Ie, people who choose midwife led care are likely to get raised eyebrows from friends or family, or even have people suggest they are gambling with the life/health of their baby. The same is true for a lot of things that felt pretty normal in the UK like birthing pools, hypnobirthing, birth centres, or home births. For example, I mentioned looking at a birth centre in conversation with a colleague in Canada and she said that her baby would have died if it hadn't been born in hospital. This likely isn't true -- the birth centres in Canada have excellent safety standards and transfer to hospital at the first sign of complication, but the perception is there.

In this respect, I preferred the integrated midwife/consultant care in the UK. I had some complications and was followed by consultants until 32 weeks in the UK. I felt that if I needed the extra support of an OB, it was available, but most of my needs (such as regular ante natal appointments) were handled well by the midwives. The either/or system in Canada results in a lot of people opting into the doctor-led care who don't really need it (like me! No judgement ) which is ultimately more costly for the public.

The only 'extra' I had the option to pay for in Canada was a private room in the hospital post-natal ward. The default was a room shared by three new moms and there was an option to upgrade to semi-private (two moms) or private. I went private at a cost of C$300 per night (about 150 quid). Everything else was free, even a newborn hat, diapers and soaps for the baby (possibly a marketing thing...)

As far as C-sections, I had vaginal deliveries both times so unfortunately have no experience to share. Perhaps other readers with experience in Canada might

Interesting...in Australia I have to pee in a cup at every appointment plus get weighed. I think it depends on hospital. Midwife led team isn't considered alternative here. Sounds like a mixture between the two.

Me too! I had a baby in the UK in 2015 and Canada in 2017. I am also a midwife and was working as such in each country when I gave birth. I agree it is fascinating to compare the systems- both as a patient and as a care provider. I often say that I wish I could combine the best aspects of both and create the perfect maternity care system!

That's fascinating PhoenixBuchanan

What were you experiences as both a patient and care provider? What elements would you pull from each system if you were to build a perfect one from scratch?

Well @zhaviva, I had midwives here in B.C. and the model of care is amazing for women- true informed choice and continuity of relationship.
I had a decent experience in the UK too overall, but my pregnancy there went a bit high risk and I was not happy with some of the management.

I think that if you are low risk, the UK is one of the very best places in the world to give birth. There is true choice of birthplace and low intervention. Unfortunately if you're high risk it becomes more "conveyor belt" whereas in my experience in Canada, the care we give is a bit more individualized. Of course it depends on where you are in the country and whether you have a midwife or doctor.

I think Canada is a little behind the times on some aspects of care- giving baths to babies for example 🙄 and generally over the top with screening, testing and intervention. I agree with you that it is definitely better in terms of patient care in hospital! The staffing levels are much better as well as the general attitude to looking after new mums and babies.

Urine sample is recommended and gold sta
Date. Checking for protein in urine which can be associated with renal disease/pre eclampsia, white blood cells and nitrates which are a sign of urine infections including GBS and E Coli, and glucose in urine is a sign of diabetes.

Weighing at every appt is not a necessary procedure as there is no ‘recommended’ weight gain as everyone is different. Uk uses booking weight.

Also just to mention, your night staff midwives are being paid more than day staff 👍 however they are more poorly staffed. Eg. During the day my postnatal ward has 5midwives (4 clinical - 8 women and 8 babies each and 1 midwife in charge), 2 health care assistants and possibly a nursery nurse. On the night it’s 4 midwives total and 2 health care assistants. Most babies are high risk of PN ward so hideous amount of intravenous antibiotics, observations sometimes hourly. Plus the breastfeeding support, ill women due to medical co-morbidities, discharges, visitors... before any general niceties. Cinderella service for such a vulnerable time. Most midwives hate working on Postnatal ward as they can’t provide the care they want or need to 😔