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How Pregnancy and Birth Are Different in the UK vs US

Amy February 29, 2016

2016 - 1

By Amy, Contributing Writer

My American Pen Pal and I spent our teenage years comparing the differences between the US and the UK; so when we both found out we were pregnant at the same time, it was interesting to compare our experiences.

There was always going to be stark differences since maternity care in the UK is provided by the taxpayer-funded National Health Service. The plus side of this means the care is not dictated by the level of insurance you have and generally everyone receives the same standard of care. Of course, the system is not fault-free and some people, myself included, do decide to pay private for alternative options.   

How Pregnancy and Birth Are Different in the UK vs US

Midwives

One of the biggest difference between the countries is that midwives run all prenatal clinics and labour wards in the UK and nearly all births are attended by midwives. A stark contrast to the US, where less than 8% of births are attended to by a midwife. Obstetricians are only called in for serious complications or surgical deliveries.

All prenatal and postnatal care is provided by midwives unless you are deemed high risk, and even then obstetricians and midwives work closely together. The UK has approximately 25,000 full time midwives compared to 11,000 in the US. That didn’t seem a huge difference until I remembered the US had an extra 260 million people!  

Ironically, the UK is experiencing a massive midwife shortage and the government has pledged to find at least another 5000 midwives. The shortage means not every woman has the same midwife throughout her pregnancy and birth which is vital as research has found that one-to-one care reduces postnatal depression and produces a higher breastfeeding rate.

The desire to have the same midwife throughout my pregnancy, labour and after care was my main reason for choosing a private midwife. It also means that often birthing centres and hospitals aren’t able to take women due to a lack of staff and many women find themselves driving to multiple hospitals whilst in labour trying to find somewhere that has the staff to look after them.

Home Births

Home births in the US are viewed as a much more radical option and I was shocked to find out that in some states it’s even illegal for a midwife to attend a home birth. In the UK, home births are offered by our healthcare system as standard and last year, care guidelines were made to encourage more women to give birth at home after research showed this was the safer option for low risk women.

2016 - 2

Prenatal Care

The US appears much more interventional when it comes to prenatal care. In the UK, we have less frequent appointments and they tend to focus more on the general well being of the mother and baby and for planning the actual birth and aftercare issues such as breastfeeding.

I was very surprised to hear of women receiving formula samples during pregnancy. The UK has strict laws on the promotion of formula for under 6 months and free formula would break those laws. Here, not only it is illegal to advertise baby formula or even make a shop display of it but stores are not allowed to offer it at a discount, give coupons or even offer store loyalty points on formula purchases. Ironically despite all this the UK still has one of lowest breastfeeding rates in the world.

Glucose Tolerance Testing may be a standard test in the US but only occurs in the UK if a woman has symptoms or any risk factors of developing gestational diabetes. PAP testing seems to be another test standard in the US, whereas UK health guidelines state that PAP testing should be avoided throughout pregnancy and at least 3 months postpartum.

I also never once stood on a set of scales during either of my two pregnancies whereas doctors in the US seem to be much more concerned with how much weight pregnant women are or are not putting on. Our health records during pregnancy are also our property and our full responsibility with no digital copy ever made. They are written by hand each time you see a midwife or doctor and then handed back to you to take home. Women also get free prescriptions and dental care for the length of their pregnancy and the first year of baby’s life to ensure financial restraints don’t restrict health choices.

Pain Relief During Labour

The UK prefers a more gentler approach to pain relief during labour. Epidurals are on the increase here and have doubled to nearly 30% in recent years.  However that’s still remarkably low compared to a 95% rate in the US. Women here are actively encouraged to buy, rent or borrow a TENS machine for their labour – something not many of my US based friends had even heard of!

The most common pain relief offered to women in the UK is ‘gas and air’ which is a 50/50 mixture of oxygen and nitrous oxide and more commonly referred to as ‘laughing gas.’ Cylinders of this is even delivered to women’s home prior to a home birth. Water is also rated as the most efficient and least risky option when it comes to pain relief and nearly all labour wards have birthing pools.

Hospital Stay

UK maternity hospitals differ greatly from the US. It is very rare to find a private room once you have delivered your baby and instead mothers share wards with up to 8+ other mothers and babies. This also means that no overnight visitors are allowed. Partners are allowed to spend the majority of the day with the mother and babies but other visitors are usually given an hour slot twice a day and visitors outside those hours are not allowed. UK hospitals, except an elite few, also have no nurseries and woman have to care for their baby at all times from birth.

Something my American friends found funny was the fact that women have to take everything they need for themselves and the baby to the hospital. Nothing is provided. No diapers, hats or even maternity pads are provided. My local hospital even requires women to bring their own pillow.

Hospital stays after birth in the US tend to be much longer than the UK. After a straightforward birth you can expect to go home within a few hours of having your baby here. It is the individual woman’s decision as to how long she stays and because there are no financial restraints attached to this decision, some women choose to stay in for longer.

Once discharged, a midwife will visit you every day at home for 10 days afterwards to help ensure breastfeeding is established and there are no health issues. My private midwife offered care up to 6 week after birth. After this time, your care is handed over to Health Visitors who look after families up until the child reaches 5 years.

After Birth Care

Prophylactic Eye Ointment and the Hepatitis B are not given in the UK. The vitamin K vaccine is offered but parents are offered drops as an alternative as standard here.

Circumcision at birth is not an option in the UK. Doctors will only perform it for medical reasons and when there is no other option. If circumcision is requested on religious grounds, most hospitals refuse to perform the procedure on babies under 6 months and require them to have a general anesthetic. Most British people are very surprised by the fact that circumcision is offered as standard in the US.

I hope this has given a little insight into some of the differences between the two countries.

When looking at some of the differences between pregnancy and birth in the UK V US perspective which country would you prefer to have your baby in?

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  1. Great post! I am an American who has lived in the UK for three years. My first two babies were born in the US and my third in the UK. In one of my US births, there were 15+ medical students (all residency and all had attended many births) rushed to my room because they had never witnessed a natural, drug-free birth. Several came to my room over the short course of my stay to ask questions. Unbelievable! Even the OB attending my birth had never heard of letting the cord finish pulsing! In the UK, I had the privilege to support a friend in her home birth with the NHS while I was pregnant with my third. It was truly wonderful, however, I felt I needed to know who would be attending my birth (NHS is whoever is on shift and you may not have met your midwife), so I hired a private midwife. She was wonderful! All of my prenatal care was done in my home, which was wonderful for me and my other two young children. My birth and postnatal care was outstanding. The NHS nurse who comes to check in on you and the baby in the first weeks postpartum makes having a new baby easy, as opposed to rushing to pediatrician appointments days after birth. I could go on and on. A few other friends had NHS home births and birth center births and enjoyed the experience. I think that the focus being on the wellbeing of the mother and supporting her and her choices is what sets the UK apart. I should also add that you are not chastised if you decline any services or tests, in pregnancy or throughout your child’s care as he/she grows.

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  2. Hello! I’m from the U.S. And currently pregnant with my second baby. I agree with this post, at least what I know of the differences between the two countries. My first baby was born at home, planned, and attended by a midwife whom I paid for out of pocket because my insurance would not cover anything. I had tried to go the all natural hospital route, but was belittled and lied to by the doctors so frequently that I was sickened just to think about going in for a visit. The doctors in the U.S. only want to make as much money (via insurance)off you as possible. There is little regard for good research on safe practices for pregnant women and safe foods for pregnant women. I was actually told that I can’t eat natural sugars like honey or or agave and need to substitute with artificial sweeteners like Sweet ‘n’ Low which we proven to be dangerous to anyone. Once I got away from the hospital scene and began a privately paid for midwife, my pregnancy went smoothly. I gave birth at home in a pool exactly the way I wanted with no interruptions, interventions, or problems. I hired the same midwife team (wife and husband team) to attend my second pregnancy and birth. I have become an advocate for midwives in the U.S. based on experience and extensive research into the benefits.

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  3. I’m in the US and I’ve been watching a lot of One Born Every Minute. I’m currently 8.5 months pregnant and researching birthing options, the differences are fascinating between here and the UK! I’m from Australia and medical care is very similar to the UK. Being in the US and my husband has very good insurance so the care I’m getting is outstanding. I’ve got a high risk pregnancy so I’m seeing a high risk OB and my regular midwife. So many ultrasounds and tests to make sure that my baby is ok. My mum was in a similar situation in Australia, she was 48 and pregnant with her 3rd baby – but she only received 2 ultrasounds and doc’s visits during the whole pregnancy, whereas at this point I’m going in twice a week. I’m sure it depends on an individual’s situation but I feel really well taken care of by the doctors in the US and grateful that I can give birth in the US rather than Australia or UK. They are just so thorough here. I’m not sure though how this would be if I had different insurance or no insurance at all.

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  4. Just one key difference when all your American friends are shocked at bringing your own nappies. The UK system is free, regardless if you are low risk or high risk. On the NHS you will receive the same care whether you are below the poverty line or in the top 5%. Just food for thought.

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  5. Hello, I am a student midwife in the UK and was hoping to incorporate this post in my dissertation? Would you be able to private message me your surname, Amy, so I can references you?
    Thank you in advance.
    Chloe

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  6. Great article! I wondered if during a hospital birth in the UK they require IV placement and fluids. Nearly all hospotals in the US will start an IV and begin administering saline upon arrival to a labor and delivery unit. Is this done in the UK as well?

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  7. To the person above, the NHS system is not actually free. You pay for it every year with tax money. We pay less money in taxes, but have to pay for private insurance. My birth was covered and included all of the items mentioned as well.

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