The most frequent question I’ve been asked during my pregnancy is whether or not I’m having twins (no, but thanks for the complex). The second-most frequent question is: Will I be having the baby back home in the States or in England, where I’ve lived for nearly a decade? My response is always the same: “Um, the free one, obviously.”
The free one is England, where — not including prenatal vitamins, cheap Asos maternity dresses, a much-beloved pregnancy pillow, and other baby swag — I have spent a grand total of £20 (about $26 USD) on my pregnancy. That’s the amount my local clinic charged me to print out an official letter giving me medical clearance to travel by plane.
But everything else has been free, courtesy of the National Health Service. My scans. My appointments with a general practitioner, midwives (who, as opposed to an OB-GYN, oversee the process) and various specialists, including a physical therapist. Prescriptions. Dental cleanings for the duration of my pregnancy and up to a year after my due date. A breastfeeding clinic — with home visits and support available after the birth — and antenatal classes. The labor and delivery, immunizations and checkups to come.
I’m not sure what this would all cost in the United States. I haven’t had health insurance — which was covered by my former company, though I paid extra for emergency and disability policies — since 2006, when I left a full-time job in New York City to go freelance and eventually move abroad. I remember all too well the co-pays and steep prescription costs, not to mention the time I got charged $1,300 by a doctor because of a paperwork error. The insurance company refused to cover it.
And I remember feeling lucky for it. For about 18 months afterward, I went without any health insurance because I couldn’t afford any of the policies I researched. I relied instead on WebMD and the odd $100 walk-in clinic visit. I was hyperaware of being a burst appendix away from bankruptcy. Fortunately, no accident befell me until the week after I moved to London, where, even without a registered GP, national insurance card or really anything proving that I wasn’t just an American tourist, I was charged just £25 for a consultation and crutches for my sprained foot.
In this era of GoFundMes and threats to the Affordable Care Act, I am immensely grateful for the NHS, which celebrated its 70th birthday this year. As a full-time freelance writer and a single woman without a partner’s second income to fall back on, I honestly don’t see how I could afford to have a baby without it.
But the NHS is only able to afford to provide these services for free by cutting out certain creature comforts and procedures it deems unnecessary. A pregnant woman here will get her first ultrasound and booking appointment at 12 weeks — when the risk of miscarriage has significantly dropped — followed by an anatomical scan at 20 weeks and a growth scan at 36 weeks. This may vary by area — my hospital only began offering the 36-week scan to patients a few months ago — and more monitoring is available if there are complications or if the mother has a history of miscarriages.
The wait can be excruciating. I was so wound up with nerves ahead of my 20-week scan that I got lost on the way to the hospital and turned up late to the appointment; when they said I’d need to reschedule, I full-on wept until they took me back and gave me the proof of life I so desperately needed. (Note to self: Stop reading online forums about when the baby is due to start kicking.) Another expat friend expressed frustration that a pregnant pal in the U.S. was already getting her first scan at eight weeks, while she had to wait another month and simply trust that her home pregnancy tests weren’t steering her wrong.
The general attitude is to be sensible and let nature take its course — and to be fair, the hospital where I’ll give birth has been doing this since the 1700s. IVF is offered provided the couple meets strict criteria, which varies by council but can include age limits and whether or not they already have children. Scans are performed when they are most vital and informative, even though that may be of little comfort to a newly pregnant woman in need of reassurance. The sex will not be confirmed until week 20 — though I cheated and paid $50 for a scan during a visit to the U.S. at week 15. Appointments are kept short, and on a recent occasion, I was told to take a photo of a breastfeeding flyer on my phone because there weren’t enough copies to go around. Not in the budget, I guess.
Circumcisions must be arranged through a private clinic because they are generally not considered medically necessary. Elective C-sections are also rare, as they are considered risky and more costly. Exceptions are made for, say, high-risk pregnancies, women carrying multiples or anyone experiencing tokophobia, or an extreme fear of childbirth, provided they seek (free) mental health counseling first.
C-sections will also be performed if there is a complication or the midwife deems it necessary, though assisted vaginal deliveries (using forceps or a vacuum) are preferred if the situation allows. Assisted deliveries are more common in the U.K., accounting for 12 percent of births versus 3 percent in the U.S.
At-home births or birthing pools are an option for those who crave a Zen delivery experience. Many moms (sorry, mums) give birth using only gas and air as pain relief, though — thank God — arrangements can be made for an epidural.
When I do give birth, I won’t be lounging around post-delivery in a private suite or feasting on steak and lobster like some of my American mom friends have. The kid and I will be given a bed in a shared room, and while I won’t be shuffled out hours later like Kate Middleton (I mean, Duchess Catherine of Cambridge) — the perfect paragon of no-nonsense NHS virtue — I don’t expect to stay more than a night unless complications arise.
Until then, it’s all pretty chill. Take my prenatal vitamins, see my midwife every few weeks and keep calm and carry on. There’s a lot to be said for this approach; research shows that maternal mortality rates are significantly higher in the U.S. (26.4 women per 100,000, per an NPR and ProPublica investigation released last year) than in the U.K. (9.2 women per 100,000). If a pregnancy is deemed high-risk, trust that the necessary support will be offered.
There’s also a lot to be said for being able to put that money I’m not spending on co-pays and insurance premiums toward diapers (erm, nappies), strollers (fine, prams), and college (sigh, uni) funds. And while I often feel like I’ve somehow wandered onto the set of Call the Midwife — my breastfeeding workshop was in Poplar, where the British drama is set, and my hospital’s claim to fame is having had Joseph “The Elephant Man” Merrick as a patient — I will never take the services I’ve received, gratis, for granted. I only wish every mom-to-be in every country could know what that feels like.
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