Reflections on a year in the UK

Our year in numbers:

Steps walked: Over 3,000,000 each. Thanks, no car!

People who learned how to walk: One. We can’t even begin to calculate his steps

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From not walking to standing in his two wrong shoes.

Public transit rides: Over 11,000. Again, thanks no car! And thank you Transport For London – you really are amazing,

Visits to parks: Over 275

Flights taken: Over 25? I really have no idea.

Friends made: 16-ish. It’s an evolving number.

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Baby friends! Vicente, Viv, and Scarlett.

Countries visited: 10 – Germany, Netherlands, France, Italy, Spain, Morocco, Czech Republic, Wales, Mexico, USA, with Germany being my most frequent destination oddly.

Family and friend visits: 11!

Flats lived in: Three

Times I forgot my passport and T had to rescue me: Two (I didn’t need a passport to take my 4.5 hour flight to Texas, why do I need it for my 1 hour flight to Germany?)

Babies born: One

Amount I miss our family and friends in Boston: Immeasurable.

How glad we are we undertook this adventure: Immensely.

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From one of our first pub visits in July 2015, and then daily life from Aug 2016. Max isn’t a baby anymore, but someone else is!

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We decided to move here for a lot of reasons – firstly because we wanted the experience of living abroad as a family, but second because we agreed that this would be great for my career.

It was a little bit of a hard decision to keep the move on track when we found out I was pregnant (13 week when we took the flight over), but we were committed to the adventure. It didn’t make things THAT much more complicated. #Imlying   However, it did make it easier in some ways to make friends since we took an NCT class and met 7 other couples expecting kids at the same time.

The journey has been lonely at times. Anyone who has moved to a new city can attest to that. We went from being surrounded by loving family and friends to feeling like a solitary family unit floating around London. T and I experience this differently – his weekdays were no longer spent with Steve, and mine were surrounded by new coworkers as part of a new piece of business where everything had to be established, not just social connections.

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A new walker and his dad in Aug 2015.

The payoff in terms of my career has been tremendous. I regularly work with and present to VPs and CMOs of very large companies – all about search. I smile when junior team members say that they want to learn channels besides search so their career is marketable — because the demand for search planners, managers, etc is off the charts here. [To be clear, I respect them wanting to learn other channels but just not for the reason of being ‘marketable.’] [Also – if you’d like to come work in London in paid search or SEO please let me know.]

There’s something nice about being at a new company in a new city — about leaving your past behind in many ways. Not that our / my past was bad; it’s just that very rarely are we in a situation where ALL relationships are brand new, and impressions newly formed. People know me first as a 35 year old American marketing professional with two kids (or one kid with another on the way); they don’t have the memory of 28 year Casey who was too casual at a client meeting or 25 year old Casey who got unreasonably upset at work or 31 year old Casey who was an enthusiastic manager and speaks really loudly. I suppose that’s not really a function of moving to the UK per say – it’s a function of leaving a company I was at for 9 years (and had a wonderful experience at for the record).

Being in a new place can be exhausting. Or maybe it’s having a toddler and a baby – but it’s probably both. I can say that a year in, I don’t have to check the map three times before leaving and then every block on the journey. I know where to buy cardamon and lamps and jeans (answer: Amazon. Just kidding. Kind of.). I sort of know how to get refill prescriptions from my GP. I love WhatsApp for talking with my Boston peeps. I definitely know what to consider when running a global piece of digital marketing business – though as they say, the more you know, the more you know you don’t know.

I don’t know how I’ll feel in another year or three – but I am glad we undertook this adventure. Here’s to pushing yourself – personally and professionally – because you just really never know what will happen as a result.

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Max and Viv enjoying life.

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Patio time!

Dentist in the UK: They Exist

Hi Friends. It has been awhile since we’ve blogged – mostly because the wordpress app for the iPhone is TERRIBLE, and after hours of working I just can’t face turning my computer on at home.

After a year here in the UK, I finally bit the bullet and went to the dentist. YES they have dentists here despite the poor reputation of British teeth. Here’s the situation as I see it in regards to why dental care is not pursued as rigorously as in the states:

Socialized healthcare doesn’t really include dental coverage – though reduced cost dental care is available to everyone – see here for the details. It’s a decent amount of money – £20 to £53 for basic care. This is MUCH less than it would cost in the US without insurance, but it’s still a decent amount of money for many families.

In addition, real cleanings cost £45 or so if you don’t have a “medical need” for a cleaning.  That’s a lot of money for most people. It’s ironic because if more people with good teeth got regular cleanings, there would be less need for more serious treatments that are heavily subsidized by the NHS. When I left the dentist, the receptionist also didn’t ask me to make an appointment in 6 months.

As a result, I don’t think dental hygiene is ingrained in the culture the same way it is in the states. Sure people brush their teeth and maybe floss, but way fewer people have had orthodontia (must be costly – though it is in the US too) or get regular dental cleanings.

The good news for me is that if you’re pregnant or have had a baby within 12 months, you don’t have to pay the £20 for the initial exam, or £50 for fillings / crowns (!) / etc. I had a filling that fell out so they refilled it – but of course I paid for the white filling (£75). That’s pretty on par with the US. EXCEPT I WOULD HAVE LOVED TO PAY JUST £50 for my gold crown… which even with US dental insurance, I had to pay $650 for when I got it a few years ago from my dear dentist.

In terms of the quality of treatment – I went to my neighborhood dentist because they received decent reviews on Google and on the NHS review site (yes all medical practitioners have user reviews!). The cavity filled was between two teeth and it’s a little jagged now – shreds my floss – so I’d give them a B-. X-rays were just single on either side and the old fashioned film kind (instead of digital). The cleaning was good, used that scrapey water pick thing and manual scraping too, followed by a polish. They didn’t floss my teeth for me but I always hated that part anyway.

In conclusion – I don’t think my teeth are going to suffer horribly for the years I’ll be in the UK, and I hope to god my crown needs replacing before I leave so I can avoid the $650 charge in the states. Here are my pretty yellow pearly whites:

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Look ma, no tarter! Or pretty filters or make-up. Keepin’ it real here, folks.

Now just to figure out when our little three-toofer and full toddler need to go to the dentist…

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I don’t know my lines!

This is what happens when your brother comes over from the states and you get a babysitter and partake in a few beers:

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Ugly chin faces. We love you Kristen!

After a few more beers, this happens when you log into your caseywilliams@gmail email address to verify your UnTapped [beer app] account:

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Hello 40+ cast members. I’m Casey Williams and I don’t know my lines!

No one responded to my obvious plea for help.

Weekends in London

As in, weekends if you live in London but not in central London, and have two kids under the age of 2.5.

We spent this glorious three day weekend exploring and enjoying  and of course doing chores. It was supposed to be kind of terrible out, but thankfully the sleet, hail, and rain ended Friday night. Saturday our goal was to get out of London… And we just managed to do so. And avoid a £20 fine each for not having the right ticket. St. Albans was a lovely town.

Sunday was chores and preparation for our friends to come over to dinner. Max ended his portion of the evening by saying “Bye Uncle,” indicating he thinks all men who play horsey, drink beer, and barbecue with Dad are Uncles. He’s basically right.

And now it is a lovely lovely day – Bank Holiday Monday. Seriously that’s what it’s called. Apparently the bankers need a break… And so do we. **UPDATE: I took a four hour nap. Clearly I needed the break!**

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Train time! Very very exciting. On our way to St Albans for the day!

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We went to St. Albans, just outside of London. I think it counts as our first outside of London day trip, though countryside residents may disagree.

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In front of the St Albans ginormous church.

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Walking on the grounds of St. Albans church.

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Outdoor lunch I at the ubiquitous pub, this one in St Albans. Not pictured: the 600 year old clock tower behind us.

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Saturday night – We learn why the swing has straps on it. Viv didn’t even squeak, though she was falling out of her swing and had lost her pacifier. She was just happy to observe pizza making!

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Sunday – Chubby mcchubbers, ready to take on the sun.

 

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Max “helps” with the buggy on our walk to Crouch End for groceries and beer. A 20 minute walk means far better selection, and a great way to enjoy the weather.

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Can’t I nap on the sidewalk?

 

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Having a Baby with the NHS – Part 3

If you missed it: Having a Baby with the NHS – Part 1 covers the pre-birth generalities. Giving Birth with the NHS – Part 2 talks about the benefits of an NCT course, and how we got to the hospital.

So now it’s time for Part 3. We all know how the story ends – with a beautiful baby girl. The exciting part is how we got there.

In addition to the NCT course, we found this helpful TV show on Netflix called The Delivery Man. It’s all about this ex-copper who decides to become a midwife. The cop is male, though – so it’s a cute little sitcom about a male midwife.

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Quirky UK comedy featuring Matthew, the male midwife.

The night before induction, I watched three episodes and then went to repack my suitcase with more pajamas because it seemed that’s what ladies wore when they birthed. And my midwives would be funny, attractive, and a bit unusual. Everyone knows you should base your real life expectations on a sitcom.

BUT IN THIS CASE IT WAS ACCURATE – Our midwife was named Scott! Not short for “Scottina” or “Scottett” – plain Scott, a male midwife. Yes a MAN was all up in my lady bits. And I could have cared less.

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Scott, our male midwife, with Vivian Hazel shortly after birth. I dig his astronomical cap.

He was very competent. The girl next to him is a first year midwife student, and mine was the first birth she attended. #yourewelcome

Anyway – after being shown to the Labour ward (where they managed to find us a room, probably by rushing some other lady out the door), we met Scott and the student, and I continued to writhe about in pain. Eventually they gave me gas as in nitrous oxide, which the US is just getting into again. We learned about gas in our NCT class as well as on The Delivery Man show, where women in labour would frantically suck the gas. I frantically sucked the gas too, but mostly it just made me dizzy, and that was kind of nice at first because it was distracting.

The student would offer the gas to me when I was contracting, and sometimes I would take it but after awhile it was mostly so I could bite down on the mouthpiece. As things got more intense, I started to feel like a dog, biting the mouthpiece or just pushing it away with my head. Ruff.

Finally (basically everything in birth starts with “finally” because it all feels like it takes forever), the very, very nice anesethisiologist (actually spelled anesthesiologist – I was pretty damn close) came down to give me the epidural. It was VERY hard to hold still, and VERY painful to get put in – more than with Max, who knows why. It sort of started to work… but I still couldn’t talk through contractions. He came back and gave me an extra bump. All of a sudden I felt human again. Well, a human without legs, but a human. I smiled. I talked with my husband, whom I no longer hated. I asked the student questions. I enjoyed life. Modern medicine is miraculous. Major props to the moms who give birth without pain relief. 👍🏻👋🏼👊🏻

Less than 3 hours after going into labour naturally, I was ready to push. The biggest difference in my “birth plan” from the US was that they were only going to let me push for 40 minutes as to not strain my heart. With Max, I pushed 2+ hours! Here they were more conservative. We tried to push back – figuratively – but they were pretty adamant. Sadly after 40 minutes of hard work, the baby was still pretty far up there.

The OB came in and was like “No more pushing, we will now take you into an operating theater where you will have two pushes with the forceps or ventouse (ie vacuum) to get the baby out, or we’ll do a C-section.”

WHAT? A c-section with baby #2?? I really, REALLY did not want that. Neither did T. And lady, your bedside manner is severely lacking. Ultimately we decided to go forward with prepping for the forceps and c-section because in their medical opinion, it was the safest for me in the long run to stop pushing. I want to see my kids get married one day!

30 minutes later, I’ve had the extra pain killer that has me convinced that I truly do not have legs any longer and has me shaking like a Polaroid picture, and they wheel me into the operating theater. This other pain killer is in case I do need a c-section – it’s mega intense but better than general anaesthesia.

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My view. It’s bright. Yes I took a picture.

I prepare to push, with my legs sky high and like 6 people clustered around my nether regions. SURPRISE, the baby has descended 5 cm, which everyone agrees is quite impressive given I wasn’t pushing… and eases my fears about a c-section. They do a little snipping, say “Forceps please… now PUSH” x2, and out comes the baby!

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A few minutes after birth (and after a quick wipe-down).

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Look, dad’s in a cap and gown!

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Scott takes care of the umbilical cord.

I very much felt like an accessory at this point. The medical staff were talking to each other and joking, but it was like I wasn’t there… until I made jokes too and they liked that. The same thing has happened to me in the US too.

We were just happy to have a healthy baby girl.

Now comes the shitty shit part of giving birth – staying in the hospital. The UK still uses wards to house patients. Wards as in multiple people in the same room, but with paper curtains between them.

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Yes, really. Wards like the 1900s, only with curtains. Wo-hoo. Curtains. What an upgrade.

You could get a private room for £300 a night. WHhhhhhHHhaaaTTT?! No way.

We were in a high risk ward with 5 moms for 10 hours, which was okay because visitors were restricted. We were then moved to a regular ward, where people were SO inconsiderate. Visitors staying WAY past visiting hours – I had to ask the midwife what the visiting hours were because it was 11 PM and there were still very loud talkers chat chatting across the way (visiting hours are 4-7 PM). The visitor was sort of kicked out.. eventually. People were on Facetime, talking at elevated levels with their visitors at all hours, and generally pretending like the paper curtains were walls.

PAPER DOES NOT EQUAL WALLBOARD. I wanted to kill everyone (not the babies). And unlike our experience in the US, there is no place for your partner to stay overnight – it’s just a waiting room chair next to the bed. T went home to sleep. We didn’t even have our own ward bathroom – it was out in the hall.

The video is of background noise in the ward during “quiet hours.” Vivian Hazel is napping.

The doctors had threatened to keep us there for a few nights “just in case.” I told T the next morning that there was no way under the sun I was staying there another night unless something was actually wrong with me. The only sleep I got was with headphones in, listening to music. I normally NEVER sleep like that. Thank GOD we were released that afternoon (so we had 1.5 nights in the hospital). Other parents we’ve talked to had equally awful experiences in wards, only often the wards were just 4 moms/babies (instead of 6).

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Swaddling the baby girl. The Brits don’t seem to be as into swaddling as the US, but we’re still firm advocates.

The biggest difference besides the whole “share your space with 5 other moms and babies ward” thing was that other than sheets, a johnny, and a bassinet for the baby to rest in, you had to bring in everything else. That’s right – blankets and clothes for the newborn, pads, even DIAPERS. Food was hit or miss – I had to ask for meals. Fortunately we had heard this in our NCT class, but somehow missed the memo on diapers. I asked for ice to help with pain management but “the hospital didn’t have an ice machine.” Seriously?

Aside from the lacking creature comforts, the actual medical care postnatally seemed to be fine. I saw a few different medical professionals. My high risk OB never came by to say hi even though he was on the ward (I saw him) and talking with the midwives about my care. I guess nothing was wrong, so why waste his time…? My blood pressure was measured regularly. OH I forgot to mention the sexy compression stockings they put on my during labour to help with circulation – didn’t have those in the states.

We were SO HAPPY to go home. Perhaps postnatal care is so lacking in comforts because they want you out of the hospital. Yes, being out prevents infections… and also saves money.

Perhaps the best thing about giving birth with the NHS is the home visits that Community Midwives make. The day after you get home, a midwife comes to the house to check on you AND the baby! Not only is it great to not have to leave your house, but unlike our follow-up pediatrician visits in the US, the midwife was concerned with my health AND the baby’s health. Our pediatrician was useless when it came to breastfeeding and other, ahem, postnatal care bits for mom. The midwife will come over a few times if needed until you’re ready to go to a clinic.

The only weird part is that they just show up unannounced. I was just happy she (yes both midwives were shes in this case) came because they were confused about where we lived and which hospital the postnatal care would be coordinated out of (the midwives are from a local hospital, not Chelsea and Westminster). Fortunately the NHS came through and midwives visited.

We also will see a “health visitor” for the baby – I’m not entirely sure what s/he will do, but they’ll be here tomorrow and will provide the all important “Red Book”, which is the baby’s paper medical records that yes, we will have to bring to all doctor appointments. [Side note – I’m not sure how to get Max ones of those…] Following that, all care will be through our local GP. And remember – the baby and I both see the same GP. Or will, once we register with one near us.

In conclusion, there were pros and cons with having a baby with the NHS:

Pros: Less expensive, midwives at the hospital, home visits from the midwife, pain relief – gas, birth centres, local care, good specialists (at least in London), combined care for baby/mom

Cons: Mother f’ing wards, weird communication gaps in care, having to bring your own diapers, creams, and pads, less flexibility when it comes to your medical care choices, paper medical records

Ultimately in both cases, we had healthy babies, which is all that really matters.

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Giving Birth with the NHS – Part 2

If you missed it: Having a Baby with the NHS – Part 1 covers the pre-birth generalities.

So now we get to the good stuff: BIRTH, or where the rubber hits the road. This is a combination “all about the NHS” and “my birth story but not too detailed”.

To warm up, let’s talk about the NCT class that T and I took to prepare for birth. NCT = National Childcare Trust, the UK’s largest charity for parents. We heard from everyone that taking a pre-birth learn all about pregnancy and babies class was a great way to meet people in your area having babies when you are. Oh, and learn about babies too. But the main point being that people take them both to make friends and to learn stuff because like many of us, our existing friends may not be having babies at the same time as us. And obviously we need friends period given our recent immigration.

The class met about an 18 minute walk through the woods from our flat in Crouch End in an after school program room. Highlights of the facility include having to get buzzed in; the miniature chairs we sat on; and most of all, the miniature toilets, which of course were made frequent use of given the fact there were 8 pregnant ladies in the class.

Anyway – the class was INVALUABLE (actually it was very valuable – almost $500!!), meeting 6 times or so plus a reunion meeting after all of the babies are borned. Not only had T and I forgotten (or never learned) a whole bunch of stuff about pregnancy and infants, but this class helped set our expectations for the rest of our healthcare experience. As different as giving birth in the UK was for us, it would have been even more jarring had our expectations not been set by this class.

And, we met some great people. I got to wow them with my technical prowess, setting us all up with a WhatsApp group. #coolkidforonce It’s really nice to feel more connected to the community, though.

Moving into birth, since that’s what the NCT class was in preparation for.

Many hospitals in the UK now have birthing centers (or rather Birth Centres) in addition to the regular maternity ward. These are very zen, spa-like spaces where you can have your baby, and often include a deep pool-like bath. They’re much more relaxing than a typical labour ward, which is good for your hormone levels. I really, really liked them, and the fact that birth centres are so common in hospitals here.

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Don’t you feel relaxed already?

Sadly, this is NOT where we – I mean I – gave birth. A. No high risk births can be held here, and B. No epidurals are given though you can have gas (ie nitrous oxide). Instead you get to float in the water, hang from fabric thingies from the ceiling, and roll on a ball. And yes, that is a double Murphy bed that folds out of the wall. And the lighting really is that moody.

Instead, we were in a traditional labour ward. Importantly, there are two different sections of a maternity ward area – the maternity ward, where mums wait to be ready to give birth and/or recover from birth, and the labour ward, where active labour happens. We learnt this lesson the hard way.

Because I was over a week late, I was scheduled for an induction on Wednesday, Jan 13 at2:30 PM. They told us to show up at 8 AM in the Labour Ward (I forgot the second part). However, because my parents were leaving Thursday afternoon, I called and rescheduled the induction to Tuesday, Jan 12 at 1:30. I explained that the doctor had told us to show up early, but the midwife was like “Hmmm I’m not sure why he did that, come in at 9 instead.” Doubtful that this was going to be sorted correctly, I asked if I could talk with the doctor. And they were all “oh no no no you can’t talk with the doctor” as though I were a crazy person. I just had to trust the system.

What transpired: Tuesday morning we trekked off to the hospital via public trans, which takes about an hour. Upon surfacing, I had the deadly realization that I had left my damn paper medical records back in Highgate. Much swearing ensued. Then phone calls to the hospital and the grandparents. Yes we had to have the PAPER records, so the grandparents met us midway with them. We finally got to the hospital – stressed and sad from awful coffee – around 10:30 AM. We checked in but everyone was confused as to why we were there early if induction was scheduled at 1:30 and what to do with us.

An hour or so later, I hear my name mentioned. Quick as a bunny slash 9+ month pregnant woman I scurried out to the hall to understand what was going on. Dr. C was talking with a midwife – no one had told him that I had called to reschedule.

So this resulted in us being at the hospital, ready for induction, but they had already scheduled another cardiac induction that same day so they preferred not to do me too. They asked us to come in the next morning at 7 AM instead. Plus we were supposed to show up to the LABOUR WARD not the Maternity ward. Whoops. No medical staff in the Maternity Ward could correct us because it wasn’t clearly written in my notes or my EMR what I was supposed to do. This is an example of lack of communication within the NHS, or perhaps “patient empowered care”.

Home we went, not entirely unhappy given the stressful start to the day. I finished up some chores, we went out for Ethiopian food, and we FINALLY got Max a haircut at Boston Cuts (which refers to a type of haircut, not a place).

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Bob and Susan looking pensive – will the baby arrive before they leave on Thursday (but it turns out their flight was actually Friday)?

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Stuffing my face with Ethiopian food. Will my hunger ever be sated?

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Max prepares himself for a haircut. Will he avoid a blockhead look? (Spoiler alert: No)

It was at the hair cutting place that I realized that the baby bump was riding MUCH lower than previously. As in WAY lower. It had already come down… but this was like “heyyyy low rider!”

We walked home and I ran a bath for Max, feeling some crampy type pain, which hadn’t been unusual. But it intensified. And then I was trying to read Max some stories, and had to stop midway a few times (The little Elephant eee heee oooo loved trains). Still, I wasn’t sure if this was labour (because with Max I was induced). #Denial anyone? Finally, I went to change into sweatpants and it was like “oh, so that’s my waters breaking. I guess this is labor.” A ha ha, Dr C, take THAT! I WILL be at the hospital today!”

T called my parents back from their bridge game and checked with the hospital – yes I was to come right in because this was baby #2 and it could proceed quickly, and because I was high risk. I insisted on a painful shower because God forbid I have dirty hair, and finally FINALLY my parents arrived at the same time as the taxi. Off to the hospital we went… it took about 45 minutes, and though the taxi driver didn’t say anything, I’m sure he noticed the heavy breathing, swearing, and open window in 40 degree weather. Things certainly were moving quickly – contractions were every 2-3 minutes. I was just hoping I didn’t give birth in the taxi (unlikely) because recently this very taxi company made headlines for sending a cleaning bill to a lady who had given birth in one of their cars.

FINALLY WE WERE AT THE HOSPITAL – longest ride of my life. I hobbled to the elevator and into the maternity area, where they showed us to a waiting room. Hysterically, there was a VERY young couple in there – the girl was less than 6 months pregnant. I can only imagine that we scared them a little. THIS SHIT GETS REAL, LITTLE GIRL. The medical staff were scurrying around to try to get us directly into the labour ward because they could see that labour was well under way for me.

They wheeled me into the Labour ward room. It basically looked like a US hospital room for giving birth, plus a huge beanbag chair and exercise ball. I focused on breathing, the medical staff scurried around… and then we met our midwife for the night.

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Ok this post was longer than I thought it was going to be, so the actual birth event – including a fun surprise about our midwife and pain management options – will be covered next time. Spoiler alert #2: A baby will be born.

xo!

 

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Having a Baby with the NHS: An Outsider’s Perspective (Part 1)

We moved to London when I was 12 weeks pregnant. Obviously the move had been planned for some months prior… but some things aren’t always planned. Yes, new company, new job, new continent, new city, AND a new baby! All with no local family or friends (yet).

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To complicate matters, I have a congenital heart condition that makes me a high risk pregnancy… though in the words of my beloved cardiologist Dr. Ami Bhatt back at Massachusetts General Hospital (MGH) in Boston, “[You’re] the lowest high risk pregnancy out there.”

Needless to say, the first thing I did when we found out I was pregnant was to research what giving birth in the UK would be like. There wasn’t a lot out there because everyone just knows how the NHS works, or learns about it in their NCT classes.  This post is intended to give you, dear friend, reader, future/current expat, insight into the beast that is the NHS, at least when it comes to childbirth.

The Basics

You pay for the NHS – it’s not free. It’s just that the payment comes as a percentage of your paycheck – i.e. it’s a tax. I was a little annoyed when I pushed back on having an extra appointment, and the doctor said, “it’s free, so why does it matter?” A. It’s not free. B. My time is worth something. I still like him. But the point is, you don’t have to pay or get invoiced for most medical care. Think about the cost savings to the system there alone!

To get medical care, you have to register with a local General Practitioner, otherwise known as a GP or doctor’s practice. This is a PIA if you’re new to the country because you don’t have an NHS number or proof of address, though technically neither of those things should prevent you from registering. All care is given based on your home address – so everyone sees a GP near home, not work. And, typically the entire family goes to the same GP practice. There aren’t pediatricians (unless you need a specialist or have private insurance).

Obviously one of the first administrative things I did was find a GP since I had a rather, erm, pressing medical condition. I ended up at Barlby Surgery at St Charles Hospital, mostly because they got good reviews online (yes all practices are review, major plus!) and you could pre-register online. Weirdly they still have nuns who work there; that or another word for Nurse is Sister. We all know how confused I get by titles.

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St Charles Hospital – a religious compound slash health care center around the corner from our first flats in North Kensington.

Downside: My GP had the personality of a paper bag. No, less than that – a bag crinkles. He was like a sheet of flat white paper. I couldn’t imagine him interacting with a toddler successfully, but he asked me all the questions and finally agreed to refer me to my hospital of choice because….

When you need something major – like to see a certain specialist, get an operation, or say, give birth, you are referred to a local hospital. You can ask to be referred to a particular place or complete a self-referral in some cases. My doctors in the US recommended the cardiology practice at the Royal Brompton Hospital, but they provide prenatal care in conjunction with the Chelsea and Westminster Hospital, so that’s where I went. Well, tried to get referred but the paperwork didn’t go through so I self-referred. Sadly, this was not close to either of our flats – but was only 30 minutes from work.

Yay! After about 4 weeks of effort and phone calls and visits, I had a GP, an NHS number, and a hospital for antenatal care.

Antenatal or Prenatal Care

The Brits are fancy, so they don’t call it prenatal care, it’s Antenatal Care. But as you may have heard, most antenatal care, birth services, and postnatal care are given by midwives. Midwives basically seem to be nurses trained specifically on childbirth, going through separate midwifery training. Essentially they seem like expert nurses at childbirth, so a little different than the US where there’s more of a hippy association (though I’m sure they are also experts at childbirth). In the UK, they’re very, very prevalent. I saw no nurses, just midwives, doctors, students, and techs.

I saw both a midwifery team and attended the OB/Cardiac clinic where I saw many doctors in a hot room. The midwives did the typical prenatal tests and checks; the OB/Cardiac clinic did some of that too, and a bunch of special cardiac things like asking “have you experienced any cardiac symptoms this week?” At first I had appointments with both, but thank goodness the OB/Cardiac team said I just had to see them. I saw the same high risk OBs every week, but the cardiac docs varied so I had to repeat myself and/or heard the same messages from them visit after visit.

When I talked with Brits about the NHS, the most reasonable complaint I heard was that coordination of care across different practices / specialties was non-existent or difficult if it wasn’t overt, like the OB/Cardiac clinic. I definitely found this to be the case – it’s kind of like everyone has their role and does it, and oh that’s nice that someone else is doing something. You have to be the connection point, which I guess isn’t totally unreasonable… but it is a little ridiculous that I had to lug around paper medical records to every appointment (even though I had an Electronic Medical Record as well). The doctors / midwives had to fill out both the EMR and the paper records for each visit!

If you didn’t have your paper records, you couldn’t be seen in 99% of cases (excepting blood work and ultrasounds). Clearly I forgot my paperwork a few times. More on that later.

Anyway – the actual care itself was good. From 13 weeks pregnant to about 34 weeks, I had regular check-ups every 4 weeks. That’s right – just every 4 weeks even though I was high risk. In reality, between the scans and bloodwork and check-ups, I was at the hospital every other week. Once – three times in one week because they couldn’t coordinate appointments to all be on the same day.

It was a combination of less prenatal care with more. Maybe it could be categorized as more scans and tests, but fewer general visits..? For example Baby #2 – aka Vivian – had two fetal echocardiograms (anatomical scans of the fetus’ developing heart to make sure it was normal) before she was born! In the US, it was just one, but then another right after birth. I also had more regular ultrasounds – 19 weeks, 26 weeks, 32 weeks, and 36 weeks – all to make sure Baby #2 was growing appropriately (cardiac patients’ babies tend to be lower birth weight). And lots of blood tests thanks to an early slightly high glucose test (tip: don’t drink juice and eat gummi bears prior to your GP visit).

The other most obvious difference between US prenatal care and UK antenatal care was that the Brits don’t care about pregnant women’s weight. That’s right, I was weighed only at my first GP appointment. I don’t even know what my final weight was before giving birth! I was told they “consider it old fashioned” to be concerned with weight. I don’t have a clinical opinion on this (nor am I qualified to give one), but it was nice not to stress or think about it too much. I still weighed myself a few times out of habit… but I really liked not focusing on that. Plus we don’t have a car here so I knew I was getting plenty of exercise.

I suppose they just figure the weight gain is something to be worried about after the baby is born. Speaking of which, perhaps it is time to break out the ole scale. Or maybe I should wait until I can walk more than 50 feet / 15 minutes at a time.

That, my friends, is all for now. The next post will cover exciting topics like: “Just what is this NCT class everyone talks about?” And, “Things besides paper medical records that are old fashioned,” and “Random other differences between the US and UK medical care.” Fascinating, I know.

Now I must take care of my 6 day old infant. Isn’t she gorgeous?

black and white baby

3 day old Vivian Hazel – healthy and happy product of the NHS. Or at least the care received through the NHS.