Tuesday, July 23, 2013

Birth in the UK: Postnatal care within the 24 hours after birth. (What kind of postpartum care might the Duchess be receiving?)

Since everyone is #RoyalBaby crazy this week, I thought I'd do my part to explain what I know about the British maternity system (To be clear, my dealings were with the Scottish NHS, which is a different body than the English NHS). First of all, while Americans were freaking out wondering why Kate was "overdue," the midwives over there were likely expecting it. They don't induce until two weeks past due date, unless there is some medical emergency. I, like Kate, was 41 weeks and 2 days. Catch up on my birth story part one, two, and three on previous blogs, and I'll begin with postnatal care here.

The midwives placed my wee boy directly on my chest (standard policy) and watched to make sure he latched on properly. They did not cut the umbilical cord, nor did they wash the baby. What is known as "kangaroo care" in the hippie-birthing community in the US seems to be standard procedure in Scotland. The "Ready, Steady Baby" book that the NHS gives out to all pregnant women goes into great detail about the importance of skin-to-skin contact in the first few hours of baby's life.

Sometimes that skin-to-skin needs to be with the father, and in our boy's case, he got more time with David than with me. I nursed him for a while, but I was bleeding a bit more than the midwives liked. "Gingers are bleeders," I was warned, but I'd still wanted to avoid the shot of oxytocin that is often standard in American births (and I'd said as much in my birth plan). The boy was nursing well, but my uterus wasn't contracting quickly enough to stop the bleeding. Minor postpartum hemorrhage is a loss of over 500ml, and I had already bled over 700ml. When they asked if they could give me the shot. I agreed, having seen fear in David's eyes. I guess it worked because the placenta was delivered pretty much immediately.

After about thirty minutes, David cut the cord and settled down in a bean bag to cuddle with the baby while I got, um, a few stitches. And that's all that I'll talk about because that's a bit more personal than I intended.

When the midwife was finished quilting my nether-regions, she left us alone with a fresh platter of, get this, tea and toast. How British is that? To be completely honest, this may have been the best meal of my life. It was thick white bread, toasted perfectly and slathered with butter -- strawberry preserves on the side. The tea was piping hot, and I doctored it with "milk and one," as they say (milk and one sugar), to make a tasty, sweet, albeit caloric treat. Birth is supposedly uses more energy than running a marathon, so I needed every last calorie.

After inhaling my tea and toast, I took a shower (in my HUGE private bathroom) and a much-needed nap.

Here's something else that Americans might consider bizarre: the baby never left our room. It's called "rooming in," and is recommended by most maternity units in the UK to help with bonding and to prevent infection (hospitals are germy places, after all). In fact, after a few hours, David and I wondered if they'd forgotten about us, as we were left in peace with our newborn.

The minimum time I'd need to stay in the birthing centre was six hours, and the boy was born at noon. By 6pm, I was hoping to be able to either stay in the large private room (it had a sofabed for David and a television to watch the premier of Season Three of Downton Abbey), or maybe even be discharged.

Instead, the midwives returned to take our dinner orders -- there was an actual menu, with plenty of vegetarian options -- and ask if I'd stay the night. The NHS likes to keep new mothers overnight (even those with uncomplicated births) in order to help with breastfeeding and offer guidance on newborn care like bathing and diaper changes. Because I'd lost a lot of blood, they also wanted to check the wee boy's platelets in the morning.

The downside to my staying overnight was that David would have to go home. Unlike Prince William, we weren't paying for private care, ergo we hadn't rented an entire wing of the hospital. I'd be staying in a four-bed ward, which was actually much roomier than it sounds. I was hesitant, but it was a huge room divided with curtains into four separate bed areas. Each area looked just like a hospital room you can imagine in the US -- chairs for visitors, a hospital bed, and some machines -- and felt very private, except that you could very much hear the other new mums and babies. There was a cradle on wheels for the baby that was an arm's reach from the bed, allowing everyone to get some rest.

David and I ate our dinner in the large dining table in the center of the ward, while the boy slept in his cradle a few feet away. Then David kissed me goodbye and took a taxi home. I collapsed in the bed and tried to get some rest.

Even though I should have been completely exhausted, I could barely sleep. The bed was plenty comfortable, but I was running on endorphins and a hormone high that wouldn't crash for four more days. I slept about 45-60 minutes at a time every few hours, waking whenever my baby stirred. A midwife came to check on me and the baby at least once an hour. When I was awake, the midwife would sit with me to make sure feeding was going well (another new mum who was having trouble with breastfeeding was allowed to stay in the ward for several days until she got the hang of it) and that the boy had enough wet and dirty diapers. The midwives even guided me through my first diaper change. It was very hands-on, and I very much appreciated the support.

Around 7am, a huge tray of tea and toast arrived on the dining table, and each of we four new mums emerged ravenous. We laughed and spoke about our births and our babies -- mine was the only one who didn't yet have a name. We helped ourselves to cereals, oatmeal, fruits, and yoghurt (a very continental breakfast), while we waited for the pediatrician to come by and examine our babes.

David came back by 7:30 -- before visiting hours officially began, but no one said a word about it -- and cuddled up with the boy and a book. The pediatrician came by and checked each baby in the ward, followed by an ear specialist who conducted a hearing test. Midwives delivered multiple packets of information on everything from SIDS (called "cot death" in the UK) to swaddling to breastfeeding and signs that the baby is hungry to how many wet & dirty diapers to look out for and various other details on how to care for a newborn.

We were discharged around noon, after checking the boy's platelets, just about 24 hours after the birth. We couldn't wait to get back home to our teeny tiny flat on our cobblestone street.

If you want to read from the beginning of the Having a Baby Abroad series of my blog, begin here.
Tomorrow on the blog: They send midwives to your home?!?!
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I wonder if the Duchess has a little
postpartum pooch?


  1. Thanks, Brigid. I love this. Good photos as well!

  2. Thanks, Brigid. I love this. Good photos as well!