Tuesday, September 4, 2012

Having a Baby Abroad/NHS (Part Five): High-risk Obstetricians and Hospitals.

Previously on "Having a Baby Abroad" ... Brigid is pregnant, goes to first midwife appointment, where they take her family medical history, and notice that her mother had a Deep Vein Thrombosis. Ergo, Brigid is labeled as potentially high-risk... 

In today's blog, we learn that they DO have obstetricians over here!

Apparently the risk of having a DVT increases tremendously during pregnancy, particularly if you are genetically predisposed to the condition. In looking over my maternity records, an obstetrician appointment was made for me. Yes, made for me. I received, in the mail, an appointment time.

Two comments:
1) Notice how they do actually pay attention to potential problems, right? It's not all yoga balls and midwives and The Secret. It's modern, preventative medicine.

2) I did not choose this appointment time. This annoyed me at first, in a typical you-can't-tell-me-what-to-do American kind of way. Now, it so happened that the appointment was actually at a really convenient time for me, so we didn't need to reschedule. But it turns out, if I hadn't been able to make it, I could have absolutely requested another time. So while this appears limiting, it's not really problematic. Also, in general, employers in this country are required to give you time off work for doctor's appointments, so it's not actually a big deal anyway.

Doctors over here don't seem to wear white coats. The woman we met with dressed more like an English professor than a doctor, which was, at first, a bit disarming. I mean, what kind of authority figure doesn't wear a uniform? But wardrobe aside, she took us into her office, went into depth explaining the potential risks of DVTs during pregnancy, inquired about my mother, and took some more bloods from me to run a few tests.

At this point, my mind immediately shifts to: How much is this going to cost? In the US, as a small-business owner with an individual health insurance plan, agreeing to any "tests" generally means incurring at least a thousand dollars in hospital, doctor, and lab fees. If a US doctor suggested running these tests, I would likely go home, read five books, make lots of phone calls, and Google the hell out of DVT risks during pregnancy, and only agree to the blood tests if it was seriously life-threatening (which, it turns out, it kind of is).

The fact that cost isn't an issue over here, and they only want to make sure I'm healthy, doesn't occur to me for several minutes. I let them take four vials of blood. Note: Just like in the US, nurses seem to be better with needles than doctors. Ouch!

A few weeks later, we received another appointment letter in the mail (which we had to reschedule because of conflict) -- this time to meet with a hematologist at the Royal Infirmary to discuss my results. This didn't bode well.

Just like our meeting with the OB, the appointment was not rushed in the least. When she told us that my antithrombin 3 levels were slightly outside of the norm, which suggested a higher likelihood of DVT, the doctor sat with us until all of our questions were answered. She explained all those fancy medical terms, suggested reading materials and a plan of action, but first said one more thing: I'd like to run another blood test. "Your results were borderline, and I don't want to prescribe the twice-daily shots of heparin unless we are sure you need them. Is that okay?"

I hate taking medicine, so I was all about re-testing. I don't know if my aversion to meds is because of my hippie-nature or because I've never been able to afford prescriptions on my US health insurance plan anyway. But I knew I did NOT want to take shots for the last half of my pregnancy. So, yes, please! Re-test.

After about 25 minutes of discussing my results and potential plans of action, the hematologist asked us if we had any other questions. Why, yes we do! Unrelated to blood, but while we've got you here...

We'd been advised by a few US doctors (and every friend who has ever had a baby in the US) that I needed to make sure I had an updated Whooping Cough vaccination. My last booster (tDap) was in 1994, so, yeah, it was a bit out of date. This shot is apparently given out standard postpartum in the hospital to new moms back in the US and is considered an absolutely-must-have-or-your-whole-family-will-die. We just wondered how to go about getting it.

"I'm not sure about that, that's not really my department," the doctor answered. We figured that was that and we'd have to call to schedule a whole other appointment. But no... "Come with me, let me see if someone else can find out for you."

What? We were so shocked, and I think we actually protested a bit, telling her not to worry and we'd sort it out. She knocked on the door of the next office over, introduced us to a nice man in a Cosby sweater (one of the high-risk obstetricians), and explained our question. Dr. Campbell was clearly on his lunch break, but stood with us for about 5 minutes in the hallway discussing various vaccinations. He then invited us into his office to sit while wandered down to the hospital library for medical journals and research. We must have spent a good 20 minutes with him going through the literature and discussing vaccination options for me and David, pros and cons, and the differences between the health care systems.

We were neither rushed nor condescended to. We got our questions answered. We left the hospital feeling like the system as a whole was looking out for us. And a doctor spent his lunch hour trying to help us sort out one simple question!

I have a lot of doctor friends in the US, and they are all caring people who truly want to help their patients. Each of my doctors in the US is really great, but I also know they are always in a hurry to see tons of patients. I always spend more time in the waiting rooms than I ever do with the doctor herself.

I don't blame American doctors. Clearly, they are rushed. I just know that in America, we're told about the overworked NHS doctors who have to see hundreds of patients a day and never have time to spend with patients.

Again, from my experience, it's been just the opposite. 

Previously on NHS/Baby Abroad blogs:  Part One: Having a Baby Abroad
                                                                      Part Two: Registration, Doctors, Midwives, etc.
                                                                      Part Three: NHS, midwives, home births. 
                                                                      Part Four: Waiting Lists, Emergency Room Visits.


  1. Really enjoying your blog.

    My own experience is that the amount of time and care given in Edinburgh has been excellent, more so than some other places in the UK. Still I'd prefer that to the bill I got for seeing a doctor for ten minutes after an accident in the states the other month.

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