What to Expect When You’re Expecting (in the UK)

stork signAs those who regularly follow this blog know, Mr Anglophile and I recently welcomed Little Anglophile, who, of course, is the perfectest little’un ever to make guest appearances on a non-parenting blog. Becoming a parent is a crazy thing, both during the leadup and the aftermath, but luckily here in the UK, we have a lot of support to make that transition as smooth as possible. For anyone curious about what it’s like to start a family here in the old country, here’s what to expect when you’re expecting a little Brit.

Antenatal Care

Unless you’re having a complicated pregnancy that requires specialist care, you’ll be looked after by midwives all the way through your pregnancy and delivery. Your first appointment is called the ‘booking-in’ appointment. The midwife (you may see the same one for all your appointments or bounce between different midwives at the same practice) will take all the pertinent info on your and your partner’s health, as well as some family history, and carry out some routine checks, like taking your blood pressure and drawing blood to test iron levels and such. Once you’re in the system, you’ll be scheduled for your first scan after 12 weeks. For that, you typically have to go to a hospital or other centre where they actually do ultrasounds. At the first scan, they’ll give you an official due date, and if you choose to run the tests for Down’s Syndrome, they’ll do that during this appointment as well, mailing you the results a week or so later. You’ll have another scan—the rather frighteningly named anomaly scan—around 20 weeks, when your baby will be checked for issues like spina bifida. You can also find out the sex, if you choose. If your pregnancy is progressing normally, these are the only two scans you’ll have. If you want more, there are private clinics you can visit, but you’ll have to pay out of pocket (usually a couple hundred quid, from what I hear).

If you’re having your first baby, you’ll have around 10 midwife appointments (if you’ve already had one without any complications and this pregnancy is progressing normally, you’ll have fewer appointments). Appointments are scheduled more frequently as your due date nears (about every week to 10 days close to the end), and as things progress, the midwife will measure your bump and check the baby’s heartbeat.

In your last couple of months, your midwife will tell you about NHS-provided antenatal classes, which are brilliant for a couple of reasons. One, they’re run by midwives, so they’re a great opportunity to get some questions answered. Two, they’re the perfect place to meet other local parents. I still meet up with some of the other mums from our antenatal class. And in case you’re worried about having to burn vacation or personal time on all these appointments, fear not: employers have to give you the time off to attend antenatal appointments and classes, penalty-free.

Maternity Leave

At some point, obviously, you’re going to have to let your employer know that you’ll be taking time off to nurture the next generation, and that’s when you’ll start planning your maternity leave. As someone coming from the US, this was a seriously eye-opening time for me. You’re entitled to up to a year off work after you have a baby, and many women take the full time. I don’t know anyone who’s taking less than six months. By law, you have to take off at least two weeks. Dads are also entitled to two weeks off, though that’s typically unpaid. The laws are changing to allow parents to share the leave, if mum wants (or needs) to return to work and dad wants to take a few months off to be the full-time parent at home. During most, or possibly all, of your maternity leave, you’ll be paid in some way. The organisation I work for offers an enhanced maternity leave which pays full salary the first few weeks, then switches to either half pay or statutory maternity pay for most of the rest of the leave. There are only a few weeks at the very end of the leave during which I’ll be receiving no pay, so it’s a pretty sweet deal overall. Companies that don’t operate like this offer statutory maternity pay, which is 90% of your pre-tax pay for the first six weeks, then £138.18 or 90% of your pay for the next 33 weeks (whichever amount is lower).

As an added bonus, even though you’re taking time off work, you still accumulate your vacation days for the year. You can then either tack those onto your leave (so you get another few weeks of leave, at full pay) or you can make them part of the leave itself, so you have fewer weeks of pay-free maternity leave.

Giving Birth

I’m not going to lie: there’s a bit of social pressure to go natural with childbirth here, so that’s the route a lot of us choose to go, if possible (I don’t think anyone in our antenatal class admitted to planning on getting an epidural, though surely some ended up going that route in the end). When it comes to giving birth, you have a couple of choices: you can give birth at home, with the assistance of a community midwife; go to a midwife-led unit in or near your local hospital (the Lothian Birth Centre, in my case); or, if you are having any medical interventions like a c-section or epidural, the nearest hospital maternity unit. Obviously it’s an entirely personal choice, but I can say from experience that they do all they can to make the birth centres the most attractive option in the hospital. This is what the rooms at my birth centre look like:

birthing centre

No joke, they all had lovely giant tubs, pull-out sofa beds, flat-screen tvs, birth balls, giant private bathrooms, the works. The midwives there were also trained in aromatherapy, which was nice and all, but didn’t seem to make much difference for me. If you go the natural route, your pain-relief options include the birthing pool (which helps a lot more than you think it will), gas and air (useless for me, but I hear others liked it), the aforementioned aromatherapy, and a morphine shot, which was awesome right around labour hour 50. The midwives at Lothian were brilliant, though I do recall bickering with mine over the lighting levels (I wanted it bright, she was inclined to turn the lights down). Just make sure you stand firm if you feel really passionately about something, ask all the questions you want, and make your partner your advocate, because at a certain point you’re not really going to be in the best shape to be speaking up for yourself.

I should mention that before you go into labour, you’re usually encouraged to write up a birth plan. Definitely do it, if for no other reason than it gives you and your partner a chance to really think about what this is going to be like and how you’d ideally like to see it go. But accept the fact that at some point, the plan is likely to go off the rails. You may decide you need more pain relief, or something might happen that necessitates further medical intervention. Don’t get too attached to the plan and get upset if you have to deviate from it.

Also: bring snacks. And reading material. You need to keep your strength up. I recommend trail mix and nuts, and maybe something starchy like pretzels or rice cakes in case you need something to settle your stomach. As for the reading material—you’ll have some lulls to fill every once in a while. Reading aloud is something you can get your partner to do. Which reminds me: give your partner things to do. Obviously they’ll be holding your hand or whatever through contractions (hopefully, anyway), but in between times, they can sometimes feel a little helpless. I put my husband in charge of music (I obsessively made both a soothing and a motivating playlist, which both got some great use) and had him reading aloud to distract me.

After Delivery

You’ve had your baby, congratulations! If you’re home, you’re probably going to just relax in bed or wherever. If you’re in hospital, you’ll be moved to a recovery ward. In my hospital, it was a tiny ward with four beds in it, all curtained off for privacy, and a communal table in the middle where we could have meals and frequent snacks of tea and toast brought round by the midwives (which seemed so amazingly British to me. I’m pretty sure from now till the end of time, the taste of toasted white bread spread with Flora buttery will remind me of having my son). The ward is staffed by midwives, as you can imagine, and they’re constantly circulating to help you out and provide advice, which is particularly great in those early days of breastfeeding (which is hard, don’t let anyone tell you otherwise!) Each midwife has a different trick to share, so take advantage of that, it’ll help! And no question is too silly, ask away!

Once you’re discharged, you’ll have a day or two at home to regroup before one of the community midwives comes around to give you and your baby a checkup. Yes, that’s right, they come to you. Does anyone in the US do that anymore? The midwives typically come around periodically over the next 10 days to make sure everyone’s doing ok, that you’re healing up and baby’s eating well and putting on weight. You can have them come as often or as little as you like. If all is well, the midwives will then be replaced by a health visitor, who similarly will come by to weigh the baby and make sure mum is doing well both physically and mentally. If everyone’s healthy and happy, the visits will taper off and you can start attending weekly free clinics in your neighbourhood. There, you can weigh your baby and ask staff nurses any questions you may have. And meet with other parents, which is important.

Astonishingly (to me) every last bit of care I received was completely free. No copays, no hospital bill to deal with at the end. And I absolutely can’t fault any of the care. Socialised medicine is actually pretty brilliant.

Breastfeeding

As I mentioned before, breastfeeding is hard. Yes, it’s natural, but it’s also a skill both you and the baby need to learn, which is why the midwives in the hospital are so helpful. After you leave the hospital, the visiting midwives and health visitors can help you out with issues you might be having, and if they can’t help, there are free breastfeeding clinics you can go to, where experts can give you advice and ease your fears. For me, the most helpful thing was to keep reminding myself to stay calm and not immediately get frustrated if it took him a little while to latch on or whatever. If you get all tense and upset, the baby will too, and that’ll just make things harder for both of you.

Out and About

It’s great spending tons of time with your little one, but you do want to get out of the house at some point, so definitely look into things you can do with him or her. Ask other mums you know about classes and activities in your area—in some areas you’ll actually find plenty of free things you can take your baby to, like yoga or playgroups. In others, you may have to pay a couple of pounds for these. Some cinemas (in the cities, at least) also offer baby-and-carer viewings of the latest films, so you can go see X-Men without feeling badly if your baby starts crying in the middle of it (the Odeon near me does a particularly good baby cinema—they come around to your seat to take concessions orders and then give you biscuits before the show starts!). Local libraries also run biweekly Bookbug (Scotland)/Bookstart (rest of the UK) sessions for babies and toddlers, which are basically music and rhyme time and are totally free (the Bookbug and Bookstart programmes also gift free books to all babies and small children in the UK, which is pretty awesome). If you can’t find any classes you want to take, get in touch with some of the other parents from your antenatal class or get together with friends who have had kids. It’s enormously helpful to be able to chat with others who are or have recently been in the same boat as you. It can ease fears and provide a lot of answers to questions or concerns you might have.

Image: Crystal Marie Lopez, courtesy Flickr Creative Commons, distributed under Creative Commons License 2.0



4 thoughts on “What to Expect When You’re Expecting (in the UK)

  1. Sorry, but that sounds horrible. And dangerous. Here in the U.S. you get a doctor every visit. That seems preferable to a midwife. In Britain you are coerced into natural childbirth. If something goes wrong for the baby, there is no full hospital staff to save the baby. As for free, nothing is free. You and other taxpayers pay heavily for it. You have given up your freedom for a freebie. My daughter is having a baby any day now and she will get several months off at full pay. The cost of all of it is minimal with insurance. I fear all our freedom will be gone with Obamacare. My mother had hip replacement surgery recently and her costs were under a thousand dollars, including weeks at a rehab place and weeks of in home visits by a physical therapist.

    1. It’s not horrible at all, and I think you may have been misinformed on a few matters. First off, midwives in the UK are highly trained medical professionals. All of them (in the US, midwifry is rather less regulated, so it can sometimes be riskier, if you’re not going through a good medical practice or birth centre). You’re not just put in the hands of some wise woman burning sage over your belly or something. They know what they’re doing, and if anything seems amiss, believe me, you’re sent right to a specialist OB. Overall, research has shown that fetal and maternal outcomes are equally good whether the mother’s using an OB or a midwife, and those who use midwives typically report a more positive birth experience and have fewer medical interventions.

      Nobody is ‘coerced’ into having a natural birth. There’s a bit of social pressure to go natural (which I think is something that’s cropping up all over, not just here) but I was definitely informed of all my options and their benefits and drawbacks, and at no point did my midwife ever discourage me from having an epidural, if that’s what I wanted.

      There is absolutely fully trained medical staff at hand in case things go wrong during the birth. Birth centres are located either in hospitals or right next door to them, with full access to specialist medical maternity units. And you can’t give birth at home if you’re too far away from a fully staffed hospital, just in case. Those highly trained midwives are really good at spotting when things are going off the rails and getting you to help immediately. I should know–I started bleeding a bit more than they would have liked and I was immediately whisked upstairs to the maternity unit (and things turned out fine). I had a friend who went into the birth centre and, when her baby’s heart rate dropped, she was immediately taken for a c-section. Believe me, help is at hand!

      Yes, all right, we do pay for our healthcare with taxes, but the tax burden isn’t that much more onerous (it hasn’t seemed that way to my husband and I), especially considering what you get for it. And the cost of giving birth in the UK is still significantly less than it is in the US. A c-section in the UK costs an average of £1700 and a vaginal birth costs an average of £750. Those same procedures in the US cost $27,866 and $18,329 respectively. A March of Dimes study found that the average out of pocket cost of a pregnancy and birth was more than $8,000! That is insane. No way do we pay an extra £8000 a year in taxes over here. We have friends in the states who had great insurance and totally straightforward births who were still paying off their medical bills months after their child was born. And there isn’t nearly the same type of follow-up care available in the states–is the OB going to come to your house to check on your baby and see how well your stitches are healing and how well you’re coping after the birth? I highly doubt it. You have to make an appointment for that. And pay a copay. If you want breastfeeding help, you almost certainly have to go to some private clinic or get a consultant, which is difficult unless you live in a major city or an area where such people are actually available. All that seriously adds up. And yet, with all that money flying around in the US, maternal mortality rates in the US were more than twice that of the UK in 2013, according to WHO. What’s driving those tragic numbers up? Poor women who don’t receive adequate medical care because they can’t afford it.

      Congrats on the grandbaby! And that’s really great that your daughter gets so much paid time off to spend with him/her. Unfortunately, I haven’t known that to be the norm in the US. I’ve never worked for or known anyone who worked for an employer who gave more than 12 weeks of unpaid maternity leave. My stepsister-in-law just had a baby and she gets no leave. Not good.

      Again, congrats on the soon-to-arrive grandchild! I hope everything goes smoothly for mama and baby 🙂

  2. Congratulations! I had a baby (in the US) in October and it was fascinating to read the differences. I wouldn’t have been able to stand the natural birth though. 🙂 But I certainly would have enjoyed the time off! What a beautiful gift.

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