American Mums - giving birth US style - what can I expect??

[AnnieLaurie]

I am shortly moving to Seattle and will be giving birth there to my second child.

I have spoken to a few American Mums over here and it seems that midwives do not feature in the States as they do here.

Can anyone tell me a bit about what the care is like in the States/any advice on what choices I may have etc regarding childbirth. Would love to hear some people's experiences.

Have visions of self strapped to a bed with feet in stirrups and lots of men in white coats...!! Do they let you move around as you wish? Do they leave you alone, or examine you all the time? Are they into natural childbirth??

Had quite a bad experience 1st time round with unsympathetic male midwife so am anxious to have nurturing, supportive female environment 2nd time round if poss.

Thanks!

Well Annie that depends. You should definitely mention that to your practitioner, and get them to sign you off a little early. Generally here it's two days for a vaginal delivery and 4 for a C-section, but that varies by hospital.

Will you have any support system when you arrive to Seattle or are you guys on your own? Look into a birth and post-partum doula in case you need extra support.

I had my first in a hospital (he is 22 now) and it was a horrid experience.
My other two were through midwives...a wonderful experience.
Check and see if there is a midwives association for your state and ask to visit.
I know our midwifery allowed visits (with the mothers permission) to see how things were done.
I had people strolling through after each birth (they always asked if it was okay first) and hopefully it relieved the stress of the new mothers. We were released to go home after 4 hours, with the hospital stay it was four days (again horrid because you couldn't really bond with the baby).
My experience was that you could walk about, birth in a bed or hot tub (that relieves much of the birthing pains extensively) and they were very comforting. Good luck on this and let us know how things go.

I couldn't wait to get out of hospital.

I had my baby around 10pm on a Sunday night and they had no food for me! No tea and toast .

I had to wait until the paed saw us around lunchtime next day before they literally wheeled me out. I tried to tell them that I wasn't an invalid but they would have none of it.

During my stay, I had people check on me every hour, which doesn't make for a good night's sleep.

On a more practical level, check your insurance to see what you will be entitled to. Some policies include midwives, some so not. Also depends on whether you're in an HMO etc...

Our insurance paid our midwife bill because she worked out of an OB's office - ie we paid the OB and he gave her a salary.

You should be okay as long as you go with midwives and stick to your guns about what you want and don't want. If you absolutely must use an OB, interview them carefully before deciding and try to talk to some other mums who have delivered with him/her to see if they lived up to their word. I've heard so many women say their OB was on board with all of their plans for a natural birth and then at the very end totally switched sides on them and started playing the 'zomg, we have to induce now, your baby is HUGE (8lbs) and do you want it to die?!' card and pressured them into inductions, epidurals, planned c-sections, etc...

Just be very careful and selective, know your rights and make sure your birth partners are on the same page. Good luck!

Oh dear, the more I hear from you all, the more anxious I am getting!!

MKG - we will have nobody we know when we move over, except a few of DH work colleagues. I will be relying on getting to know people/make friends from moving in Oct to giving birth in Jan - that is not a very large window for relationships strong enough to look after your children for a day or so.

Oh, I just want to stay in Edinburgh

from what you are all saying, I hope Oct will be enough time to look for/book a midwife in time for Jan.

Thanks everyone though, for your words of wisdom!

I'm American and a registered nurse who has worked in both the USA and the UK. I have also given birth in both places. USA is safer hands down. They have better staff/patient ratios for instance and better facilities at the hospital. Those two examples makes a huge difference and massively increases your chances of a good outcome.

When I gave birth in the UK there was only one midwife and one HCA on the post natal ward. There is no way 2 members of staff could care for all those women and babies.

I gave birth at 11PM at night and was only checked once in the night for bleeding and vital signs. Scary shit. You should be checking a new mum every hour unless you want to end up in front of a judge. But they were so short staffed that it would have taken them all shift to get to each patient once.

Christ sorry about the grammar and typos.

Hi Vian - but would you agree with other's comments that in the USA they tend to be very quick to go down the medication and assisted delivery routes rather than going with the natural flow as dictated by the mother?

I just want to be in the presence of a sympathetic and caring midwife/nurse, who supports me and tries to steer things down the natural route, rather than being rushed into medical procedures. Will I get that in a standard Seattle hospital?

My DS was a fairly quick birth, with no painkillers so am reluctant to be pushed into any kind of intervention since I have done it once all by myself.

Annie, it varies so much from State to state and even from hospital to hospital so it is hard for anyone to tell you what to expect. Research your options.

I gave birth at a teaching hospital in the US with no midwives. My local hospitals are known for having a high c-section rate (from 50% - 75%) and, being teaching hospitals, I was expecting a lot of interventions and examinations. I had a birth plan but didn't need it. I was lucky that I had a relatively easy labour, delayed going to the hospital as long as possible. I had to be very firm about not wanting pain relief or pitocin or anything. There was a nurse with me almost the entire time and an OB delivered DS which is normal practice here. The birth itself was ok but I would prefer to have the option of midwives and not delivering in a hospital but here that is not possible. The worst bit was being woken up every hour through the night to have my BP and temperature taken as if I were ill.

Come join us on the thread Dooney linked to.

Look at it this way. If something untoward happens to you or your baby then the nursing staff and medical staff are possibly looking at loss of jobs, professional registration, criminal charges, finanicial ruin...

In the UK, they would get in trouble but it wouldn't be quite as bad. The NHS is non-interventionist because they are stingy. I work for an NHS hospital. They tell people that this isn't necessary and that isn't necessary etc etc. They are trying to save money. People get hurt.

The docs and nurses will do what they need to do based on their knowledge and experience to ensure that you and your baby are safe. Sometimes this means that medical intervention in required. If they do not need to go down that route then they will not because it is a lot of extra work. I have seen a few women and babies in the UK die because they are so reluctant to be aggressive (i.e.cost cutting) here.

This is my opinion based on what I have lived and seen anyway.

At the end of the day it is going to depend on the particular hospital, the staff on duty, and what happens during your delivery.

'The NHS is non-interventionist because they are stingy. I work for an NHS hospital. They tell people that this isn't necessary and that isn't necessary etc etc. They are trying to save money. People get hurt.'

I can say that about several insurance providers and HMOs in the US.

Or Medicare and treatment of Medicare patients in some US hospitals, the result of which has nearly killed my father twice, the most recent of which was a couple of weeks ago.

The infant mortality stats are high because of lack of insurance. As the OP is married to someone who will probably have a job that gives insurance this won't affect her.

I work in the NHS and see people die all the time because of short staffing, missed opportunities, rushed assesments and cost cutting. But do you know what ends up on the death certificate? Old age. Pneumonia. Sepsis.

That's not to say that I think the USA is a bed of roses and the NHS is not. Far from it. Both systems suck for a lot of people.

They have birth centers staffed with midwives only in the USA. They did in Pennsylvania anyway. These birth centres were like little houses away from the hospital (but on the grounds) with comfy rooms. Very homely. But it was on the grounds of the hospital so if it all went to hell they could get you sorted quick.

I don't think Pennsylvania is alone in having facilities like that.

Oh no, turniphead, you have just taken away the one glimmering light I had - No gas and air??

Well, can I get a dentist to deliver the baby?

I had no pain releif with DS1 because he was so quick that by the time they got me a room and examined me he was coming out!

I have always thought that if I can manage it with nothing 1st time round (and cope with the excruciating pain etc), I could def do it again, with the help of harmless Gas and Air.

Think might tell DH to stuff his new job and stay put...

Yes insurance companies can be stingy but here it is the whole system that is stingy from the top down to ward level. My ward sister cannot even get them to approve her buying soaps and flannels on budget. The nurses supply it all When I worked in the USA we could work our way around insurance companies sometimes to get people what they needed. Basically we lied or borrowed. Here there is nothing you can do.

Horses for courses, Vian. I loathed the hourly checks when I had my baby in the US. What I would have valued would have been a nice cup of tea, a bit of colostrum into baby, and then tucked in for a 3-6 hour sleep.

When you give birth, it is physiological to have a decent sleep for both mum and baby. The American medical system does not respect this at all.

In the UK, midwives are supposed to keep an eye on you for two hours, and then let nature take its course. The UK system may fall short, but at least the intentions are good.

The UK is non-interventionist as default not because it is stingey, but because it is more holistic. When you move away from treating a family with new addition to an amublating pelvis, you get more interventionist.

The NHS non-interventionist?
Whence therefore the thousands of MN posts about unwanted exams, fetal monitoring, cascades of intervention, unwanted inductions, refused homebirths not to mention unpleasant MWs, dirty wards, shocking postnatal support etc?
Anyone would think everyone here in UK had a great birth with fabulous laid back natural birth guru MWs. A lucky number do. But that doesn't sound like our NHS to me. Certainly not in London!
The US system may have its drawbacks but you are a private patient and if you know your stuff, nobody can force you into things. Personally I have opted for an obstetrician-led model myself here in the UK with total continuity of care as I simply wasn't happy enough with the midwifery care I received with my first baby.
Both systems have advantages and disadvantages and I don't think the OP should be unduly worried - you obviously know what you want and don't want, so fight for it (or get your husband to!)

You could have bleed to death and died in your bed if not for those hourly checks. That is why they do them. It is a small risk but it happens when people are not checked. If you ever saw a woman hemorrage to death in the night after giving birth (first check was deemed okay, dead 3 hours later after not being checked for a few ) then you would check them every hour too. The staff would rather be in the snack room watching telly believe me. Checking people every hour sucks.

We usually check people's blood sugars in the night. Had one patient who refused to have hers checked between 9PM and 8AM. We all told her this was a bad idea and explained why. She did not want to be woken up. She hypoed out in the night and died. Family sued. Nurse got sacked even though is was documented that patient refused to have her blood sugar checked at night.

The center I was thinking of was in Bethlehem, Pa. It was there in 1999 when I trained as a nurse anyway.

You could have bleed to death and died in your bed if not for those hourly checks. That is why they do them. It is a small risk but it happens when people are not checked. If you ever saw a woman hemorrage to death in the night after giving birth (first check was deemed okay, dead 3 hours later after not being checked for a few ) then you would check them every hour too. The staff would rather be in the snack room watching telly believe me. Checking people every hour sucks.

We usually check people's blood sugars in the night. Had one patient who refused to have hers checked between 9PM and 8AM. We all told her this was a bad idea and explained why. She did not want to be woken up. She hypoed out in the night and died. Family sued. Nurse got sacked even though is was documented that patient refused to have her blood sugar checked at night.

The center I was thinking of was in Bethlehem, Pa. It was there in 1999 when I trained as a nurse anyway.

I feel like you are patting me on the head and saying 'there there, Mrs Ambulating Pelvis. Do remember to leave your brain at the door and listen to what the good doctor tells you (for his own benefit'

I think patients should be allowed to do what they want...i.e. refuse treatment and refuse nightly checks etc but it should be documented and the staff should not have any comeback whatsoever when it all goes wrong.