In our first few months here we’ve had a number of interactions with the UK’s health care system. Several of you have asked how we like it, so I thought I’d share a bit about how we’ve found things so far.
One thing I knew I’d like in coming here is the emphasis on using midwives for “normal” women’s health and baby delivery. I have nothing against OBGYNs, but I don’t quite see the need for specialists who are too busy to spend real time with you when experienced midwives may be able to provide more sustained care. We saw that during our stay in the hospital, when we had the continuous help of one of the midwives on duty (she was great!), but then, when she wanted to bring in a doctor to double-check something, we ended up waiting many, many hours for him to make his brief appearance. So yeah, midwives are good by me, as are other experienced technicians and such, particularly when, as is the case here as well as the US, there are constantly problems with being short-staffed.
There is also a tendency for you to get more in-home visits here, particularly after a child is born, which I think is a GREAT idea. Unfortunately, again due to staff being short (and Nathaniel’s visit days happening to fall on weekends), we have been regularly asked to come up to the hospital for quick check-ups instead of getting in-home visits. After wringing my hands a bit, I finally decided to just politely decline to do that and, when asked, explain that my child risked more exposure to accident and infection in hiking up to the hospital than he would in not getting check-ups every three days.
Throughout our stay I’ve found myself repeatedly declining care because I didn’t like the terms or felt that tests and such were not adequately explained to me before they were ordered. We found the same to be true in the States with Katherine, but here we’re not surrounded by Ithaca hippies who may share our reluctance to simply follow orders. I’m dismayed that there isn’t clearer communication between patient and care provider, and that one has to assert “no” before the options become clearer. And, to be honest, I don’t like being put in a situation where I feel like my forceful side is being encouraged to come out; as my family members can tell you, I have plenty of that in practice already!
Since health care is institutional on a larger scale than I’m used to, I’ve found that the one major drawback to the system is the constant handing off of care from one doctor/midwife/nurse to another. You are given files to carry around, and then each new visit with a new physician means a bit of reading on their part to catch up. I like having my files; I’m one of those people who Googles terms until I have a good sense for the medical shorthand and the results of each test and visit–a much better sense, in fact, than I get during the visits themselves. But what I find rather annoying is that having multiple providers simply shows me how subjective much of the medical care can be. Some people hold rigidly to the guidelines; one midwife went into a panic when my pregnancy bump measured small (yes, Nathaniel, you’re too small at nearly 9 pounds!), and immediately took up a refrain of concern and the need for much further testing to be sure the baby was okay. I could have wrung her neck, knowing how easily such sounds of alarm can haunt a pregnancy, even though, second time around, I was a much less anxious pregnant woman. But I saw a doctor one week later who laughed, told me she herself had measured even smaller with her kids, and congratulated me on what she was sure would be a sizable baby. Again, such different viewpoints leaves the individual patient with a lot of responsibility for making decisions about tests and who to consult–and when to say yes and when to say no–that I didn’t expect to be part of going to the doctor.
Yesterday I got a visit from a midwife. We ended up having a very short visit, standing in my doorway, with her scanning my files and firing off questions. Nathaniel was born facing the wrong direction, which makes for a more painful labor, so that earned a warm squeeze on the arm from her, as did the speediness of the labor (always funny what they find interesting when reading your case notes!). A quick look up and down at me (I apparently just look healthy?) and she was off. Today, on the other hand, we had a “health visitor” who stopped in for a longer visit to inquire how home life and the newborn and older sister were doing, letting us know of various children’s services in town, giving me good information about medical norms in the UK for early-childhood care, etc. Very different visits, and both part of the UK’s attempts to provide lots of opportunities for early-childhood trouble to be caught, and for new parents or parents whose newborns are struggling to get advice and encouragement. Thus far Nathaniel’s giving us very little to ask about, since he’s eating quite well (apparently 10 pounds on the dot today) and acting like a perfectly normal newborn.