Epidurals in the UK vs USA

[LorelaiLana]

I live in UK and would rather have US style for pregnancy and delivery.
I know my thresholds and I most certainly want an epidural.

In UK its all abt cost cutting and cost saving since its "free", while in US its all abt charging as much as possible since its "insurance driven".

The main difference is not due to medical ethics or anything as noble as that, but MONEY!

US assigns specalists to care so that they can charge specialiast rates and UK keeps you 1000 miles away from a speaclists so that they can do as much as possible with a low wage earner like midwives!

But overall IMHO epidural is humane and natural is inhumane, especially if denied to someone who wants it badly.

 

[Jaz_]

Well tonight the new USA one born every min starts!!!!! OMG how exciting!!! lol so il def be watching an cn if there r ne natural births on ther....im like alot of the UK women on here i DO NOT want an epi, its just scares me, i want to move about mayb have a water birth, r birth on all fours i have no intention of being restricted to a bed could think of nothing worse wen your in alot of pain! Im going to a mid wife lead unit wher they dont even offer an epi if i need one that badly il b tf to a near by hospital, I do believe that its a natural process, our body is built to do this, an although im aware there will be alot of pain i want to work through that an be able to move around wen my baby comes an be able to go home asap

P.S im not saying i wouldnt take ne other pain relief goin, just not an epi! xx

 

[Vicki_g]

Interesting question! But my thoughts are it all boils down to this:

Epidural = cost, additional staffing and it may take longer to get you out of hospital and the bed freed up. These are all major problems for the NHS and I would imagine are the primary reasons why they would rather encourage you to try other stuff first.

In the US, and I am no expert having never lived, worked or given birth there (!), I would guess that seeing as people are paying for their healthcare, there may be more instances of lawsuits being brought against hospitals where, for example, a woman has experienced considerable pain because an epidural was not offered. The hospital may promote them more there to avoid this kind of circumstance. Just a (maybe cynical) thought.

Personally I am willing to try other things (having also done an NCT course) but realistically I would still like an epidural if possible. My mum has a theory that nobody goes to the dentist for a filling and asks for no anaesthetic so they can feel the natural pain of their tooth falling to pieces so why feel the pain when you're pushing a watermelon out of your bits! Lol! I had an abcess in my tooth last week and it was agony. It was also entirely natural but my God, I did not want to feel the pain of it and was popping paracetamol as often as I could! My plan though it just to see how it goes - if I manage without then I'll be very proud of myself and if I have one, well hurray for that! Especially if I've been labouring for hours and I'm shattered.

 

[YorkieMom]

I'd like to try it without an epi, but I really don't like the feeling of being out of control and loopy, so I'm not sureI'd like the G&A. My dentist back in Canada gave me some kind of gas to calm me down before a filling and I hated it. Just the feeling that I had no control, so I really don't know what I'll do at the time.

 

[Kess]

I think some of it is a spiral effect as well. In the UK, we still have plenty of people who have given birth without an epi who can tell us that they coped without and so on (e.g. my Mom has been telling me she did it twice with no pain meds and it was an amazing experience etc), whereas in America it's drummed into women that they won't cope without an epi and all they know are people who've had them, so they have much less chance of having a positive roll model for natural birth. So they go into labour assuming they'll need an epi and so are much more likely take one at the first opportunity (and it's offered so much earlier and pushed more in the US due to the medical model predominating).

 

[Palestrina]

In defense of the U.S. I've been really happy with my level of medical care. Yes childbirth is way more medicalized here but being here on these forums since TTC I can tell you I sure as heck am happy I'm not in the UK. First of all, I've been having ultrasounds at 6wks, 8wks, 9wks, 11wks, and 12wks, whereas most women in the UK (from what I noticed on the forums) didn't even see a midwife unitl 12wks! I've had regular monthly appointments to see my ob/gyn since the very beginning of my pregnancy until 32wks when I started going bi-monthly and then until 36 wks where I've been going weekly. My doctor has called me back to answer my questions within 30min of a phone call. I pay for my insurance so yes, I expect to have service when I need it. Call it overmedicalized, I call it service.

Furthermore, our hospital holds monthly "open houses." We took the opportunity to go, each and every ob/gyn from the hospital was there to talk to us and greet us. They assured us that there was an anesthesiologist (specialist trained exclusively in obstetrics) on call 24/7 on the delivery floor and that pain relief would never be denied as being too soon or too late. We toured the labour floor, the nurseries, the recovery floor, and they took us through the whole process of what would happen on delivery day.

The hospital also provided us with ante-natal classes. During these classes we were informed of pain relief but also how to avoid medicalizing our birth. It was explained to us to labour as long as possible at home so that we could keep medical interventions at a minimum. We were taught how to labour, how to push, and what to expect from the doctors on call. They have assured us that pain relief is available to us but only if we want it, in no way have I been pressured to epi! We are encouraged to move as much as possible during labour and have explained to us how important that is in coping with contractions.

An epidural does not cross the placenta and it does not have an effect on baby. It also wears off quickly. I feel no danger with an epidural and since they're not giving any medals for no pain relief I'm not interested in the pain. Also we do not have G/A or tens machines (I don't even know what a tens machine is) so we don't get as many choices as those in UK do.

 

[special_kala]

In defense of the U.S. I've been really happy with my level of medical care. Yes childbirth is way more medicalized here but being here on these forums since TTC I can tell you I sure as heck am happy I'm not in the UK. First of all, I've been having ultrasounds at 6wks, 8wks, 9wks, 11wks, and 12wks, whereas most women in the UK (from what I noticed on the forums) didn't even see a midwife unitl 12wks! I've had regular monthly appointments to see my ob/gyn since the very beginning of my pregnancy until 32wks when I started going bi-monthly and then until 36 wks where I've been going weekly. My doctor has called me back to answer my questions within 30min of a phone call. I pay for my insurance so yes, I expect to have service when I need it. Call it overmedicalized, I call it service.

The norm in the Uk is to see a MW around 8 weeks then again at 12 and have a scan. All those scans arnt really necessary though

We also have regular MW appointments

Furthermore, our hospital holds monthly "open houses." We took the opportunity to go, each and every ob/gyn from the hospital was there to talk to us and greet us. They assured us that there was an anesthesiologist (specialist trained exclusively in obstetrics) on call 24/7 on the delivery floor and that pain relief would never be denied as being too soon or too late. We toured the labour floor, the nurseries, the recovery floor, and they took us through the whole process of what would happen on delivery day.

90% of hopsitals offer tours and talks

The hospital also provided us with ante-natal classes. During these classes we were informed of pain relief but also how to avoid medicalizing our birth. It was explained to us to labour as long as possible at home so that we could keep medical interventions at a minimum. We were taught how to labour, how to push, and what to expect from the doctors on call. They have assured us that pain relief is available to us but only if we want it, in no way have I been pressured to epi! We are encouraged to move as much as possible during labour and have explained to us how important that is in coping with contractions.

We are also provided with antenatal classes

An epidural does not cross the placenta and it does not have an effect on baby. It also wears off quickly. I feel no danger with an epidural and since they're not giving any medals for no pain relief I'm not interested in the pain. Also we do not have G/A or tens machines (I don't even know what a tens machine is) so we don't get as many choices as those in UK do.

There isnt that much difference in the care apart from when labour hits it seems its very medical in the US, ive read alot of american ladies say what the doctors have said they "can and cant do"

 

[YorkieMom]

I can definitely see how living in the US (and also Canada) I would be happy with the care that I recieved living in either of them, although I think I'd be a bit bitter about paying so much in the US for it.

In the UK we aren't denied medical care if there is a need for it. Everyone gets their normal scans (usually 2 or 3) during the pregnancy (is there really a need for more?).

In my case I was provided with free surgery to check my tubes, free drugs & hospital visits to get me to ovulate and become pregnant, and I've had (& will have) scans at 6, 12, 12, 13, 17, 21, 28, 32 & 36 weeks because I need to be monitored. I've had a CVS, chromosome testing, 1 general scan, 1 anomoly scan and 2 cardiac scans - all of which have been preformed free of charge to me by the top doctors in the UK at the fetal medical unit in London. If I lived in the US I'd be bankrupt by now! Not sure what they'd do in my sitation in Canada, but if I had to pay for anything, it won't have been much.

There are definitely some plus sides to the US though - nice birthing rooms, etc, etc and yes, while I'd love to have them, they're luxuries and I really couldn't be bothered to pay any extra for them.

 

[cutie4evr01]

I think epidurals are more common here in the US because a lot of hospitals still make you lay on your back and be monitored throughout your labor. We took our hospital tour and were reassured I'd be allowed to walk around, labor in different positions, and use my birthing ball, so we were all set to go natural. Then when I arrived at the hospital they said they needed to monitor the baby for a few minutes before I could get up, then they wouldn't let me up because the baby's HR was not fluctuating as they would have liked (which to me is crap because it was at a nice stable HR, nothing to be worried about). Anyway, long story short, I was stuck in the bed for a few hours as I progressed from 4 to 7cm, by which point it was really unbearable so I broke down and had the epidural. I really believe if I had been allowed to move, shower, use my ball, I could have made it without. Several of my friends have described similar experiences, at a variety of hospitals, so I think this is pretty normal.

 

[Vicki_g]

An epidural does not cross the placenta and it does not have an effect on baby. It also wears off quickly. I feel no danger with an epidural and since they're not giving any medals for no pain relief I'm not interested in the pain.

Definitely this for me also! I would rather have the epi and feel nothing than have G&A or something else where I feel totally out of it and weird.

 

[DarlingMe]

Did anyone watch the episode? Remind me which one was the first episode and let me know what you thought! It first aired here probably 6 months ago or so. I am excited to hear your opinions!

 

[Parkep]

I used to live in Canada, and was under the impression that pretty much everyone giving birth had an epidural. I had no idea there was any other birth positions other than lying on your back. I went to my first NCT class last week and was shocked to learn that only about 25% of UK women get an epidural. Why do you think this is?

Why is it normal for women in North America (both US & Canada) to get an epidural, while it's more normal for women in the UK not to get one?

Is it because Canada & the US don't offer Gas & Air? I've heard G&A doesn't do much anyway. I don't believe they really push Tens machines in North America, I'd never even heard of them until I moved here.

Not sure what part of canada you were from...But where i delivered, they went with everything i asked for. They never suggested a epi, they let me know my options I also had G&A it was my support blanket haha. And i never once was on my back delivering. I was on all 4's against the back of the bed, I was standing leaning over the bed etc.

 

[oaklvr]

The hospital I gave birth at allowed me to do what I wanted while in labor, they knew I was going for a natural birth. That said, once the contractions became so painful, whether being on my ball or being in bed nothing helped. They hit me with a little oxygen after my epi since I was freaking out or I had a strange reaction to the medication. I got the epi at 7 cm, after 14 hrs of only dilating 1.5 cm. I couldn't take any more. Same with my first birth. I just have long 'hard stage' labors, that take a long time to progress, nothing to do with the epi, moving around or anything, which proved it to me this time. One thing I did notice was when they were getting my epi ready I dealt with the contractions so much better, maybe knowing there was relief for it? I dilated faster after the epi as well. I'm all for natural birthing and really wanted to, but I'm glad women aren't made to feel like we're all losers and can't 'take the pain' here in the U.S. if we want some pain relief.

 

[Miss_BB]

I used to live in Canada, and was under the impression that pretty much everyone giving birth had an epidural. I had no idea there was any other birth positions other than lying on your back. I went to my first NCT class last week and was shocked to learn that only about 25% of UK women get an epidural. Why do you think this is?

Why is it normal for women in North America (both US & Canada) to get an epidural, while it's more normal for women in the UK not to get one?

Is it because Canada & the US don't offer Gas & Air? I've heard G&A doesn't do much anyway. I don't believe they really push Tens machines in North America, I'd never even heard of them until I moved here.

I think its because we have a National Health Service, we don't have to pay out of an insurance claim for medical intervention - and in the US they will make more money if its non natural.

Not to mention in the UK we are encouraged to try and have natural births, whereas in the US you are not "normal" to have an unassisted, no medicated birth. It's all about culture and way of thinking.

Women in the UK are hardcore

 

[Lauki]

Personally I don't like the idea of not being able to control my own body. I really want to be able to move around and be free to be in a position I'd like to be in. With an epidural you're restricted to flat on your back.

I can't even lay flat on my back when not pregnant, it hurts and makes me feel really uncomfortable, so I doubt I'd want to be on my back when I'm in pain already. As the epidural won't stop you from feeling higher backpain will it?

Obviously it's everyone to their own, but I was quite surprised how easy they were on OBEM US to give the epidural. The 40 year old lady seemed to be coping just fine? She was laughing and joking. Obviously it's up to her if she'd want an epidural or not, but if I'd be doing so well I'd rather not have on and be able to deliver on hands/knees!

 

[Ouverture]

Regarding the healthcare debate here (I already put in my 2 cents about the epidurals) I think both systems have their benefits and drawbacks and the debate comes in with each mom's personal situation. People with no health insurance would obviously prefer that it be provided as in the UK, those of us with health insurance tend to prefer the current system in the US because it gives us freedom of choice. It's all about your own personal experience.

I have great health insurance and so my level of care here in the U.S. is phenomenal. I love that I get to choose my doctors, choose my midwives, choose my care options, etc. I HAVE CHOICE! That is important to me. I can choose the hospital (or in my case, birth center) that I want to deliver at. I'm not 'assigned' anything, and I have a right to complain and otherwise say 'NO!' when I feel that something isn't right. . .because I'm paying for it. I'm blessed that OH has a job that offers this health coverage. We pay several $100/month out of his paycheck for it, but it's worth every penny. Either we pay for it that way, or we pay for it in taxes.

It is a misconception that you can't get healthcare in the U.S. Anybody can walk into a hospital/emergency room and be treated. As a matter of fact, a lot of people do just that - including people who aren't citizens. . .and if they can't pay, guess who/what does? Our taxes. Nobody is denied services if they need it. Many people go to the ER for the common cold, because they don't have coverage to see a family doctor. This is something we do need to work on as a Country, that is for sure. And the elderly is another issue, many of them can't afford proper coverage at a time when they need health care the most. THESE are the core problems of the U.S. system. . .not that you can't GET healthcare

If you have no health insurance, it will either cost you an arm and a leg out of pocket OR you'll have creditors after you (at which point, if they can't collect in 7 years then you're off the hook). . .but you CAN get treated. I didn't have insurance for years and would go to Urgent Care and get treated for things. . .it's a risk you take. As a matter of fact, many hospitals operating in areas of low income have some of the BEST maternity units. Why? Because the low income population seeks less prenatal care and has more high-risk deliveries.

There are things that I think both systems need to improve upon. . .

 

[Kess]

Regarding the healthcare debate here (I already put in my 2 cents about the epidurals) I think both systems have their benefits and drawbacks and the debate comes in with each mom's personal situation. People with no health insurance would obviously prefer that it be provided as in the UK, those of us with health insurance tend to prefer the current system in the US because it gives us freedom of choice. It's all about your own personal experience.

I have great health insurance and so my level of care here in the U.S. is phenomenal. I love that I get to choose my doctors, choose my midwives, choose my care options, etc. I HAVE CHOICE! That is important to me. I can choose the hospital (or in my case, birth center) that I want to deliver at. I'm not 'assigned' anything, and I have a right to complain and otherwise say 'NO!' when I feel that something isn't right. . .because I'm paying for it. I'm blessed that OH has a job that offers this health coverage. We pay several $100/month out of his paycheck for it, but it's worth every penny. Either we pay for it that way, or we pay for it in taxes.

It is a misconception that you can't get healthcare in the U.S. Anybody can walk into a hospital/emergency room and be treated. As a matter of fact, a lot of people do just that - including people who aren't citizens. . .and if they can't pay, guess who/what does? Our taxes. Nobody is denied services if they need it. Many people go to the ER for the common cold, because they don't have coverage to see a family doctor. This is something we do need to work on as a Country, that is for sure. And the elderly is another issue, many of them can't afford proper coverage at a time when they need health care the most. THESE are the core problems of the U.S. system. . .not that you can't GET healthcare

If you have no health insurance, it will either cost you an arm and a leg out of pocket OR you'll have creditors after you (at which point, if they can't collect in 7 years then you're off the hook). . .but you CAN get treated. I didn't have insurance for years and would go to Urgent Care and get treated for things. . .it's a risk you take. As a matter of fact, many hospitals operating in areas of low income have some of the BEST maternity units. Why? Because the low income population seeks less prenatal care and has more high-risk deliveries.

There are things that I think both systems need to improve upon. . .

I was told by American acquaintances on another (non-baby, non-political) forum that although you can get treated in an emergency without insurance, if you have a longterm illness such as diabetes, people still lose limbs from that being untreated if they don't have the money for medication or Doctors visits, whereas the only time anyone over here would have that sort of tragedy would be if they somehow didn't know they had diabetes or something, as soon as it's diagnosed it's managed. Also, again, from the same group of Americans on that other forum, don't some people diagnosed with cancer or other long-term, expensive-to-treat illnesses choose not to tell anyone as they're facing the choice of bankrupting their family for a potential cure (or even paliative care) or dying quietly? One thing I was told is that the average family is "one serious illness away from bankruptcy".

I agree that both country's systems need work, but I also wanted to correct the misconception that we get no choice in the UK. Yes you are usually encouraged to go to your local Drs surgery (because they plan them around population density and avoiding anyone having to travel too far; they're almost always in walking distance), but they work in practises, so you'd have the choice of any Dr at that practise - normally half a dozen or so. You also have a fair amount of choice in the UK with hospitals, I think, though that's only from my experiences of illness, not anything birth related as I'm having a home birth. And it's perfectly possible and acceptable to complain here too if something isn't to your liking, because you're the patient and it's your body. The English tend not to want to make a fuss and complain, but that's just our national character, it's not a feature of our health system . Finally, if you want, you can get private health insurance over here - for a lot less than you pay, by the sound of it! The NHS is always available, but you can opt out and go private if you prefer, and you can go private for some things and NHS for others, or whatever, totally pick and mix, up-to-you .

 

[LorelaiLana]

The big difference is the choice and the level of care. In US you have that if you have insurance. And even if dont you can still get decent care.

But here none of the insurance cover pregnancy. Whether you have money ( moderate enough money to plan and spend on your health and comfort and not filthy rich/royal) or not you get the same crappy service in dingy hospitals. Its standardly poor all across unless you have hit the jackpot and live in a area which somehow has defied the norms and is a better hospital.

I am still unable to get out of my sort of cultural shock I had when I looked at a UK hospitals. I think if you are not in hot cities like London, cambridge and oxford you are out of luck!

 

[tristansmum]

i did not want epidural for a number of reasons.
1. i wanted to leave hospital asap after birth
2. i did not want a catheter
3. i wanted to be mobile and not give birth on my back.
4. had thought about water birth
5. didn't want any of the risks of epidural eg head aches, leaking spinal fluid, numb areas
6. epidural can slow it down and increase risk of assisted birth
7. i wanted to see if i could do it without.

i got to 10cm and pushed for almost 2 hours without. he was stuck so i had a full spinal block in theatre, failed forcepts and EMCS. Not what i had planned but i'm glad i didn't get it as i know the reason for my c section was totally out of my control. next i will attempt a vbac without an epidural again. however, if i need it i would take it. i discovered from this birth you can't plan these things and have to be flexible.

i think the difference between the 2 countries comes down to our cultures. In Uk we have the option of gas & air which does really help some women. Also as its NHS epidurals are not on tap... often you have to wait so we are more prepared for this. In USA its very popular and so if everyone else is getting one then why wouldn't you?! Here other options of pain relief are discussed my MW, ante natal classes, magazines, books ect. Epidurals are always last on the list. Its always seen as the final choice of pain relief and so thats how many women see it. we go into labour knowing its there but thats there are other things to try first. Perhaps in USA (i don't know as not from there) this is not the case.

 

[Sidsapple]

Hello Ladies, well I can add another country to the debate as I'm french and was shocked to find out that in uk they tend to push you towards having a natural birth. I always thought that I will have an epidural as this is what we get in France, and I naively thought everywhere the same... I'm looking forward to my next antenatal appointment to discuss it with my MW...