Wednesday, March 8, 2017

What the hell do you do without the NHS? An English woman’s guide to having babies in America. PART ONE

No sooner did my Clearblue pregnancy test confirm I was pregnant with baby number one back in England, did I casually call my local GP surgery who promptly sent a lovely NHS midwife around to our home for a booking-in appointment.

I was given a detailed schedule of what was going to happen (which you can find here) and an abundance of baby-related reading literature and useful guidance from the midwife.

We discussed my choices; which hospital? The closest one, as the next one was hours away by car. Birth options? As I was still in my twenties with no medical issues, it would be a midwife led natural birth with pain relief if needed on the day.

There was nothing surprising about this as it was a story echoed by all my friends who already had babies and by those who were pregnant at the same time as me. It was a shared experience and in solidarity it all felt very familiar and safe. I was very comfortable.

Although in reality I had little choice, I still felt in control and like my care was in the safest possible hands. I never had to think about or question who would care for me and my baby during the pregnancy and beyond.

Midwife appointments, blood tests, scans, the birth and recovery. Everything taken care of under one roof by a single provider….. The NHS.

A truly unique and wonderful institution I realise now I completely took for granted as my pretty little newly pregnant brain was free to read the baby guides and fuss over nursery plans.

Over here in America it was a slightly different story when I got the good news from my trusty Clearblue stick. While I couldn’t possibly begin to explain the intricacies of crazy healthcare system out here, the first thing that struck me was the sheer number of choices women have surrounding their pre and post natal care.

There was no single phone call to get the ball rolling, in fact there were many, many fact finding phone calls. And no matter where I called, all calls started with the same robotic response from the receptionist; ‘You got insurance?’ Not even a courtesy congratulations.

Thankfully we do, and it must be good as the second question is always; ‘who with?’ Get these two answers right and you can continue to research your options.

Should you fail this test, I’m not sure what women do, does this account for why America has some scary birth rate statistics? Two women die everyday in the US from childbirth and 98% of these are avoidable. Shocking. Read more here.

I had also heard some horror stories about births costing women up to $10,000. I’m sure if you choose to go ‘out of network’ to a provider not covered by your insurance company then this is a very real possibility, a certainty if you don't have insurance.

From what I can gather all insurance companies work slightly differently and employers negotiate deals with insurance companies to determine how much their employees will pay for their health care when they need it.

In our case, the insurance company covers 80% of the bills, leaving us to pay 20% of them up until we reach a certain point, then it’s fully covered.

So far we’ve been out of pocket $100 for blood tests and $600 for ultrasound scans.

The system out here is I feel operated like a business and lots of healthy women are choosing to having c-sections. Birth is treated like a medical, clinical and frankly billable process. Your insurance covers this, so if you want it you can have it. A natural birth requires less intervention so is less billable, less money to be made.

Thankfully where we live in Brooklyn I was able to sign-up with some neighbourhood midwives who have delivery rights at our local hospital.

They follow a similar approach to the NHS. I plan to give birth at my local hospital under midwife care having a natural birth with pain relief if needed on the day.

Blood tests and scans are provided by two different medical offices with the results fed to the midwife. I have also had to select a pediatrician to look after the baby after the birth. Subsequently this has led to appointment juggling, paperwork and bills hassle which simply didn't exist in the UK.

So there you go, that’s the plan at least, but we know sometimes babies have different ideas. Stay tuned for part two of this tale after the birth in May when I can reveal what the care is like during the birth.

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