Epic (and slightly political) pregnant musings……

Time for a VERY overdue blog post….. I will blame it on the fact that I managed to find employment before Christmas doing supply teaching at a local British Forces Primary School for a whole month!!!  It feels very good to have earned some money of my own again after a few months off AND as I am now also receiving my Maternity Allowance (thank you Department of Work and Pensions! Oh and thank you to myself for being in full-time employment for the last five years and therefore paying heaps of National Insurance and Tax)  I can actually spend (fritter) money in town without feeling hugely guilty.  
It has been an interesting week with regard to my unborn child and one that has made me consider British healthcare and its worth at the moment.  I am a big fan of the NHS and think that we are incredibly lucky to have such an amazing free resource at our fingertips but various things that have happened over the last year have made me consider whether some drastic changes might have to be made in the future.  My dad is a popular NHS GP who with his partners runs a tight ship at his surgery.  Having worked at his surgery as a teenager and during university holidays (nepotism at it’s best!) I have seen how a well run practise can make people feel that their illnesses and worries are appreciated and respected (even if they appear to us non-doctor goers to be slightly melodramatic……)  
My own experiences over the last year have been a bit more hit and miss and I have at times felt very unsupported by the medical professionals supposed to be helping me through some tough events.  I fell pregnant for the first time at the beginning of 2012 and everything appeared to be going swimmingly.  Unfortunately, at our 12 week scan we discovered that the baby had no heart beat and was therefore no longer viable having stopped growing at approximately 8 weeks.  Whilst this was very upsetting we both also believed that in this case something had obviously not been right with fetal development and that therefore it was the right thing to happen.  We were taken away from the scan room and put in a room down a corridor away from the waiting rooms where other people were waiting to see their babies.  I remember (rather stupidly I realise now) being conscious of not wanting the waiting people to see me crying as I walked past because I didn’t want to put a dampener on their excitement.  We were then left in our little room waiting to see a doctor who took about 25 minutes to arrive due to other clinics.  I understand that doctors cannot drop everything to come and see someone who is not an emergency but what was frustrating was the fact that once we were left in our room no-one came in to see us to let us know how long we might be waiting or to offer us a drink while we waited.  We eventually saw the doctor and were then packed off home with a selection of leaflets on miscarriage and a decision to make as to where to go from there.  Over the next few hours I decided (with help from various friends and my Dad) that I would go with the pessary option to bring on a more natural miscarriage.  My initial reasons for this were that my body would see it as a more natural occurrence and that hopefully I would recover more quickly and be able to hopefully fall pregnant again sooner.  I subsequently rang the hospital to book in to go and get things moving only to find that the clinic closed at lunchtime and wouldn’t be open again until after the weekend.  Nobody had told us this whilst we were at the hospital and I felt very much that I had been left in limbo.  Over the weekend we tried to keep busy (and therefore distracted) by going shopping, for walks and watching junk on TV but as I was a totally emotional wreck prone to bursting into tears it was hard and not helped by the number of pregnant women/newborn babies I seemed to see everywhere I looked.  I eventually managed to speak to a lovely doctor on the Monday morning who asked me to come in the following day to discuss things further.  On the Tuesday my amazingly supportive husband therefore ferried me the 45 minutes back to the hospital where we were booked in to see someone in the Early Pregnancy Unit.  On arrival, we could hear the doctor and nurse talking about the fact that my maternity notes seemed to have vanished since the Friday scan (I had been told to leave them at the hospital) which didn’t exactly boost our confidence in the set up.  However,  we then had a fantastic meeting with the lovely doctor who went through everything again and who was clearly rather appalled at the lack of information we had been given on the Friday.  As a result of our chat, I started worrying about my decision to go with the pessary option so he recommended that we go off to get bloods done (this had also been forgotten about the previous Friday), have a cup of tea and read the leaflets he had given us on ALL the options available to us.  As I sat in the Phlebotomy waiting room I read the leaflet on the ERPC procedure and instantly felt that this would be the better option for us as it wouldn’t entail me going through a potentially long, painful and emotional miscarriage which might not even work and which would then mean having an operation anyway.  We were therefore booked in for the Thursday of that week.  On the Wednesday evening I started cramping and having slight bleeding so I knew that things were on the move anyway but still knew that the operation was the right path for me to take.  We arrived at the hospital (yet another hour and a half round trip!) at 1pm with me absolutely starving having been nil by mouth since 7am.  We were seen straightaway by a lovely anaesthetist and fab nursing team who told us that the consultant would see us soon but that “he was always late so we could be in for a long wait”  He eventually turned up at about 3pm and stayed for about 3 minutes.  During this time he brusquely gave us a rundown of what would happen and then asked us if we had any questions.  I was still rather shell-shocked by the whole experience so said “no” but my husband then asked if we would need to come back for another scan to check that everything was out.  The response we got was a very supercilious “of course not!  I will know when everything is out!” and off the consultant went.  Whilst I understand that he will deal with this situation every week I was shocked by his coldness and apparent lack of compassion for what for us was a deeply upsetting experience.  I was eventually taken to theatre at 5.30pm (having agonisingly been put in a room opposite the kitchen where the nursing staff were making tea and toast for everyone else on the ward – the smell of toast must rank as one of the best ones there is…..)  Our experience of the NHS in this occurrence was therefore a very mixed bag.  I cannot fault the day surgery nursing staff who were kind and compassionate and similarly the doctor on the EPU was fantastic but I have to say that the way we were treated by everyone else was disappointing and I can distinctly remember saying “I never want to go back to that hospital ever again” as I felt in general quite unsupported in what was a very emotional experience.
On a more positive note, it seems that we are fairly fertile as I fell pregnant again 6 weeks later finding out on the morning my husband drove off to Germany to start the job he is currently doing!  I therefore rang the midwife and arranged my booking in appointment already knowing that this time I was going to choose the other hospital that was an option to us in our last posting.  Having taken time off work for the appointment I arrived on time only to be told that she was running 45 minutes late.  As most NHS appointments in my previous town seem to run late I was prepared and had brought a magazine as the ones in the local hospital are so rubbish (Take a Break anyone?)  The midwife then popped her head out of her office door and said “Be with you ASAP.  Have you been pregnant before?”  “Yes, but it resulted in a missed miscarriage in March” I replied.  “Oh, so you’ll know how to fill the paperwork out though?  Do you want to get on with it?  It will save me some time if you do.”  she responded.  Slightly shocked at this apparent delegation of duty I meekly took the paperwork and got on with it.  I am still unsure how she knew that I was going to be able to fill it in accurately but think it probably came down to some assumptions on her part based on the way I was dressed (work clothes) and my accent (standard middle class rather than pure Wilt-shy-errrrrrrrr)…..  When I eventually saw her, she rushed through the appointment saying “I need to make up time”, knocked my urine sample over EVERYTHING and bundled me out of the door.  This time, I can distinctly remember thinking “thank God I am moving away and don’t have to see her again!”  
Due to what had happened with our previous pregnancy we decided to pay for a private scan at 9 weeks (it so happened my husband was back in the country temporarily) to make sure that everything was okay.  The clinic where we had this done were fantastic (as is to be expected when you are throwing £80 at them for 10 minutes work) and we were relieved to see a little bean with a beating heart.  The sonographer told us that we weren’t as far along as we had thought so that we should reschedule our NHS 12 week scan as they wouldn’t be able to do the Nuchal Fold measurements.  As we would not have known the gestation of our baby at this point without having spent our own money we decided to be a bit naughty and keep quiet so that my anxieties could be kept at bay with another scan.  Lo and behold (and with me demonstrating my best surprised face), our baby wasn’t far enough along at our first 12 week scan so I was booked in again for approximately 13 weeks.  I cannot fault the team at this second hospital.  They had taken the time to read my notes so knew what had happened previously  and were therefore compassionate and kind whilst checking our baby ensuring that I only saw it on the screen once they had seen a heartbeat and felt that everything was okay.  Had we not been imminently moving to Germany I would have been more than happy to have given birth there.
Since we moved to Germany at the end of August I have been able to compare NHS vs Private Healthcare and I have to say that if I had the money I would go for a combination of the two.  Our baby will be born in a private German hospital (we don’t have to pay as it is covered by British Forces) but I also see a British Forces NHS midwife for general appointments and the difference in care has been very interesting.  Back in October, we had a very long 20 week scan at the hospital with a doctor who spoke amazing English and who explained everything to us as she checked our little boy.  Then in December we had a similarly detailed 31 week scan (standard fare at this hospital) with the same doctor.  Seeing as how in the UK you get your 20 week scan and then that is it for the rest of your pregnancy (unless you have any problems) we saw this as a bonus opportunity to see our baby and really appreciated knowing that everything was fine.  
It has been in the last week that I have really experienced private medicine at its best.  Last Friday the telephone rang at 8am and we were asked to come back into hospital as something was not clear from our 31 week scan.  I immediately panicked and burst into tears (standard response from me at times of stress) and so off we went.  When we arrived we saw the German midwife who did all the usual checks (urine, blood pressure etc) and then told us that there was nothing to worry about but they just wanted to check something with the baby’s heart as something had not been clear.  Obviously I was filled with instant dread and therefore began to imagine all the things that could be wrong with our baby.  After a good 15 minute long scan two doctors told us that everything was fine and that we could go home having explained that they just like to be careful and that was why we had been called back in.  They also told us that they had been trying to contact us over Christmas but that as we had been in the UK we had not answered the telephone or they would have had us in sooner.  All in all we were very impressed at the care they took over checking everything out.  
Then yesterday more drama!  At a routine British midwife appointment my baby’s heart rate was erratic and too high so off to the hospital I got sent again.  We arrived at the labour ward where I was put in a very nice room on a very comfy bed and hooked up to a CTG monitor.  I stayed hooked up for 30 minutes whilst the German midwives monitored the baby both from inside the room and from their midwife station.  We were then told that everything looked absolutely fine but that they would send me for a scan just to check before I could go home.  So the most scanned baby in the world took centre stage again and we got another look at our robust looking little boy.  My experience yesterday was amazing (although obviously a little stressful) and has made me feel very confident about the care I will receive when I go into hospital to give birth.  The German midwives speak amazing English, the hospital is clean and modern and I was really well looked after.  However, they were a little bit bemused as to how quickly the British midwife had delegated responsibility to the hospital.  They asked me how long she had monitored the baby’s heart rate before she had rung the hospital to which I replied “maybe 2 minutes”  I was then asked “and then did she test again after a few minutes?” to which I replied “no”.  They were absolutely amazed that I hadn’t been monitored for longer at the Army Medical Centre before being sent to the hospital.  Even I could see that she should have tested again after a certain period of time (particularly as I had told her that I had walked into camp at a fairly fast pace which I imagine could effect how my baby feels as well as how I feel) but instead her reaction was to send me straight down to the hospital without any further monitoring on her part.
In conclusion therefore I would say that from my experience whilst we are incredibly lucky to have the NHS and the ‘free’ service it provides it also appears that it is very dependent on where you go as to the level of care you receive.  The things that I have learnt during 2012 and this small part of 2013 are that:

  • The care you receive can be a bit hit and miss depending on where you are.  Surely we should expect to receive a good level of care wherever/whoever you are?
  • There are some medical practitioners who seem to have lost the ability to think compassionately which is surely one of the key elements of practising medicine?
  • Our hospitals are over stretched but not helped by rubbish clinic times and practitioners time-keeping abilities (why is it just accepted that someone is always running late?  I wouldn’t be allowed to always run late in my work (also public sector) so why should they?)
  • Whilst there are some not very nice medical practitioners there are definitely lots of amazing ones who haven’t forgotten the importance of kindness and who are proud to work hard at their jobs.
  • I would almost certainly pay for a combination of private and NHS care if I could afford it.
  • Miscarriage is far more common than you realise.  This new found knowledge and other people’s experiences of miscarriage definitely got me through mine and I hope therefore that this blog post might help someone going through the same thing.
Finally, any midwife who can spend more of your appointment asking you where there are good Jo Malone shops in the South East of England rather than re-monitoring your baby’s worryingly high heart rate might need to rethink the structure of their appointments……  Whilst I am more than happy to talk Jo Malone and other amazing products I can also understand why the German hospital was a bit frustrated to be spending time on me when the only problem was a lack of initial monitoring.  Good job they didn’t seem to be busy!!!
Apologies for the ranty, personal, political blog post but I needed to get it all off my chest!
Mili x