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spires from Carfax

a pregnancy with the National Health Service

Books + Ideas — April 2013

When you spend five hours in A+E (Accident and Emergency) to get something looked at, or have to wait two hours after a scheduled appointment for an ultrasound, it's easy to get frustrated with the National Health Service (NHS). But one of the other sides of that is having access to an obstetrician and assistants, an anaesthetist, paediatricians, and assorted midwives for the delivery of a premature baby.

The medical checkups ramp up only slowly in the regular course of pregnancy. And even labour and delivery are regularly non-medical: nearly half of women here give birth in the Spires midwife unit, with no doctors and no instrumentation or other intervention, and some of those women are home within four hours of delivery.

But things didn't go so straight-forwardly with us. Camilla had two one-night stays in hospital with concerns over high blood pressure and pre-eclampsia risks. And then her waters broke one morning early in the New Year. We went straight up to the Maternity Admissions Unit and she spent the next twelve nights in hospital, until both she and the baby were ready to leave.

The quality of care was pretty impressive. We only had one intern who left a bad impression: he didn't know how to take a blood pressure measurement (!) and when he wasn't sure about the diagnosis he pretty much asked us what we thought it should be (on that particular subject I could actually have told him, but eventually he had the sense to consult a registrar). The anaesthetist and obstetrician were efficient and reassuring, kept us informed as to what they were doing, and in the obstetrician's case found a balance between maternal and foetal distress.

But it was the midwives who handled the actual labour and delivery who most impressed me. (A special thank you to Claire, who got Camilla through the worst part of the labour, and Jenny and Maria, who saw us through to the actual birth.) The midwives pretty much managed everything, even making the decision to delay the entire syntocinon induction while waiting for an epidural. They consulted the doctors outside the room, and the anaesthetist and obstetrician only came in when necessary. Obviously it would have been nicer not to have had the canulas and IV feeds and monitoring equipment, but then it would have been nicer to have had a forty week pregnancy and no concerns about pre-eclampsia, too.

Camilla recovered remarkably — within five minutes of delivery she was back to being herself again — but had to stay in five days post-delivery for monitoring of her blood pressure and stayed longer than that to look after Helen. Born just before 35 weeks, Helen was premature and "poorly" at birth (a 1 minute Apgar score of 6) and though she recovered rapidly from that and was a respectable 2.6kg she then had jaundice, so she ended up spending eight nights in hospital.

All that must have been staggeringly expensive. One nurse mentioned that I was saving the NHS £10 every time I washed a pair of the support stockings which Camilla was wearing to reduce the risk of VTE, but that will pale into insignificance compared to a fortnight's bed care, five nights in a nursery, and a couple of hours time for an anaesthetist, plus everything else.

But not only did we not have to pay anything, we never saw anything even resembling a bill. There are some "amenity" extras one can pay for: prints of ultrasound scans, tv access when you're in a ward, and private rooms at around £500/night. And early on in the pregnancy we had a few extra ultrasounds done at a private clinic. There's also a little bit of advertising floating around: "free" packs from drugstore company Boots, advertising for baby photography in the lift, and so forth. (Something the hospital doesn't offer is wifi, though perhaps they assume people who really want that would have mobile Internet of some kind. Fortunately as Oxford University staff Camilla and I both had access to high-speed wireless.)

The lack of billing helps make NHS medical care genuinely universal. While not all UK hospitals are as good as the John Radcliffe, that's certainly the goal. Private hospitals may be shinier and more comfortable, but there would be only a tiny number of those that actually offered the same quality of care and anything difficult or complicated would in most cases be handed over to the nearest specialist NHS unit anyway. So 99% or so of people in the UK receive basically the same medical support in childbirth. Of course the infants involved then go home to vastly different circumstances, but there's quite a decent range of post-natal support services as well. "Equality of opportunity" gets more than lip-service here.

There's a lot about the UK National Health Service that could be improved, as with any huge complex organisation, but it's clearly more efficient than the US alternative and for most people I think clearly better.


  1. I read this with interest, since I live in Sweden, which has an entirely government-run health service (ie. almost no private medical practitioners). I can tell you that, from your description, things are better in the UK than here, as well. Once you get to a doctor things tend to go okay more often than not, but getting to see one is a major undertaking, and frequently unsuccessful (there are no doctors to give you a referral). I am yet to even get a doctor to agree to an x-ray, in spite of the fact that both my chiropractor and my chiropodist think that it would help diagnose my leg problem. On the positive side, I think that pregnancy help is probably on a par with what you describe for the UK, in the sense that midwives do most of the work, and seem to do it well (and my sister-in-law, who is a midwife, would insist that I say this). Similarly, here you do not get a bill. Will you be returning to have all of your children in the UK? Maybe I should come there to get my x-ray!

    Comment by David M — April 2013
  2. My own children did not require the level of attention that Camilla and Helen received. The two older girls were born at the now defunct Crown Street women's Hospital. Like you, we did not get a bill. There is plenty going for the two public health care systems.

    Hard to understand the American mindset. they object to Obamacare on the most absurd grounds, socialising medicine is one. Now, the anti-gun control drive is another outlet for the nutter's rant.

    Comment by DL — April 2013

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