Pregnancy and Birth Across The Pond: From Trinidad to London

The long walk to the Women’s Health Department in the Sutton hospital was almost déjà vu. The physical building resembled that of Port-of-Spain’s General Hospital. I suspected both institutions had been designed in the same era.

In many ways, public health care in Trinidad and Tobago resembles the UK’s National Health Service (NHS). Both systems are state funded, claim to be under financial pressure and are heavily criticized by the public they serve. The NHS today is frequently in the spotlight with problems that are old thorns for Trinidad’s General Hospitals: unacceptably long waiting times at the Accident and Emergency; overcrowded wards; patients unable to access non-emergency care at their local centres; shortages of doctors; questions over expenditure by administration; client deaths linked to inadequate care.

It’s well known that the human resource element in Trinidad and Tobago’s public health system has not in recent decades been able to support its clients by spoiling them for choice.

I chose private care for my first and second pregnancies in Trinidad because this allowed me the luxury of choice; which doctor or midwife to see; when to schedule appointments; which hospital to choose; what to include in my birth plan; if to have a doula; even some choice over my post-birth breakfast menu!

I wanted to avoid the unpredictability of being attended to by various strangers. Relationship building takes time but builds trust. Trust facilitates confidence and confidence makes birthing easier, on the mind, if not on the body.

For my third pregnancy I found myself living in the UK. I chose to be a client of the overburdened NHS for my third pregnancy, would I be satisfied with my options?

Well, the policy of the NHS is to encourage home births where possible since studies of UK and similar populations show that home births cost less but add no significant increased risk for “low risk pregnancies.”

Waiting to see the midwife for the first visit 12 weeks into my pregnancy, I found myself in torrents of tears after looking at the cards and photographs posted on the walls from families that had chosen home births. An emotional bomb had hit me unexpectedly. Underneath the nausea and fatigue there was a little human being under development who would, by God’s Grace, be joining us just six months into the future. Reality hit home.

The midwife loaded my answers to her numerous questions into her computer programme. The programme did its analyses, reducing the error of human misjudgements. I was deemed “low risk” and a candidate for home birthing. This, despite me being almost two years short of the big Four Zero!

I was thrilled.

The midwife who was responsible for managing home births in the area was an amazing woman. Like my obstetrician in Trinidad, she gave me all the time in the world when my questions needed to be asked and my anxieties needed to be addressed.

She emphasized my right to choose a home birth. She showed me the assessment criteria for home birth to be met towards the end of the pregnancy but expressed her conviction that the client’s right to choose should prevail. She referred to women who did not meet the criteria but whose preference for home births was respected despite contradicting medical advice; one woman was diabetic; another was giving birth for the seventh time. “We cannot refuse to come, once we have the staff,” she insisted.

Pregnancy care under the NHS offers more routine screening blood tests (including assessment of body iron stores and degree of Down Syndrome risk) and shorter waiting times than typical community health centres in Trinidad and Tobago. On the other hand, under the NHS low risk women have half the number of routine clinic visits on their schedule and perhaps because I never appeared over or under weight I was only ever weighed once.

To my surprise and horror I was expected to bring urine in a narrow glass tube supplied by the clinic, wash the tube and use it again for the duration of the pregnancy! Yes, the NHS has been under great pressure to manage its expenditure but I have to admit their system is more environmentally friendly than the use of styrotex cups!

Midway through my nine months I learned of a card for pregnant women which entitled me to free medicine and dental care for the pregnancy and first year after baby’s birth. Well off I went to the dentist, grateful for my savings of a few hundred pounds and mindful of the money previously spent because I did not know about this ‘pregnancy privilege!’  There were no doctors at the community clinics I attended so though the midwife could recommend iron, she couldn’t write a prescription and I had to wait my turn at the GP’s office again – or pay at the pharmacy.

I took the tour of the hospital’s labour ward and birthing centre. It was delightful to have the option of a water birth in a private room at a birthing centre but in the end the attractions of a homebirth won me over. In theory I could have rented my own birthing pool and had a water birth at home but the labour proceeded so efficiently when it did get going that I doubt I would have even made it into any pool.

A must read if you are interested in birthing naturally and in understanding waterbirth!

Gentle Birth Choices by Barbara Harper, a must read if you are interested in birthing naturally and in understanding waterbirth! I really wanted a waterbirth after reading this and after being introduced to the subject at the Mamatoto birthing centre in Belmont, Trinidad. But in the toss up between the inconvenience of renting or buying – and filling (then emptying and maybe selling) a pool at home, versus using the waterbirthing facilities at the hospital’s birthing centre in Sutton, home birth pool free actually won! Any my early labour was so long while my active labour was so short, there would have been no time to get in and out of the pool anyway!

After the birth, our doula (labour support person), made the midwives tea and brought them fruit and chocolate we’d set aside for them as refreshments. We took photos together. NHS policy emphasises the role of the midwife in helping mother and baby to get started with breastfeeding and the midwives were happy to wait for baby to have her first feed before weighing her.

She was remarkably calm. She nursed and slept and was unperturbed by the activity and conversation around her. And if it  wasn't for our doula we would have had no photos of her first hour as her grandma and dad are not camera enthusiasts!

She was remarkably calm. She nursed and slept and was unperturbed by the activity and conversation around her. And if it wasn’t for our doula we would have had no photos of her first hour as her grandma and dad are not camera enthusiasts!

Midwives and the district health visitor made at least four visits to our home in the two weeks that followed. It was wonderful not to be roasting our newborn at the bus stop in what was a sweltering hot summer. It was comforting to know that the system actively searches out mothers at risk of postnatal depression. The home visits also seek to help and support breastfeeding and even though this was my third time with a nursling, they had some useful reminders and assurances for experienced mums too.

Despite the conscious efforts by midwives both in the UK and T&T to encourage, inspire and support breastfeeding, not many women breastfeed exclusively for the first six months. In the UK new mothers are less likely to have the family support needed to facilitate sustaining breastfeeding and despite knowing that best is breast, despite baby latching on and breasts full of milk,  the sheer quanta of time required to breastfeed means that many busy mums – even stay-at-home mums – are defeated before they begin.

Reading about breastfeeding is a useful part of preparing for your new baby. You won't have time to do much of it once the little one arrives.

Reading about breastfeeding is a useful part of preparing for your new baby. You won’t have time to do much of it once the little one arrives.

The Birth Book by Sears and Sears

Read as much as you like but be sure to attend birth preparation classes too! Nothing replaces the insights of experienced women. Nothing replaces the sharing and caring, the camaraderie amongst pregnant women. The Birth Book by US paediatrician Dr. William Sears and his wife, registered nurse and midwife, Martha Sears.

Nursing Mother, Working Mother by Gale Pryor

You may have thoughts of pumping and working but don’t rely on optimism or even on Gale Pryor’s brilliant book, Nursing Mother, Working Mother. By all means, learn what you can from books such as this one but your strategy and how best to execute it must come from women who’ve done it successfully, from understanding the obstacles you might face and maybe even from working with the breastfeeding counsellors and consultants whose experience and guidance can sometimes be a make or break factor.

While breastfeeding and ‘low tech birthing’ for low risk mothers with adequate antenatal care are cost effective for the national purse, in Western society freedom of choice is upheld as a sacred principle. Yet with dire predictions that nations’ health bills will be strained by ageing populations heavy laden with Alzheimers’, cancers and other chronic diseases, will a push towards natural birthing and breastfeeding be forced into policy? And isn’t policy impotent all by itself? In the UK, home births and exclusive breastfeeding remain the exception and not the norm, despite the policy support they enjoy.

For women to embrace breastfeeding and low tech birthing as gold standards to be aspired to where possible, the following would be imperative:-

  1. Conveying the information and reassurance needed for women to embrace such options with conviction.
  2. Providing adequate and flexible maternity and paternity leave
  3. Providing easily accessible and relevant antenatal classes for all
  4. Providing workplace support for mothers who wish to pump milk at work
  5. Providing competent and widely accessible breastfeeding support for mothers after birth.
  6. New training and retraining for a wider cadre of supporting health care workers.

This article was first published by Fresh Start, the on-line magazine of Best Start, the breastfeeding and advocacy organisation run by the very dedicated and amazing Adepeju Oyesanya. Thankyou for the privilege of publishing with Fresh Start, Adepeju.

The article was first published on page 20 of Fresh Start’s May 2014 edition, link below: 

http://issuu.com/freshstartbybeststart/docs/fresh_startbybeststart_may_2014__4

The original publication did not include the photographs that are part of this post.

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