Would there be more medical intervention over here if the NHS had better funding?

[thecakeisalie]

I'm watching a US show about delivering babies and it never ceases to amaze me how routine medical intervention is over there. It seems rare to go through labour without an epidural and c-sections seem a lot more common. Also they start induction earlier than we do and don't like women going overdue at all. I'm not sure how wide spread this kind of care is across the US but from what I gather the rate of intervention is much higher over there.

Do you think it's literally just a funding issue that means the NHS push for natural delivery with limited pain relief? Personally I'm glad they do because I feel where possible an intervention free birth is ideal and after being pushed to have an epidural with DS1 simply because of raised bmi I have experience of how this can lead to more intervention (epidural stopped contractions and they had to induce my labour with a hormone drip/break my waters to get things going again). Obviously I'm not suggesting intervention is a bad thing in all cases as it can be life saving but I feel watching this show they really over use it.

Could look at it the opposite way - in the US individuals or insurance companies pay for the interventions, so it's in the hospital's best interest to try and bump the bill up as high as they can!

Personally I'm horrified how medicalised birthing has become in some countries. C-sections and epidurals have become the default for no specific reason in the majority of cases (of course sometimes they are necessary). Read- Ina May Gaskin, Marie Morgan and Grantly Dick-Read; for a refreshing view on natural child birth. Well Dick-Read is the pioneer ;)

i think its swung too far the other way in the uk. pushing people into having natural births with no consideration of the mothers mental wellbeing in some cases makes it a very cost (or seemingly so) driven policy, wrapped up in natural being best.

The best way to have it is a balanced system where all ways to give birth are given equal merit and consideration. The us has one extreme we have the other...

I know what you mean RockChick about the hospitals wanting to make money. Its just that the doctors on the show really seem to believe that intervention is the best course whereas over here our midwives are much more pro-natural labour where possible/ideal. It makes me glad things are the way they are but also made me wonder if things would be different if there was more money available, would consultants prefer higher intervention if they had their way.

DirtyDancing - I will look up some of those as I'm really hoping for another natural birth this time. With DS2 it couldn't have been more different with very quick pushing, limited examinations and no epidural! I would rather go through the pain but be active and be able to feel everything. Feeling that overwhelming need to push was the most bizarre but satisfying feeling.

Also why do they feel the need to do so many internals all the time?! Glad it's not just me who finds it a bit strange to watch because it's so different to the way we do things over here.

peeapod I do know what you mean. I've only experienced unnecessary intervention with negative results myself but for example I have heard of women being pushed to go without an epidural when they are certain that is what they want. It is interesting to think how much of that is to do with funding rather than the fact that it can have negative effects on labour.

As you say it needs to be a balance of choices. On the whole though I think I prefer our system to the US one, obviously all systems have room for improvement.

It's old, but you might like to see if you can find a copy of Jessica Mitford's 'The American Way of Birth'. It has been much more medicalised there than in UK for many, many decades now

i'm not sure that 'greater readiness to intervene" = 'better care"

All births are NATURAL.

Whether babies are born through CS, with pain relief of whatever type, with the help of forceps or vaginally in a birth pool.

One is no better than another. Just different. And personally I abhor this idea which does nothing except make some mothers feel guilty, incompetent and as if they have failed. Just so that some people can feel superior in some way.

I think of it a different way...if the NHS had more money for maternity services, there would be more midwives, more maternity support workers, more breastfeeding supporters, more bottle feeding supporters, better peri and post natal mental health services, better ante and post natal care, more maternity wards with better equipment allowing you to give birth the way you want to, more community based midwives so you could have a home birth and be attended by the same midwife you saw for antenatal care, the same midwife for all your antenatal care...I could go on, but my point is, there wouldn't be more interventions in birth, but generally better care before, during and after birth for everyone that could actually reduce not increase interventions!!!

Stevie77 - no need to be so picky over the language being used in this thread. I am not suggesting one style of birth is 'better' than another or that we start issuing badges of honour. I am merely asking the question of would more intervention be seen as a good thing if the nhs had more funding. Also I am not in favour of Doctor encouraged unnecessary intervention, not intervention required for medical reasons. No personal justification or guilt required!

mrsannekins - wouldn't that be nice if we could have all those things! I was just curious if rather than them putting funding into that they would just put it in to pushing for more intervention like the US.

Stevie I think the term "natural" is being used here as an opposite to "medicalised" as opposed to "natural vs unnatural" which could be taken as offensive. I don't see how you can be offended by what has been said here!

natural is a whole lot better than normal.. which is the language of choice on the nhs website.. drives me ... grrr

you want more medical intervention?

personally i want whatever the mother wants not what the nhs consider in their best interests..

Certain pain relief used in the Uk isn't used in the states, like gas and air. Also, injections of opioids are also less common. Yes, the epidural is far more common there (2/3 labours as opposed to the 1/4 here), but it would be a rare thing to see a full epidural rather than a walking or mobile epidural, which is less widely available in the Uk, probably due to staffing restraints as an extra person is required to monitor you as you are moving around.

As far as forceps and ventouse, only 5% of deliveries in the states end up being done with those, but it's 13% in the UK. Of course, the csection rate so 30% in the states compared to the UK's 24%, but then... Whose to say whether those are planned or emergency (which would explain the lower assisted delivery stat)?

I don't know that I agree that completely natural is best, it's whatever each mother wants. Modern medicine makes sake pain relief available to us and if we want it, it's there.

I think the bigger issue with the states is that some women acre pressured to be induced earlier than they should be, or pressured into having a c-section when they don't need them. Apparently 11% of sections in the states are medically unnecessary! That's ridiculous.

Sorry, sidetracked a bit there. I think if the mat service had more funding the better epidurals would probably be available everywhere. In that sense, it would be more medicalised.

I think more staff would mean more time and energy devoted to patients, and that would mean better communication, more informed mothers to be, and overall more satisfaction.

It's a whole mindset. It's not just confined to obstetrics. Things are culturally completely different in the US and the fact that it makes money for health insurance companies is a big driver.

Eg after your baby is born they would automatically have a whole programme of checks with a paediatrician for the next 3+ years which would only happen here if something was actually wrong. They don't have much of a GP system in the states. You see a specialist for everything.

Personally I prefer the British way but that might be because I am British! Having lots of checks and investigations of healthy people is basically screening them for disease. There will be a certain false positive rate which adds up to a lot of unnecessary investigation, cost and worry over a whole population.

The outcomes of US healthcare vs the expenditure show it is very poor value for money overall. There is definitely such a thing as too much medicine. Unnecessary intervention has clear harms. I am not in the least bit jealous of US drs or patients. I genuinely don't think that most UK drs have their treatment decisions affected by funding apart from maybe some very specialist cancer drugs.

thecakeisalie but the language is the issue as it conveys so much.

Anyway, the issue with the states is totally different and I don't think you can conclude, based on it, that if the NHS had more money to spend on this part of it it would lead to more intervention. One of the reasons for higher rates of intervention in the US is, as has been mentioned, the structure of the health system and the involvement of insurance companies. Hospitals have a clear financial gain to make if they carry out more procedures, use more resources. Second, the higher rate of intervention is also due to medical lawsuits. Doctors would try to avoid a situation where they could get sued if something goes wrong, hence more intervention.

I don't think that if the NHS had more money, any of the above would happen here unless things would change dramatically i.e. how the health system is run.

Mamadoc I don't prefer the UK system over the US system (I'm not US but have a fair knowledge). Things have gone too far the other way in the UK. Actually, kids SHOULD see paediatricians and not GPs. Children are not mini adults and medically, are totally different. There is a very good reason for this medical specialism. There should be more developmental checks here but due to funding there aren't. Not because it's not needed. Big difference. Just like there is no recommendation for vitamin D and Iron supplements for babies because if they do they would have to subsidise it.

Also, the way some GPs are here - not up to date with advances and medical research/recent knowledge, is far from ideal.

The system in the UK is far from perfect and far too driven by cost cutting (understandably) and penny pinching. Personally, I'd rather pay the NHS a supplement and get a better funded system then not and have to put up with a third rate system which drives many people towards private medical services.

Having lived in the states, it's not just all specialists, I had a family doctor (GP), and if I wanted a specialist I needed a referral. Aside from paeds anyways.

In Canada it's similar. I saw a paediatrician until I was about 13, not a GP, and their system is similar to the NHS in that it's free. And it's also common to be under the care of an obgyn during pregnancy, though midwives are around, just not as common.

I'm a specialist Dr in the Uk so clearly I need to acknowledge my bias but I really don't think patients in the UK get a bad deal from seeing a GP rather than a specialist routinely. A GP often has a relationship with a patient or a family over a long time which is really invaluable.

GPs do have paediatrics training of course which is quite adequate to a routine development check. My paediatrician friends don't want to do routine checks on a lot of normal babies and children either. It would be a waste of their skills. I don't quite get why children and pregnant women are a special case but people with other conditions can be seen by a generalist.

In my own field I don't want to be swamped with people with minor illness who could easily be treated by their GP. It's more cost effective for me to just see those people who are more seriously ill or fail 1st line treatment.

I really don't think our system is all about saving money or doing things on the cheap. For one thing it's not very cheap. It costs a big proportion of the total budget and we spend about European avg on healthcare ( way less than US though). That is spending from all sources public and private. The last Labour gov Increased spending on healthcare and although I don't agree with all their policies they did dramatically cut waiting times which were bad in the past.

SaggyOldClothCatPuss - no personally I certainly wouldn't want more. I loathed the intervention I was pressured to have as I feel it just leads to more. This time I want a home birth with limited examinations and to be left to get on with it. I was just curious as to whether in the US they genuinely believe intervention is the safest way and if so would we end up going down the same road.

Stevie77 - as always discussing childbirth is an emotive subject I apologise if the language used has offended you, it is difficult to know what terms to use to encompass a certain type of birth. What I was trying to say is my choice of language was not meant in a judgmental way.
You've got a very good point there about lawsuits I guess dr's over there are less likely to have a wait and see attitude for fear of things going wrong.

I think I'm coming to the conclusion that we have a different approach over here that's not just based on funding. Hopefully better funding would be used in the way mrsannekins listed.

I hadn't even thought about the differences in healthcare for children and babies. I'm not really sure how I feel about those differences. I do think the GP's are under a fair amount of pressure to be the front line with such short often rushed appointments. Although I'm not sure I'd want to see a specialist straight away either.

I'm from Germany and I prefer the specialist system we have - you have a family practitioner and see him for day-to-day niggles and aches and sometimes he would refer you.

But you don't need a referral, you can make an appointment with the specialist if you need to. If I lived back home I'd have a OB/Gyn that I am familiar with because I would go for my smear test with him once a year, and he'd be the one who would do most check-ups during my pregnancy - not like here where I'm only 4 months along and have seen about 3-4 different midwives by now because you get sent from pillar to post.

Once baby is born there are a few more standard things that get checked for every couple of months just to make sure baby's development is ok - there are 7 examinations running up to 24 months and then 4 more until the child is 6 and starts school. Most of the time you'd go to your child's paediatrician for that.

All this doesn't mean that there's necessarily more intervention during birth, though - Gas and Air hasn't been used since the 70ies and in general it is all about childbirth without too much intervention and pain relief. You can get a PDA/Epidural, and walking epidurals are now available, but a lot of woman choose what we shall call 'natural' for the sake of the argument.

I do believe it depends on what system you're used to, though...

Stevie I completely agree. I'd happily pay a supplement for more services. I'm sure lots of us who can't stretch to full private care would pay extra to move a step above the close to minimum that's offered. I just want an option that's neither the baseline nor full privatisation. I want more choice and I want options presented to me so I can make informed decisions- not to be told what I'm getting like I'm a child.

I'm from UK but going to be giving birth in France in March. Did a lot of research thinking I'd be in UK system, and had to re-learn how different it is here; there are some US parallels, although the health system is a mix of state-funded and private, most people have to get top-up insurance because state doesn't refund everything.
Traditionally France has also been highly medicalised, with something like 90% epidural rate at many hospitals. But it's usually for lack of other options, despite some recent improvements in choice. Gas & air still not available in some places due to fear it might damage the baby, neither pethidine, and you would be VERY lucky to have a water-birthing centre near you.
This means women are still sometimes left the choice of epidural or no pain relief at all, which clearly might lead people to more medicalised outcomes, especially as the traditional birthing 'style' is often "flat on your back + stirrups" (they still apparently try to do this during pushing stage).

My hospital is very proud of the fact it encourages movement, has birth balls, music and aromatherapy, but they still want to do internals every hour, physiological 3rd stage is frowned on, the labour room is very clinical-feeling compared to many UK places, and I've been told that pushing will mean lying down (that's what THEY think!).
Also, homebirth here very rare because the midwives have to get their own insurance to do it, too expensive.
Personally I would like to at least have the choice of trying for a non-medicalised birth, and I think this is where the UK is right (at least in policy if not practice).

Interestingly enough I've just started reading a blog by a German midwife and the consensus when reading the comments is that most women regret being seen as a 'patient' and not just a pregnant woman, and that they would prefer a more relaxed approach.

A friend of mine had too much amniotic fluid and now has to go to her gynae twice a week for a CTG - even after the hospital said everything was fine after her next check up and said the CTG can be reduced to once a week, her gynae refuses so she still has to trudge in twice a week and work up the time at work in the evenings.

I work for the NHS and "natural" non or little medicalised births are a target, because simply that fewer interventions are seen to be less risky. I also believe that if the NHS had more money services would be better. Of course if we had a system in the US model with insurance etc it would be more medicalised.