Pregnancy in the UK

My last post was a recap of last year and led us to the current  pregnancy. I told you about my experience from positive pregnancy test, HG, my hospital stay at 6 weeks gestation and that we told Emme after the 12 week sono. 

Just to back up a moment for the purpose of this post...

(Pic- 11weeks)

I went for my first midwife appointment at 10 weeks (don’t think I touched on that??) and at that time was so miserable-as the midwife could see. I would have to constantly sip on ice cold decaf tea to avoid swallowing and tasting my own saliva and throwing up—honestly the worst! That appointment was about 2 hours long. I was shocked and never expected to be in there for that length of time. This was my first encounter with any midwives and I am told this will be the midwife I will see throughout the pregnancy (and possibly at birth if she is on shift). It was an appointment that consisted of mostly me in a chair and the student midwife at the computer going through multiple tabs and questions. They asked me every single question in the book:

-Past pregnancies/past labor experience

-They asked me my plans for birth with this one/offered me a home birth with the home birthing midwives--I said no thank you. 

-Family history (specifically on the female side, and focused in on diabetes)

-Smoking/Drinking history

-Current child medical history

-Living situation: do I rent/own? Do I feel safe in my home? How does my partner handle stress? Does anyone you live with or that takes care of your child smoke? Does anyone do recreational drugs? Do I have any animals? How many bedrooms? What are my plans for sleeping arrangement for my infant? 

-They assessed me for possible signs of depression (which made me laugh). Of course I was depressed back at this time, I never left my bedroom and I didn't hardly go hours without being sick. So yeah, I told them to take my answers at that time with a pinch of salt. 

-I wish I could remember it all, but really I wasn't well and with every new question I was like my goodness what more could there be to ask?

They did my weight, blood pressure,  took a sample of my urine which was normal, and took some blood work from me to check for immunities, iron levels, etc...basic stuff. What they didn't do that they did in USA was they did not take a pap smear? In USA (I believe from my recollection), no matter when you last had your last pap smear they do one at your initial OB appointment?? Here in UK because I have had one within the last 3 years (yes, that is how infrequent they do them here) and it was normal, I did not require one. In that moment, I was probably quite glad of this... I was running out of iced tea and ready to go home. At the end of the appointment they sent over a referral to the sonography department to request a 12 week sono. I was to then wait for a letter in the mail (old school, I know) for my sono (known as 'scan' here) appointment. At this time, they predicted my due date based on cycle to be May 6th, 2023. 

(Pic-12 weeks)

Week 12--we did indeed receive our pigeon post with a scan appointment. It was going to be when I was 13-14 weeks or something so I of course called the number on the appointment letter and asked for sooner (I honestly don't know why they send letters, it is always on a day that does not work, or I am unable to make...just let me talk to a person or log onto a portal to book!! I digress..). The lady was able to change my appointment for the date I turned exactly 12 weeks. 12 week scan was quite relieving. I was so happy to see a very active wiggly baby in there after all those weeks of being so sick. It gave me new life in this pregnancy. They did all the measurements and pictures I expected of a 12 week scan, but when I asked if they could turn sound on for heart beat, she said 'we don't do this at this stage'. So that was different from USA. At this point I had also not had a doppler done at the midwife appointment, so yet to hear that little sound. The sono predicted me to be further along than based on my cycle and set a new due date of May 2nd, 2023. Hey, it is 4 days and I will take it. As described in my last post, we couldn't wait for Emme to get home from school this day and we told her the big news. At this appointment, I was also asked if we wanted to do blood work for genetic testing. It tested possibility for 3 genetic syndromes: Edwards syndrome (Trisomy 18), Patau's syndrome (Trisomy 13), and Down Syndrome (Trisomy 21). We opted to do the blood test which was free and provided under the NHS and got the results about a week later to say I was 'low' risk for all three. The way the test is designed (low, moderate, or high--I believe) is it doesn't give you a definite NO, but if my chances had been moderate or high then I would have gone for further testing if I agreed (such as an amniocentesis). This is not to say that baby does not have those syndromes, it is just a low chance, and obviously it did not test for any of the other many syndromes out there, but we opted to do the test to be as informed as possible. 

Weeks 13-15 were pretty uneventful. I returned to working both of my jobs and I arranged my schedule to be morning until late afternoon as evenings have always been my trigger for illness. Unlike the US, the UK take this work place stuff super serious!? I had to have return to work meetings with my managers and for my clinic job I had to do about a 20 something page risk assessment to look at all aspects of my job and how that may affect me as a pregnant woman or my unborn child. We had to discuss how I would manage my work days, stress levels, bending and sitting, possible infection risks, taking frequent breaks, making sure I eat and drink, discussing in my job when and if I would require special equipment, my vaccination status, and so much more. All had to be reviewed and signed by myself and manager and sent off to HR. I returned to work fitting very easily into my nurse uniform (clinic) and most people did not know of my pregnancy or why I had been off. I didn’t really want people at work to know other than management until I had that 12 week scan. Over the weeks the uniform got a bit tighter and tighter and it became more obvious of my reason for being off. I was happy to tell people at that point about our second one on the way. 

(Pic-16 weeks)

Week 16 we were off to Malta! Even before pregnancy my husband and I had taken a week off in November saying it would be a good time to take a holiday. We put off booking anything when we found out we were pregnant in August, and waited until just weeks before to see how I was going to be feeling. As I felt pretty OK on the two meds I was taking (zofran 2x a day and cyclizine 3x day), we decided this may be our last chance for awhile to go jet setting. Malta seemed like the perfect choice with its warm temperatures, warm waters, and only a 3 hour flight from Heathrow. As Emme is 4 years old, she is not yet statutory age for school, which is 5. We were able to request her to come out of school for that week and whilst the head teacher didn’t “approve” it, there was not much she could do and we didn’t stand the chance of being fined. We felt that Emme is in year R and while she may miss a week, it was learning that we could help her with and catch her up on. We felt this trip was important for all of us. I won’t go into loads of details about the trip as I posted like 72 photos on FB, but I did want to say it was beautiful and I did well with my nausea during the trip. We managed to go to the kids mini disco every night at 730 and then we were in bed every night by 830-9–haha. Much past that and I would feel to the point I would need to be sick. Something switched in me that week and I don’t know if it was leaving my home environment that helped or it was the fact I was 16 weeks, but I wanted to eat EVERYTHING and all the time. (Good thing it was all inclusive!) I was finally able to stomach a cup of coffee and it was life changing. I had so much energy. I craved crunchy salad, fresh fruit, and lots and lots of cake and sushi? (cooked!) The food was delicious and I came back from that trip absolutely not fitting into my nursing uniform. The night we arrived back, we were on the plane and Daniel and I both didn’t feel great. It was a combo of it being later evening and us both having lack of sleep, I think? But I got off that plane and went straight to the nearest convenience shop in the airport and got a bottle of cold water. I absolutely chugged it and I did not feel sick or get sick! This was the first time in the pregnancy I was able to drink or stomach water. Up to this point I had been drinking peach iced tea, hot decaf green tea, and some sips of Diet Coke. I actually never regained the ability to drink water in my entire pregnancy with Emme. I drank crystal lite lemonade until the final push (lol). 

Being back home with a bit of a tan, ability to drink coffee and water, and I was a new woman. Ever since then I’ve just obviously grown. I’ve definitely been able to eat and stomach more foods in this pregnancy than I ever did with Emme. The “sickness” feeling isn’t often 100% gone, but I’m not physically sick as long as I took my meds. 

I went for my 16 week midwife appointment. Not much to report there. I was in the office maybe 10 minutes? I had a student midwife, again, and she just asked me if I had any symptoms I wanted to discuss and am I feeling the baby? (Yes! Much earlier than with Emme) Checked my urine and she asked my safety questions like if I feel safe in my home and then she did the Doppler for heart beat of babe, it was 138. She set me up to come see the actual midwife in February. That’s all folks. 

(Pic-17 weeks)

Weeks 16-19, not much to report. Energy and mostly happy in the day and nausea and uncomfortable sickness feeling came on about 3ish-4, didn’t go away until I went to sleep. Still was on the 2 meds. Continued to grow and feel baby more and more. 

20 weeks we went for our anatomy scan. We got to see the sweet little thing on the screen. The baby was VERY active and she chased it all around for its measurements. She said on several occasions “this baby is all arms and legs”. The baby definitely appeared to have very long legs just from seeing it on the screen, but I am no pro at this. All measurements were good and she was happy with all of the organs. For a moment she looked at baby’s mouth/nose assessing for any possibility of cleft lip and she froze the screen. I just gasped and said oh that’s Emme’s mouth and nose! I wish I had asked for a picture of it. This baby has the same facial features (from what I could see) as Emme. We got to see the heart and its chambers, we got to see the blood flow, but she did not turn on the noise so we could hear the actual heart beat. I asked if she could and she said they do not do this at this gestation as too much “heat” or something?? Not sure, I remember in USA hearing Emme’s heartbeat at (I think) every Sono? She said I would get to hear the heartbeat again at my next midwife appointment. She then went on to the southern region bits and both Daniel and I looked away as to not “ruin” the surprise we both want for the gender. At the end, she had gathered all the photos she needed and the measurements. I then asked her about this pain I am having (mostly at night) in the upper left quadrant of my abdomen. She said she didn’t mind scanning it just to see. She put the probe on and all we could see was baby’s butt right up there next to my stomach. She said it is likely baby gets in it’s comfy position (also as I sleep on my left side) and I am feeling the pressure from baby on that area. Only thing that has me thinking since the scan is that we saw baby’s butt during that part and it went to move and she suddenly went “close your eyes!” to us… making me believe it was showing off it’s organs we do not want to be made aware of yet (whoops!). We saw nothing, we know nothing, and I think that is bothering some family and friends more than it’s bothering us :) 

(Pics-21, 22, & 23 weeks--all over Xmas period)

Weeks 21-23 we celebrated Christmas. I kept busy and on my feet preparing to host Boxing Day and also look after Emme being off school and working both my jobs. It kept me busy and not much thinking about the pregnancy (in a negative way). I weaned myself off of the zofran and continued just the one medication, cyclizine. I also added back in my multivitamin and was able to stomach taking it with food at night. I started to feel like my iron might be low, so I returned on the vitamin to see if it will help. 

(Pics-24 & 25 weeks)

I am 25 weeks pregnant now and next appointment will be my glucose tolerance test first week of Feb when I am 28 weeks. I will see the midwife the following week and go from there. I am told I will not require any further Sonos unless they are to be worried about position, size, or lack of movement of the baby. I can’t remember the exact measurements of the baby but 250grams and 12 inches long is stuck in my brain, so that could be it? Haha. I just know she said it is long and I can see that on the screen as well as feel it in my belly! 

Now that Xmas is over and we’re into the new year I’m starting to slowly plan for this baby and try to collect bits when I can that I know we will need. One step at a time. As far as how Emme is handling it… she is not the most cautious around myself and belly although we continue to remind her. She does give my belly kisses whenever she wants to and she calls it “mummy’s baby”. She says it’s a girl, and it will not be a boy as boy’s are stinky. She randomly tells us different names she likes for the baby GIRL which changes day by day (mostly names of Disney princesses) and she is reluctant to give us boy names as it is NOT a boy she says. I myself have no clue, though I sway more towards thinking it is a boy but really don’t have much evidence for this. 

My main issues are that I now have low hemoglobin/iron so I am quite pale and tired. I have a cold that is really lingering on and I really struggle to sleep. Between trips to the toilet and not being very comfortable, I am awake a lot in the night. I am off both anti sickness meds--win!! I also have restless leg syndrome at night that drives me crazy, but overall I am OK. I have energy to move my body everyday, go to the gym, swim, clean my house, and run after Emme when need be. I hope to continue to do well and want to get to 39 weeks again (like I did with Emme). 

I posted on my social media asking if anyone had further questions I hadn't thought of and there was a theme:

1. How is care different in UK as it is nurse (midwife) led versus OBGYN MD led?

I feel the differences so far have been that I don't really feel like I have a choice here. In Peoria, on our OSF insurance company, we weren't really restricted to which office we attended, it was our personal choice and based on who was taking new patients? The only thing that insurance led on was which hospital you attended to birth the baby. (it was cheaper to go to the hospital that was primary choice for that insurance..in my case, my working place at the time--OSF). The OB I had in Peoria was based on family and friends recommendations and I was already seeing him (yes, HIM) for my annual pap smears. I would float with my job to the newborn baby nursery/post partum department and I also based my choice off of who the nurses liked, ha! In Peoria (USA) there were offices I could have chose that had midwives leading the service, but ultimately I stayed with my OB that I had already been with for years prior to pregnancy. I would attend my appointments in the USA and the nurse would do my weight, take my urine sample, do my blood pressure, ask me some questions on the computer and then I would wait for my OB. I never had the horror stories that others did where they waited hours for their OB's to return to the office from the hospital doing deliveries or anything like that. In general, I was pleased with my OB. He listened to me, he knew me, he remembered things about me (and my family, haha), I felt really well taken care of and heard. Oh, and because I was so sick with my pregnancy with Emme, he set up a standing order at the infusion clinic for myself to go in and get IV bags of fluids whenever I wanted. He would also always be very quick to recommend or try nausea/vomiting medications in the beginning of my pregnancy until we found something that worked for me. This being said..... its a service you PAY FOR (some of it). The genetic testing I did when pregnant with Emme was something like $400. My hospital bill after having Emme was about $1,000....yes this is all with insurance that cost us about $400-$500 a month. So did this play into my experience?? During my loooooooooong labor with Emme my OB was not initially on call when I went to the hospital (the first time). I had been in active labor for about 8 hours and it was getting to where I couldn't breathe through the contractions. I was 4cm dilated and the OB on call sent me home--ha! I returned back to the hospital about another 8 hours later, and my OB was on call at that time and he said, well of course put her in a bed (I was still only 4 cm dilated, 16 hours into active labor). He was quick to come to the bedside and show his face and was also quick to say, your body may need that epidural, but if you want me can try other things first. It ended with an epidural and me going to sleep for about 5 hours until the next morning (when the epidural stopped working just in time to push!). He stayed 'around' that evening and into the next day. It was the nurses who were trying so hard with me and helping me with pushing and really doing all the hard work. It wasn't until Emme was almost basically out that the OB came in, barely had enough time to put his gown on, and out she came into his arms. So yeah, that last bit he wasn't really THERE for... but I was told throughout my entire labor he never left the hospital. (Could have something to do with my step sister being on the floor above me in premature labor that night as well.... we shared him as our OB.) 

Anyhow, in terms of my experience so far with it being midwife led... I just feel quite alone if I am honest from a medical standpoint. 

I also feel like because my midwife is through my GP office, if something can be handled by the GP, then the midwives will refer you there. For example, I have recently been having some epigastric pain. I had something similar with Emme and my OB ordered an ultrasound to make sure it was not my gallbladder/liver, and he did blood tests to check for all of that as well--all was fine. With this pregnancy, I called the midwife helpline and they said call your GP. I said well, why? They said you're too far along for the Early Pregnancy Assessment Unit to see you, yet you're not yet 26 weeks so we wont see you in our triage office? I called the GP and without doing any tests they stated it must be gastric reflux. I then persisted they do an ultrasound and blood work and while they said no to the US they did order the blood work. I had that done and was called back the next week to state my hemoglobin and iron are low and I need to start on omeprazole in case I am having bleeding in my GI tract/stomach, but also to start iron supplements. Of which I said, done that many a time and they make me very sick. She said, well start the anti acid, keep taking the vitamin you can stomach, and have your midwife re evaluate at your 28 week appointment--my GP passing the buck back to my midwife. 

This question and the differences to be continued as I have my 28 week appointment, the appointments thereafter, and my delivery. 

2. Do they still do the glucose testing over there?

They only test for gestational diabetes if you have risk factors (Age, familial history of it with your maternal side/sisters, diagnosis of pre-diabetes at any time in your life, etc.). I ticked the boxes on a couple things so they are having me do my 28 week glucose tolerance test to be sure. I see my midwife the next week for results and to have another appointment with her to check the fetal heart sounds, my urine, BP etc. 

3. Do they test for abnormalities?

The NHS offer at your 12 week appointment the blood test that tests for the 3 genetic tests as stated above. Should you want anything further such as the Harmony test, you would need to get that done privately and pay the £400 to do so. We did not choose to do that this time. We were reassured the other test came back low probability, but equally, we decided should this baby have a genetic abnormality it would not change the outcome. We would still be having this baby. 

4. The difference between being pregnant in USA vs UK?

Pro's and Con's to the UK.

Pro's:

-Job safety and security as well as pay should you need to be off due to the pregnancy. 

-The weather stays quite mild throughout the year so I have been able to stay on my feet and taking walks in all seasons.

-Maternity leave--we will get to that in a moment.

Con's

-Lack of pregnancy clothes ANYWHERE except online. 

-Lack of stores to buy baby things--even as simple as a crib or a stroller. No big outlet/chain stores here to try different things out before you buy it. Everything is online.

-No breast pump offer with your 'insurance'

-Popularity of single and/or manual breast pumps over electric double ones. Of course, there's always Amazon.

-The cultural acceptability to comment on a pregnant woman's body. I will go into this more...

I don't want anyone in the UK reading this think, 'oh my, did I offend Jamie??', it's been COPIOUS amounts of people. People I know, people I do not know. In general it seems to be socially acceptable (and not apparently rude), to call a pregnant woman 'huge, massive, big, large' and asking 'are you sure it's not twins?'. Now maybe people in the USA are reading this and saying, well that happened all the time to me in the US?? What I can say is, never for a moment did ANYONE in the US comment on my body--whether it just be referring to the bump or not---as any of those adjectives above. Neither did I think it was socially acceptable to say to anyone I was around in the US that they are any of those adjectives. In general, I am not so much worried about having those comments thrown at me, as I do not feel I am any of those things, I feel I am pregnant, lol. But I just have to point out that this has been a massive difference here whenever I enter a room, basically, that people comment on how I look. I did have a conversation about this with someone I am close with here, and she said 'they are not referring to you, they are referring to your bump', As in, I am getting big--the baby is getting big, I am getting massive--the baby is getting massive, etc, etc. I am to not take great thought into it and it is a positive thing??? In my opinion, people are stating the obvious. However, equally, what if I was really really small? I wasn't growing? Baby wasn't growing? I equally don't think people should be commenting on that? There could be something genetically wrong with the baby? If  you are reading this, it is basically my PSA to state 'you never ask a woman (if you don't know for 100% certain they are with child) if they are pregnant'--this is common sense and practice. You also do not comment on a pregnant woman's size whether it be small or large as really, it's not your business to do so. Leave that up to the OB and Midwives :)

5. Medical care between USA vs UK?

I think I have explained this one quite well in the first question. I will continue to blog --most likely after baby is here. 

6. Maternity leave/time off?

Right. So I know this is a hot topic in the USA at the moment. Even when I was pregnant with Emme, I was so infuriated at the US system. You look at other countries doing XYZ, why aren't the US doing that? I don't want you all reading this to think the UK has it made. People are off for a year paid. This is also not the truth. Basically, the first portion of your maternity leave and the amount of pay you get is based off of where you work (kinda similar to USA). So for me, the first 9 weeks of both my jobs I will be paid 100% of my wages. You say, wait, only 9 weeks? Yes, this is the only portion of my maternity leave that I will receive income as if I am still working. It goes as follows (and this is only for me, I can't speak for others, and had I not been in employment long enough, this would not be as follows):

Birth-9 weeks: 100% pay from employer(s)

9weeks-26 weeks: 50% pay from employer(s) + Statutory Pay (based off income and comes to a certain amount per person--paid by the employer, but they receive/reimbursed back via the government)

27-39weeks: 0% from employer(s), Statutory pay only (as seen above)

40-52 weeks: Unpaid 

So as you can see, a lot of people likely go back after the 26 weeks. Some companies let you spread out your income across the time you are off, but not all. For my jobs, I will accrue paid time off/annual leave whatever you want to call it, whilst I am off on maternity leave. I have been told I can tack that onto my leave at anytime. So if I want to be paid some of my leave money from 6-9months to supplement I can. Equally if I want to be paid some of that from 9-12 months, I can do that too. One of my bosses has also said, I can tack the accrued time off on from 12-15 months to allow me longer time off. The max amount of time off before having to return is 15 months. (This is an NHS rule) Ideally, I will budget and take care to be off for one year. That is my goal. You can see that financially it may be a struggle, but we have been saving since we knew about the pregnancy and continue to do so. This is the last time I am doing this, I want to have the time off whilst I can. Both of my jobs have been good about for example, I say I want the 12 months off and at 9 months I am feeling ready to return and financially need to return, I am allowed to do that. 

It's not so much the PAY that makes UK maternity leave so much better than USA, its the RIGHT and the CHOICE to be off with your child for up to 15 months. Even if I was told you will not be paid for ANY of it, having the right/choice to decide up to that amount of time to be off with your child is a blessing compared to my right to be off 8 weeks in America. 

I took 12 weeks off with Emme (the max allotted), but I wasn't paid for over half of that as I didn't have enough time off accrued (I was sick for a longer period beginning of my pregnancy), and I was not allowed/would not keep my job if I didn't go back. The 8-12 week period also had to be approved by my manager to have it. She of course gave it to me, but it's the fact I even had to ask.  It was absolute torture to go back to work for fear of losing my job and health insurance when my baby was still very much breastfeeding on demand, waking multiple times a night, and really just needing her mother? This was the beginning of our very long research into moving over to the UK. 

Hope I have answered your questions and look forward to blogging again. Please do add comments and questions for next time :)