Birth Culture Differences

[KandyKinz]

Since all of us here are uniting from all over, I thought it would be interesting to get a summary of the “birth culture” we’re surrounded by. It may help put things in perspective when reading other people's posts. For example, common models of practice regarding prenatal care, common societal attitudes towards pregnancy, birth (including place of) and breastfeeding, as well as any local statistics if known (such as home birth, epidural or c-section rate)

I’ll Start

(please note: I am about to make many generalizations about common themes in maternity care I have noticed. What I am about to say reflects my opinions which have been formulated by personal experiences and may not be reflective of the practices of all doctors, nurses, hospitals, midwives, parents, etc.)

Ontario, Canada

Doctors...
The medical model dominates. The majority of women are cared for by their family physicians or obstetricians. Clinic visits are kept very short (usually <5mins) and time spent in the waiting room tends to be long as Obs are often overbooked. They have extremely high caseloads likely due to the fact that they are caring for both normal and high risk pregnancies. In most hospitals the Ob’s work in shifts so there is no guarantee that your ob will be the one delivering the baby. Once in the hospital it is the nurse that spends most of the time with you and does most of the assessments including vaginal exams. The OB will come by from time to time to check up on things but many will not actually stay in the room until the head is visible between pushes. Once baby is born, the ob often checks you the next day, discharges you from hospital and then you see them again 6 weeks later. If you have a family physician they will want to see the baby in the first two weeks and then at 2 months when the first immunizations are due. Many families however do not have family docs, so communities have implemented programs where a health nurse comes to visit the family during the first week to make sure all is ok. If it’s not you’re looking at a wait of 3 or more hours in a walk in clinic

I would say that most people here feel that having a doctor is preferable and safer then having a midwife and I have known many women to be scrutinized by their family for choosing midwifery care. Despite how well our midwives are trained and solid research proving home birth to be just as safe as hospital birth many still think having a homebirth puts the baby and the mom at risk. About 20% of midwifery clients have home births which accounts for only 2% of the births in Ontario.

Midwifery
Midwifery is still a relatively new concept in Ontario (it was legalized in 1994 and is still not "legislated" in some provinces). The model of midwifery practice here is that the woman is the ultimate decision maker in her pregnancy and birth, that the woman has the choice of where she gives birth (home or hospital) and that the woman will receive continuity of care (meaning she will have the same midwife or midwives (no more then 4) who will care for her in her pregnancy and postpartum and that a known midwife will then be there for the birth. Regardless of home or hospital the midwife will stay with your for the duration of the labour and for approximately 3 to 4 hours afterwards. They then come and see you <24 hours later, Day 3, Day 5, Day 7 and then you go see them in clinic at 2 weeks, 4 weeks, and then at 6 weeks when you are discharged from midwifery care. Midwives will also come see you at home more frequently if you are having concerns or breastfeeding problems. Clinic visits tend to be longer with midwives, with an average of 30 minutes and tend to be less formal and medical like. Many midwifery clinics have couches instead of those uncomfortable medical beds etc.

Standard Prenatal Care of Normal Low Risk Pregnancies (Both OB and Midwife Care)-Visits are scheduled every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then every week until you have your baby.
- There is one routine u/s done at 18-20 weeks
- Genetic screening (IPS, MSS) is offered to all women. The IPS involves an U/S at 12 weeks.
- Glucose testing is done between 24 and 28 weeks. Some offer this, Some do it routinely, Some don’t do it at all.
- GBS screening is done at 35-37 weeks.
- Routine inductions of labour are offered at 41 weeks.
- Newborns are given erythromycin eye ointment and vitamin K injections within 4 hours of the birth.

Doctors tend to do all of the above testing without much or any discussion. They just seem to do it… (again 5 minutes doesn’t offer much time for discussions). Also, in hospital it is not uncommon for nurses to give the baby the medications listed above without discussing them with the parents. Midwives offer the above testing to women with full discussions then the women decides whether to accept or decline.

PAIN RELIEF
It is very common here for the majority of women to want to have an epidural long before they even get pregnant led alone go into labour. Natural birth is certainly not the norm. My hometown hospital has an epidural rate of 40-50% and it would likely be more if the anesthetist would come in during the night for epidurals!

C-SECTION
The C-Section Rate is also really high at 35%.

Overall unnecessary interventions are rampant. For example, At my local hospital everyone admitted goes on the EFM for a 30 minute "admission strip" despite recommendations from their society of obstetricians and gyencologysts not to do that.

The rates of pharmacological pain relief, inductions, c-sections and interventions in general are lower among women under midwifery care, but then again it’s a different type of woman who chooses midwifery care.

BREASTFEEDING
Unfortunately here breastfeeding is kept a dirty little secret that is done in private. It’s very uncommon to see anyone breastfeed publicly. Thumbs up to all those proud publicly breastfeeding moms out there! While many women do breastfeed initially, most do end up switching to formula early on. Likely the result of lack of support, lack of knowledge, the embarrassed linked to breastfeeding around people and the fact that breasts can‘t kick the image of being primarily a “sexual object" Among those that do breastfeed there’s this false belief floating around that it is only beneficial to the baby for the first 6 months. It is very uncommon for people to breastfeed beyond that. The stats I have is that 88% initiate breastfeeding after birth and only 15% are breastfeeding at 6 months. Midwifery clients have much better rates of success when it comes to breastfeeding, it could be the extra support of it could just be the type of people midwifery clients are. Lactation consultants are available for support, in some larger areas there are free drop in breastfeeding groups with lactation consultants present and there are also private lactation consultants that will come and see you for a fee of $30 to $50 a session.

CIRCUMCISION
This use to be very common practice among my generation and few males were left natural. Now only 10% of newborn males get circumcised and it costs $150 to $300 for this painful and unnecessary procedure... (Oops definitly let my bias out there... sorry... kinda....)

 

[mrsmo7]

Hello here in the uk the main difference is we all have a named midwife and if we are considered low risk we do not have a consultant (doc) at all and our G.P has nothing to do with our pregnancy.

We are generally seen by our midwife at around 8-12 weeks who takes our history then at
12 weeks we have a dating scan.
we see the midwife at 16 weeks
and have a anomaly scan at 20 weeks then (if all is well)
we see the midwife at 25 then every 3 weeks until the birth unless you ask to see them more often.
We also have blood test done at 12 and 28 weeks.

Pain relief and c-section rates seem to be about the same as there and we also have quite a low breast feeding rate

UK breastfeeding rates

Overall, only 35 per cent of UK babies are being exclusively breastfed at one week, 21 per cent at six weeks, 7 per cent at four months and 3 per cent at five months


And although we have a legal right in the uk to have a homebirth if we want one the homebirth rate is still only about 3%
Circumcision is quite rare in the uk and is only do privately

 

[KandyKinz]

UK breastfeeding rates

Overall, only 35 per cent of UK babies are being exclusively breastfed at one week, 21 per cent at six weeks, 7 per cent at four months and 3 per cent at five months

Wow, that is quite low, I was under the impression that breastfeeding was a more common and accepted practice in European Countries

 

[cupcake23]

-Your care can be Midwifery, Shared care (GP & Midwife) or hospital based (high risk)
-The UK c/s rate is around 24% but can be higher in certain London & private hospitals.
-Some Hospitals are or are in the process of gaining Baby Friendly Initiative (UNICEF) however breastfeeding rates are still low.

-Midwives are registered professionals (Royal college of Midwives) They are duty bound to provide care during pregnancy, birth (have to attend a birth any where) and post partum (up to 28 days) If everything is 'normal' then you are usually discharged back to your GP/ Health visitor on day 10.

-The health visitor is a registered Nurse/ Midwife that has undertaken further training to provide care and promote health in children under five (breastfeeding, immunisations, weight gain, weaning etc)

-Circumcision is only done in the NHS if its for a medical reason otherwise its done privately or by a Rabbi.

I'm south American (and in my family) we have cultural things that we do
-Breastfeeding is the norm, I've never met a south American that has not assumed your breastfeeding, if you tell them your not they will question you about it.
-Your not meant to leave your house for 40 days, you don't open the door because you will get a cold! lol
-Your family cook and clean for you and the only thing you do is look after baby
-you have to wear a belly wrap to get your tummy back to normal
-The parents cant cut baby's nails, someone trusted has to do them the first time
-Once the cord falls out you put a button in its place to flatten it

I cant think of any more but I will add.x.

 

[Sophist]

The US is very similar. I'll note difference in red.

Doctors...
The medical model dominates. The majority of women are cared for by their family physicians or obstetricians. Clinic visits are kept very short (usually <5mins) and time spent in the waiting room tends to be long as Obs are often overbooked. They have extremely high caseloads likely due to the fact that they are caring for both normal and high risk pregnancies. In most hospitals the Ob&#8217;s work in shifts so there is no guarantee that your ob will be the one delivering the baby. Once in the hospital it is the nurse that spends most of the time with you and does most of the assessments including vaginal exams. The OB will come by from time to time to check up on things but many will not actually stay in the room until the head is visible between pushes. Once baby is born, the ob often checks you the next day, discharges you from hospital and then you see them again 6 weeks later. If you have a family physician they will want to see the baby in the first two weeks and then at 2 months when the first immunizations are due. Many families however do not have family docs, so communities have implemented programs where a health nurse comes to visit the family during the first week to make sure all is ok. If it&#8217;s not you&#8217;re looking at a wait of 3 or more hours in a walk in clinic

Your baby is usually visited by a pediatrician every day or every other day in hospital. Mom stays in hospital with baby for 48-72 hours (depending on vag or C section birth).

I would say that most people here feel that having a doctor is preferable and safer then having a midwife and I have known many women to be scrutinized by their family for choosing midwifery care. Despite how well our midwives are trained and solid research proving home birth to be just as safe as hospital birth many still think having a homebirth puts the baby and the mom at risk. About 20% of midwifery clients have home births which accounts for only 2% of the births in Ontario.


How midwifery is regarded in the US depends on your area (people are more favorable to it in the Pacific Northwest, California, Arizona, etc than in the south & midwest. It also depends on your socioeconomic status & education level. If you make more money & are educated, its seen as trendy. If not, its seen as risky & stupid to have a home birth.


Midwifery
Midwifery is still a relatively new concept in Ontario (it was legalized in 1994 and is still not "legislated" in some provinces). The model of midwifery practice here is that the woman is the ultimate decision maker in her pregnancy and birth, that the woman has the choice of where she gives birth (home or hospital) and that the woman will receive continuity of care (meaning she will have the same midwife or midwives (no more then 4) who will care for her in her pregnancy and postpartum and that a known midwife will then be there for the birth. Regardless of home or hospital the midwife will stay with your for the duration of the labour and for approximately 3 to 4 hours afterwards. They then come and see you <24 hours later, Day 3, Day 5, Day 7 and then you go see them in clinic at 2 weeks, 4 weeks, and then at 6 weeks when you are discharged from midwifery care. Midwives will also come see you at home more frequently if you are having concerns or breastfeeding problems. Clinic visits tend to be longer with midwives, with an average of 30 minutes and tend to be less formal and medical like. Many midwifery clinics have couches instead of those uncomfortable medical beds etc.

Midwife visits are around 45 minutes to an hour. Midwife stays with you after birth until you and baby are "stable" which varies in length of time. Hospital transfer rates vary by midwife, and often by whether the mom has had natural labors before. Most mw's follow the same care schedule as OBs

Standard Prenatal Care of Normal Low Risk Pregnancies (Both OB and Midwife Care)-Visits are scheduled every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then every week until you have your baby.
- There is one routine u/s done at 18-20 weeks
- Genetic screening (IPS, MSS) is offered to all women. The IPS involves an U/S at 12 weeks.
- Glucose testing is done between 24 and 28 weeks. Some offer this, Some do it routinely, Some don&#8217;t do it at all.
- GBS screening is done at 35-37 weeks.
- Routine inductions of labour are offered at 41 weeks.
- Newborns are given erythromycin eye ointment and vitamin K injections within 4 hours of the birth.

Doctors tend to do all of the above testing without much or any discussion. They just seem to do it&#8230; (again 5 minutes doesn&#8217;t offer much time for discussions). Also, in hospital it is not uncommon for nurses to give the baby the medications listed above without discussing them with the parents. Midwives offer the above testing to women with full discussions then the women decides whether to accept or decline.

Very similar to US. Some women can convince their doctors to induce them any time after 37 weeks.

PAIN RELIEF
It is very common here for the majority of women to want to have an epidural long before they even get pregnant led alone go into labour. Natural birth is certainly not the norm. My hometown hospital has an epidural rate of 40-50% and it would likely be more if the anesthetist would come in during the night for epidurals!

C-SECTION
The C-Section Rate is also really high at 35%.

Overall unnecessary interventions are rampant. For example, At my local hospital everyone admitted goes on the EFM for a 30 minute "admission strip" despite recommendations from their society of obstetricians and gyencologysts not to do that.

The rates of pharmacological pain relief, inductions, c-sections and interventions in general are lower among women under midwifery care, but then again it&#8217;s a different type of woman who chooses midwifery care.

C-section rate in the US is 25-50% depending on the hospital. C section rate for hospital transfers from planned home birth is about 3%.

BREASTFEEDING
Unfortunately here breastfeeding is kept a dirty little secret that is done in private. It&#8217;s very uncommon to see anyone breastfeed publicly. Thumbs up to all those proud publicly breastfeeding moms out there! While many women do breastfeed initially, most do end up switching to formula early on. Likely the result of lack of support, lack of knowledge, the embarrassed linked to breastfeeding around people and the fact that breasts can&#8216;t kick the image of being primarily a &#8220;sexual object" Among those that do breastfeed there&#8217;s this false belief floating around that it is only beneficial to the baby for the first 6 months. It is very uncommon for people to breastfeed beyond that. The stats I have is that 88% initiate breastfeeding after birth and only 15% are breastfeeding at 6 months. Midwifery clients have much better rates of success when it comes to breastfeeding, it could be the extra support of it could just be the type of people midwifery clients are. Lactation consultants are available for support, in some larger areas there are free drop in breastfeeding groups with lactation consultants present and there are also private lactation consultants that will come and see you for a fee of $30 to $50 a session.

Women get breastfeeding support from La Leche League, WIC, or privately hired lactation consultants. Individual opinions vary from extremely supportive to grossed out by breastfeeding. So women BF in public, but are extremely likely to have negative comments made by onlookers. There are laws protecting a womans right to BF in any place she and baby are otherwise legally allowed to be in. Employers have to provide women a non restroom, private place to pump.

Women are strongly encouraged to BF to 1 year, most don't make it to 6 months.

CIRCUMCISION
This use to be very common practice among my generation and few males were left natural. Now only 10% of newborn males get circumcised and it costs $150 to $300 for this painful and unnecessary procedure... (Oops definitly let my bias out there... sorry... kinda....)[/QUOTE]

I think the circ rate in the US is about 45-50% right now. It's up to the parent. Some insurance companies refuse to pay for it and consider it "cosmetic" surgery. Some doctors refuse to do circs as they consider it genital mutilation.

 

[cupcake23]

We also have birth centres, birth centres are small maternity units which are staffed by midwives. They offer a homely rather than a clinical environment. They are good at supporting women who want a birth with no or few medical interventions. Birth centres do, however, tend to follow the same rules about care during labour and birth as hospital maternity units.

 

[kiwimama]

New Zealand
(Note: I do not know a huge amount about this subject, only what I have experienced and/ or read about in text.)

As soon as a woman knows she is pregnant, she must find a LMC (lead maternity carer) which could be their GP doctor, an obsetrician or a midwife. Maternity care is free for all NZ residents, even private midwives, who are paid by the government.

Doctors...
I think that most woman do not use a doctor as their lmc, using their GP doctor is rare nowadays. If a woman has a high risk pregnancy then often they will be overseen by an obsetrician but even then a midwife will usually perform the majority of the prenatal care but an obsetrician be there for the delivery etc.
Midwifery
The majority of NZ woman choose a midwife (usually a private one) as their lmc (78%.) As an lmc, they provide all prenatal care, all the way through the labour and birth and until 6 weeks after the birth. It is a very accepted practice and our government pays for all the care they provide. All midwives must go through the appropriate university course and then join and be recognised by the NZ Midwifery Council as a fully trained and competent midwife.

Standard Prenatal Care of Normal Low Risk Pregnancies (Both OB and Midwife Care)
-Visits are scheduled every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then every week until you have your baby.
- There is one routine u/s done at 18-20 weeks. I believe this is the only one that is done and you do have to pay for it, although they aren't too expensive. If you want you can ask your midwife to refer you for a scan and they will (if they are nice!) but you do have to pay for it. I had some growth issues with my pregnancy and had scans every 2 weeks which I didn't have to pay for.
- I believe Genetic screening is offered to all women, but I'm not sure it is done by alot of woman. I think you would have to pay for it. I never had this done.
- Glucose testing is done between 24 and 28 weeks.
- GBS screening is done at 35-37 weeks.
- Inductions of labour are offered at 42 weeks. (I'm not sure how strict this is.)
- Newborns are offered Vit K injection at birth otherwise you can opt for oral drops, but I think you do need to sign something to say you are ok with it being done. It is not compulsory.

PAIN RELIEF
I really do think that midwives do try and get a woman through labour without an epidural. The national average is about 25% of all labours. I think the majority of midwives would try and get a woman through labour with natural techniques, g&a or pethidine if they had to use anything.

C-SECTION
The rates show about 25% of births are c sections. Of that 25%, 38% had the procedure electively. After reading up alot on homebirth and just being in a hospital puts you at a much greater risk of going under the knife, I think alot of these c sections are unnecessary. Ie, in 1983/4 the rate was 9.6%. I think the majority of these would have been when they genuiney needed to be done, not simply because a woman wasn't progressing etc. I also think the increased use of epidurals leads to greater rates of c sections.


BREASTFEEDING
At six weeks, the full and exclusive breastfeeding overall rate was 89%. At three months, the full and exclusive breastfeeding overall rate was 54%. At six months, the full and exclusive breastfeeding overall rate was 26%. We do quite well at pushing breastfeeding in this country. The government rolls out campaigns every year really encouraging breastfeeding. There are free clinics you can attend with lactation consultants there to help you latch and give you advice etc. This is all really good but recently an article on tele was stating we push it too much. My friend was on this show and can vouch that it is true (and from the huge amount of feedback alot of other woman feel this too.) My friend had a breast reduction a few years ago and although her milk was in in breasts, it wouldn't come out. Her baby was starved the first 3 days of her life because midwives would not allow her to have a bottle. I think the amount of help and advice we get is great but women do need to be allowed to make their own choice as well.

CIRCUMCISION
Not at all a common practice in NZ. Stats say around 15% are circumcised.

The Homebirth rate is increasing very slowly. Average is 7% but as high as 10% in some areas.

 

[kiwimama]

^^ oh yes and women are discharged from hospital asap after having a natural birth. Awhile ago some hospitals were offering vouchers to women if they left the hospital less than 3 hours after giving birth!

 

[bky]

New Zealand


Standard Prenatal Care of Normal Low Risk Pregnancies (Both OB and Midwife Care)
-Visits are scheduled every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then every week until you have your baby.
- There is one routine u/s done at 18-20 weeks. I believe this is the only one that is done and you do have to pay for it, although they aren't too expensive. If you want you can ask your midwife to refer you for a scan and they will (if they are nice!) but you do have to pay for it. I had some growth issues with my pregnancy and had scans every 2 weeks which I didn't have to pay for.
- I believe Genetic screening is offered to all women, but I'm not sure it is done by alot of woman. I think you would have to pay for it. I never had this done.
- Glucose testing is done between 24 and 28 weeks.
- GBS screening is done at 35-37 weeks.
- Inductions of labour are offered at 42 weeks. (I'm not sure how strict this is.)
- Newborns are offered Vit K injection at birth otherwise you can opt for oral drops, but I think you do need to sign something to say you are ok with it being done. It is not compulsory.

Just to add to this I was offered nuchal screening between 11-13 weeks (also had to pay for, scans are $50 after subsidy here), and the blood test at 16 (didn't have, would have been free), but was told that only the first scan in the 3rd trimester needs to be paid for. I had a placental position scan which I paid for at 32 weeks, but was told if I ended up needing more that those wouldn't be charged.

Also your LMC is responsible for your first 6 weeks of postnatal and infant care (supposed to be around 10+ visits after the birth I think? The NZ College of MW has more info on the website), though usually people switch to Plunket or one of the similar schemes (probably like a HV? not sure) for infant care before the end of 6 weeks.

I like the BF support (especially the billboards encouraging public BF) but do feel it can be a bit OTT at times. One of my MW was pretty adamant I go to a prenatal BF class. I didn't, but was a bit put off by her attitude as I was/am already strongly pro exclusive BF for me and my baby. I just felt a bit put out by her attitude and sympathetic to anyone who wasn't as pro BF as I was.

 

[Rmar]

Wow, great detailed post.

Here is a quick overview of Australia:

Hospitals and intervention

Midwifery run but doctors are around. When I was born in 1992, my mum was told to wait to push until the doctor came into the birthing room. Some regular interventions include an actively managed third stage. You have to ask for it not to happen otherwise they usually take it as it is going to happen. I'm not sure about the overall rate but in the hospital I was born in, the rate for going into labour spontaneously is around 50%. C section rate stands at 30.3%. Epidural rate is 60% which is the same as augmented labour.

Homebirth

Homebirth rate is under 1%. Cost isn't covered by insurance so it is around $4,000.

Other care

U/S seem to be routine at 12 weeks, 18-20 weeks and some other time which is discussed. Genetic screening isn't the norm but things like GBS and Glucose testing are at the same time as most other countries.

Circumcision

The rate varies from 10-15% with half coming from the Jewish population and some indigenous communites that have been told that it is cleaner. The other half is for medical reasons. It is becoming rarer each year and more and more doctors are refusing to perform it.

 

[marley2580]

Were they not trying to make homebirths illegal in Australia? Or was it Independent MWs?

 

[Rmar]

Yes, technically they are trying to make it illegal for IM's to practice outside a hospital or birth centre setting but it is another way of saying they want homebirths to be illegal. I know a few IM's who say they will come over for a cuppa any time of the day and may just happen to bring all of their equipment with them and maybe you could offer to give them a loan that they just so happen to never pay back, friend-to-friend. They will do it at the risk of being fined $30,000 for individuals and $60,000 for organisations because it is just so important to them. The only problem is that they can't sign any kind of documentation. To have a birth certificate, you will have to go to a hospital, they will have to do a vaginal exam on you to check that the baby is actually yours.

I am very crappy about this whole thing especially because it was slipped in to another bill that increases maternity care within the hospitals which is a great thing but it is very obvious that it was planned that way. It seems like it was planned to be passed quietly but it didn't happen that way and debates got very heated. As it is, a poll that was done by NineMSN showed that 80% of those that took the poll believes homebirths aren't safe. I wonder how many of those people actually knew what a homebirth included.