Bellies to BirthCast

Bellies to BirthCast  |  Week of December 15 |  Episode 6  |  Subscribe

Birth in the UK vs the US

Karen Shopoff-Rooff, a mother of two who chose a homebirth with her second child after giving birth to her first child with midwives in London, discusses her experiences with the differences between the UK and US maternity systems, as well as switching providers late in pregnancy. She also discusses how common complications can be successfully handled during a home birth.




A full transcript of the interview appears below:


CATHERINE:  First of all, welcome Karen; it's a pleasure to have you with us.


KAREN:  Thanks very much.


CATHERINE:  Tell us a little bit about yourself. What's it like to give birth in the UK? What are the primary differences between the two systems?


KAREN:  Well in the UK, midwifery is the standard of care. A pregnant woman would not go and even see an obstetrician unless he was high risk to begin with, or having some sort of complication later in the pregnancy that the midwives identified and then felt that you needed to be seen by a specialist. The obstetrician is really seen as a specialist rather than as the primary caregiver for that pregnant woman.


CATHERINE:  Now, what were the ultimate reasons you chose to give birth at home with your second child?


KAREN:  Well, we had such a positive experience with the midwives, and well then our first son was born at a free standing birth centre with a private group of midwives, and we were really seeking the same type of experience that we had with the very personal, very peaceful and very calm. Trying to seek out the normal in birth rather than the, I don't know, exciting or perverse drama that pervades so much of American culture.


CATHERINE:  I know exactly what you mean. Now when you were pursuing this decision, what role did your husband play? Was he immediately supportive?


KAREN:  He's absolutely supportive of thinking of using midwives; there was no question that we would use midwives with our second pregnancy. He was less quick to come to the idea of a home birth I think, mostly because our first experience within a free standing birth centre, that facility was located immediately in the basement to a hospital there by making transfer very, very easy. However, the options for doing that in our new home in Austin, to transfer from a birth centre would have really been a more difficult transfer than from home, and so the appeal of having it at a birth centre was really just vanished – it wasn't an option. And at the time, there was no midwifery option in hospital, so that really left us with the idea of home birth. We did our research, and just decided that that was really the best thing for our baby, for me, and then ultimately for him as well, because he was concerned about us. He's very supportive the entire way; the entire pregnancy and in the end, he's spoken to more than one of my friends husbands in the two and a half years since, and has become a complete home birth advocate. [He] really recognises now, having seen first hand the benefits, why it can work really well for other people.


CATHERINE:  It's amazing how they have started on the fence and then…


KAREN:  Oh yes.


CATHERINE:  Once they've had that experience, they just can't compare.


KAREN:  No, no. The other thing from the husband's point of view is with respect to midwifery. Very strongly in home birth, because the child's also being born in the husband's home as well is that they're centrally involved. They're not a cast aside role player; they're, they're very much a strongly supporting figure. I think that really begins their relationship with their child on a much stronger base than the old model of dad wandering the hallway. 


CATHERINE:  I absolutely agree. They sometimes feel like an accessory.


KAREN:  Yes.


CATHERINE:  In the hospital or birth centre. There are so many other people that walk over them. In home, it is definitely more of a central role.


KAREN:  Right.


CATHERINE:  As you were preparing for your home birth, you and he had previously said that although you had found midwifery care here in the States, you ended up switching to a different midwife; relatively late in the pregnancy.


KAREN:  Yes, about thirty four weeks.


CATHERINE:  What were the primary reasons you felt the need to switch?


KAREN:  We just had a personality conflict with the midwife. It was something that, very early on, well part of it was that we weren't both on board with the home birth to begin with, and that sort of left us looking at what were the birth centre options in town? That really narrowed down our choices, and so we selected a midwife who we felt really comfortable with on a professional level; have absolutely no question about her professional competency, but didn't really click with her personally.  And as the pregnancy progressed and it became more and more clear that we really wanted to do a home birth, it sort of became that question of, “if this isn't somebody that we'd be really excited about inviting over to our home for dinner, do we really want that person in our home for the birth of our child?” It's hard to say because.  It was very, very difficult to phone her and tell her, particularly at thirty four weeks, that we felt that we needed to make a change. Because midwifery is a very personal profession as well, but I honestly think it was just the most difficult thing that I've ever had to do in my life, but really probably one of my best decisions as well. It was one of those things that, particularly because early in pregnancy, you only see your care provider every four weeks. Then we'd talk about different things. I think, oh well, that's not really what I am thinking; that's not really what I'm envisioning, but I'd let it role off my back. But then you start seeing them every two weeks, and those things were happening more frequently. And then it just got to the point where I was like, wait a minute, is this still my birth, is this still my experience to have? It's up to me to step up to the plate and take control of the situation.


CATHERINE:  Right. I think you have an excellent point; that you're your child's first advocate.


KAREN:  Yes.


CATHERINE:  And you're advocating for who will be present and making sure that your wishes for that child will be respected, and if you don't have that kind of relationship with your care provider, you have to make that tough decision of this is just not best for our family.


KAREN:  Right, and then I also went through the ideas in my head of if I'm not completely relaxed and allowed to do what I need to do during the labour, this could wind up being the bad home birth story.


CATHERINE:  Right.


KAREN:  Instead of a good one. I think that; I think it would have been very different had it been my first child and not my second, but again, because I had such a positive experience; I had such a clear vision in my head of what I wanted, what I was aiming for, and as it became more clear to me that I didn't feel like that's what I was going to have as an option, I just needed to, get out.


CATHERINE:  I hear all too often women saying, well, I didn't want to step on toes, or I didn't know how that would work, I didn't want to hurt feelings.


KAREN:  Right.


CATHERINE:  But ultimately, you recognized that…


KAREN: Yes. 


CATHERINE:  Tension and stress can really impact your labour.


KAREN:  Oh, and I have no ill will at all towards this midwife. It's just part of midwifery, such a strong part of midwifery and why I think it works so well is the personal connection.


CATHERINE:  Yes, it's ongoing relationship.


KAREN:  Exactly, and if that's not there, then in many ways to me, that's just as important as whether they take insurance or not. 


CATHERINE:  Right, absolutely, you need to form that foundation.


KAREN:  Yes.


CATHERINE:  If not there, it might be with someone else.


KAREN:  Most midwives do recognise that.


CATHERINE:  Right. I hear it a lot from people as well; that if you don't click with a client – that's okay.


KAREN:  Yes, yes.


CATHERINE:  Because you might know someone else that would be perfect for them.


KAREN:  Exactly, exactly. I mean, I'm glad that I did; I still have a relationship now with the midwife who I switched to; that's been very positive. So definitely in the long run, it was very difficult, but very worth while.


CATHERINE:  Now, what other types of challenges did you face as you started preparing for your home birth? Did you have any other obstacles to work through like insurance coverage?


KAREN:  Oh, absolutely. Insurance is always a nightmare when dealing with midwifery, unfortunately. That's a whole other hot button issue though. Here I was, I had two care providers with two completely different payment structures. In the end, I wound up paying hugely out of pocket for my home birth because of my split. But in the long run of my child's existence, how much it costs to get them into this world is just a drop in the bucket.


CATHERINE:  Absolutely.


KAREN:  I can't, I can't lose too much sleep over it; I consider it a really good investment.


CATHERINE:  So if you had stayed with the first midwife, would care have been covered?


KAREN:  Well, yes. A higher level of care would have been covered because she was a certified nurse midwife as opposed to the midwife who actually attended the labour and delivery is a lay midwife.


CATHERINE:  Yes.


KAREN:  And my insurance coverage is slightly different.


CATHERINE:  Right.


KAREN:  For that and then my; the first midwife that I used had built into her contract administrative fees, based on how long you were with practice that were non-refundable; a hundred dollars a month a bed with her so it was seven hundred, eight hundred dollars.


CATHERINE:  Um hum.


KAREN:  Again, thank God I'm in a position to say it's only money, but I truly believe that you just have to say, there are some things in life that are worth paying for.


CATHERINE:  Right, money can be replaced.


KAREN:  Exactly, exactly, you know we will cut back in other places, but you know good health, good health care is really not negotiable as far as I'm concerned. 


CATHERINE:  I completely agree. Now, in terms of preparing for both births, how did the systems compare between the UK and the US?


KAREN:  Well honestly, our prenatal preparation for our first child in London was part of what made our experience so fantastic. There is a group in England called The National Child Birth Trust and they run fantastic anti natal courses. At eight weeks you meet one hour or two hours once a week for eight weeks with a group; you go through all this sort of basics of pregnancy, child birth, what to expect post partum, how much your lives are going to change with this, but what's so amazing about the NCB classes is that the instructors are really charged in a very positive way with creating community out of the classes. Our group is built so strongly from the classes that we actually went back to London this summer, and had a joint fifth birthday party with the nine other kids that were born with my first one.


CATHERINE:  That's incredible.


KAREN:  It's incredible, and I can honestly say that the midwife who ran those classes was the head of the midwifery consortium we used; she wasn't at my son's birth, but it was her other midwives were there. But the power that they instil in the process of giving birth and having support and creating a community out of all these other new parents is really unparalleled. And for us, I mean its very cliché and cheesy to say, but It was absolutely life changing. So in that way, we felt extremely well prepared for our second son's birth – for the home birth, because what she had taught in our first set of classes in London, just was so meaningful and has stuck with us so well that we; I think a lot about how my life would be different had we not been living in London, and had my first child not been born there, and we hadn't ever used midwives and have never found this NCT class, because it's really been life changing for us.


CATHERINE:  And I think one of the things you hit on there too is how much preparation is a part of how your birth experiences goes and how your views are on how everything went.


KAREN:  Absolutely.


CATHERINE:  It's completely common for women to just skip classes.


KAREN:  Right.


CATHERINE:  That's just mind boggling to me. They definitely don't come out with the story that you have.


KAREN:  Well right. They allow it to happen to them rather than being an active participant. Really, frankly, what is the most important thing you're ever going to do in life?


CATHERINE:  I completely agree, yes.


KAREN:  I don't understand.


CATHERINE:  Now that we've talked a little bit about your preparation and care options, did you take any other courses or preparation for your second birth, or did you feel that you had such a wonderful training from your experience in London that you were well prepared for a home birth as well?


KAREN:  Well, I didn't take any special courses, but really, once you have one great birth experience, you really become kind of like a birth junky and you read all the birth stories. You can, and you quit watching all those birth stories on television because they're just frightening and scary and so far out of the realm of normal that they make me irritated to even know they're on. If I have surrounded myself; you know, I can't say completely unknowingly because it's self selection in finding your group of friends that - my group of my closest friends are all home birthers, which I think is a very strong statement that something that, even though we're very different politically, we're very different social economically that I guess the bond or the shared experience we have had by doing a home birth has really brought us together on other levels as well.


CATHERINE:  I completely see exactly what you're talking about; that child birth choices are such a basic part of who you are, that they do in a sense, define you.


KAREN:  Um hum.


CATHERINE:  Even though you can be so different in other arenas, it's just a common thread that can take over a relationship. Like you said, even though it's maybe not intentional, those are the people that you're gravitating toward.


KAREN:  Right.


CATHERINE:  Because it is such an important part of your life.


KAREN:  Right. And I find it very interesting as well, because of the necessity of the father being on board with the whole idea of a home birth, that we get along very well with the couples as well. You know how difficult it is to like meet couples where all four people get along? We don't have that problem with one of our friends who have home birth. And I don't know, I'm not  a psychologist,  I can't explain why that happens, but I do think that there is some sort of like base understanding that goes on.   It allows you to relate to people.


CATHERINE:  Absolutely. Now, you've indicated that you do have a pretty wide group of friends that are home birthers. When you were first planning your home birth, did you encounter any resistance from other friends or family members?


KAREN:  We had a lot of concerns from family members who I think, understood that while we chose to have midwives in the UK because that's the way that it's done there. They didn't really understand why we didn't do it in a hospital here, because that's the way it's done here. And basically, what we did is I went through and from all the research that I've done online; collected a whole list of links, and articles, and put them in a big Word document and just sent them to people. Partly, in a defensive stance to say you know we didn't just chose to do this to tick you off, but we actually researched it and thought about it, and think it's a really good idea. But also because rather than just being defensive and saying, hey, we researched it, to really try to educate them as well. And as I had friends in the last few years, sort of turn to me to say, hey, you had a home birth; I'm kind of thinking about it, but you know my husbands not really sure. It's been often, someone will say, hey, I have this Word document with all these internet links on it; everything from like Web MD, to the British Journal of Medicine, to, you know, this and that, that says home birth is an incredibly safe option. Home birth is aimed to be the standard of care in many countries around the world. This is it you know, people out in the woods, beating on drums, and we're going to send you a carrier pigeon; the baby is born. So it's been an ongoing type of education. I think in a lot of ways, that's been the most exciting part to me, is that we didn't just have a good experience, but maybe some other people have learned from it as well. Who knows what kind of experience they're going to have now that they wouldn't even have considered before.


CATHERINE:  You never know how many lives that will touch when you share that story with others.


KAREN:  Yes.


CATHERINE:  The commonality in this country is home birth before the experience. They're not realising that this decision is based on what the research is really saying; that home birth is a safe option.


KAREN:  Yes, yes, well in fact now, if you are a pregnant woman in the UK, and you're on the National Health Service, your having a home birth has to be presented to you as a viable option. And, if you have no risk factors, it has to be presented to you as the preferred option. It's not about saving money, because it's a lot more expensive for people to go to your house than for you to come to them.


CATHERINE:  Right. In the long run, it might save money in, at least in this country, in terms of the number of interventions.


KAREN:  Oh well, absolutely. The reason that a midwife in Austin can charge nineteen hundred dollars for every single prenatal visit, six postnatal visits, and the labour and delivery, is that's like the price of an aspirin in the hospital; you know, even with you the entire time.


CATHERINE:  Absolutely.


KAREN:  Yes, like I said, that's another option for me.


CATHERINE:  Now, tell us a little bit about how you prepared in the event an emergency did arise. What steps did you take to prepare in case something were to happen? You've already indicated that transfer wasn't as easy of an option if it would have been in London.


KAREN:  Well, we know that we are about two and a half miles from our closest hospital and honestly, to call 911 and get an ambulance transfer to a hospital two and a half miles away, I figure is very, very close to the same amount of time it would take you to be transferred within the hospital up to an emergency situation, and have the team ready and everybody there. So it really became almost a wash in terms of timing. I had a friend who came over and spent the night with my older son.  She knew that she was going to be able to be there for the duration of the delivery. Honestly, I've had complete faith in my midwife to do what needed to be done and to do; make the appropriate decisions at the appropriate times. One of the things that I think that people don't understand about midwifery, because there's so much talk about emergencies, is the greatest benefit in my mind to having a midwife, is that you have somebody with whom you've established a relationship; who understands behaviour and your type of thinking. And she is with you from very, very early on in labour and as such can identify any potential problems very early on; before they become an emergency. That, I think, is priceless.


CATHERINE:  That is as rates in an insurance policy that many of the complications that can arise and that are dangerous, can only be identified by physically being with the woman.


KAREN:  Um hum, yes.


CATHERINE:  The nurse just down the hall.


KAREN:  And I think that that's really something I tried to tell people a lot.  If you are considering midwifery, but for focusing more on the emergency aspect, is that the reason that midwifery is this successful and that home birth have such positive outcomes is because if problems arise, the midwife is there to take care of them and either deal with them in an appropriate way and stop the problem from escalating or, is there to take appropriate action; transfer you before the situation becomes an emergency.


CATHERINE:  Absolutely. It's not "uh oh, here's an emergency on our hands", it's "let's prevent, prevent, prevent".


KAREN:  Exactly.


CATHERINE:  But we have nothing left to treat.


KAREN:  Yes.


CATHERINE:  Yes. Now, tell us a little bit about your birth. Did an emergency arise?


KAREN:  It was – I don't know if I'd call it an emergency, I'd definitely call it a complication in that my labour was incredibly, incredibly, fast. Which people think is fantastic; however, I'm not really an advocate of a crazy fast labour. It's kind of like trying to hop on a freight train while it's already moving. However, my; I, I was contracting quite regularly and was obviously, I was going through a transition. It became, as I was pushing and the midwife was monitoring my baby's heart rate, there were some pretty significant decelerations in my baby's heart rate for two straight contractions. And pushing. Her incredible calm through the situation was so confidence inspiring in me. Even as we were going through it, he – my husband, I was birthing in a water pool in my living room and my husband was in the pool behind me, and I could see after the first time that she took the reading, she turned to her apprentice and no noted that that was a significant acceleration, we'll need to monitor again on the next contraction. She did and she looked and told the apprentice what the reading was, and then she took my hands in her hands and she looked at me and she said, I need you to take deep breaths and a lot of love and a cry down to your baby and then push your baby out; time for your baby to be born. And, she motioned to the apprentice to get the neonatal oxygen, and I looked at her and my husband was supporting me from behind, and my son was born on the next contraction. And it was; it was incredibly peaceful. She gave him oxygen; didn't really need it as it turns out, but I was glad it was there. She was prepared, he took it, and he cried within ten seconds; it always seems like forever, but I had another friend who was there, a photographer, and she was taking pictures. In hind sight, it was really interesting because my friend who I know very well – home birther herself, said that it was one of the most amazing things that she's ever seen because the midwife was so calm and so peaceful and there was never a sense of, oh my God, what are we going to do. You know, there was no scary music playing in the background; none of that. She looked at me, she told me what needed to happen, I believed in my ability to birth my baby, and he came out, and he's perfectly fine. In fact, he's a little bit crazy; he's two now, he's everywhere. But I really am afraid to think of what would have happened had I been in a hospital. It's opposite situation with my first son at a birth centre; I pushed him for very close – just under three hours, which never would have been allowed in a US hospital. And so look at my two situations; one where I had really long pushing stage, and one where I had a very, very short pushing stage, and I think neither of them would; I would not have been allowed to birth my child in either of those situations, in a hospital, I don't think. However, they're both perfectly normal, I'm perfectly fine, I didn't tear with either of them, I can't think of a better outcome.


CATHERINE:  No, absolutely not. Now, the first thing that came to my mind was that in a hospital, if we're looking at late decals like that, you're almost certainly going to get either forceps or episiotomy, extraction, something to make sure that we get that baby out right away.


KAREN:  Right now, right.


CATHERINE:  Your midwife was able to tell you what needed to happen; that  factor wasn't there.


KAREN:  No, not at all. It's hard, it's hard to say what would have happened had it gone on another three minutes, or another two sets of contractions if I hadn't been able to do it, but you know he was there, he was ready to be born. And frankly, this is also another funny thing that I sort of just, in hind sight, – that's who he is, he's a drama kid. He's all about causing a ruckus. Where my first child, he didn't you know it took nearly three hours just about and that was the most calm, peaceful birth, where I'm like laughing and making jokes through the whole thing. It was just really like sensitive, calm, quietness. And you know, I don't want to read too much into it, but it is very interesting.


CATHERINE:  Interesting; how they let us know who they are.


KAREN:  Oh my gosh.


CATHERINE:  From the very beginning.


KAREN:  Oh yes.


CATHERINE:  So now in retrospect, you have that experience of having a home birth versus that birthing centre, what were the foremost benefits in your mind of birthing from home?


KAREN:  All of it. I mean, it's hard to say because it's so inter connected. I think, the foremost benefit would be that I was able to birth in my own home, be very relaxed and have somebody attending to the birth who believed in my ability to birth my child. I would say another huge benefit is even though my older son was not quite three years old; he's grown up with the idea that having a baby at home is normal and that's how babies are born. And part of why I think that God gave me boys, is that I can do a lot of work for the feminist movement. Like between them; about things that women need and women want and you know having them see that as men, they get very involved. They can get very involved in the birth of their children, become very close to their children – if they're included.


CATHERINE:  Absolutely, you've raised another important issue; that by raising boys so that they're accustomed to birth, they realise what their role is.


KAREN:  Right, and you know the birthing with - my home birth baby was born overnight. I had said that I had my friend who was staying with my son, first time in his life, he slept all night Long. He would simply try at three years old, it was a monumental night. he clearly new that something was going on and he needed to sleep, but he woke up at his regular six o'clock in the morning or whatever. And he woke up and said to the midwife, baby is here, and it was as if he just got this present over night. There was no - the baby was born into the home, into the family, it was seamless.


CATHERINE:  Um hum.


KAREN:  And it's hard telling what he'll remember about that. He thinks he has a lot of memories; we look at the pictures a lot, but growing up with that as an idea of normal I think is going to be incredibly powerful for him.


CATHERINE:  Absolutely. Now if you were to have another child, would you make different decisions the next time? Would you choose a home birth?


KAREN:  Oh, no, absolutely I would have another home birth. You know the only way I wouldn't is if I had some real medical need that would put me or my child at risk. Honestly, and I tell people this all the time, I can't imagine having to go through labour and delivering a child and not being in a nice warm tub of water, because both of my kids have been water birth.


CATHERINE: Um hum.


KAREN:  And I just can't imagine knowing, having somebody tell me to lie down.


CATHERINE:  Or someone to tell you what to do.


KAREN:  Right, or when I have to push. Because frankly, it was rather clear. 


CATHERINE:  Yes.


KAREN:  Yes. And I think that if it comes - the really good midwives have; they know how to dance and they know when to talk it they know when to sit there.


CATHERINE:  Um hum, and they know that mostly it's a job of watching and waiting.


KAREN:  Yes, yes, now I'd have to say that, but absolutely. Not planning to have another child, but if it would happen, it would be born at home. Although, my husband says he's going to be devastated when he has to sell our house. You know, in three years. It'd be hard to leave a place a child's been born in.


CATHERINE:  Absolutely. What is the one piece of take away advice that you'd like to share with other women who are considering home birth, who might be on the fence, or just exploring their options during their pregnancies; what would you say to them?


KAREN:  I would tell them to do their research, to find a care provider that they feel comfortable with on a personal and professional level, and then you just, you make the decision the little voice in your head tells you to make, and I believe in that. I believe everybody has a conscience and if there's one point in your life to listen to your conscience, this is a really good time. And that it's hard because our society does not embrace this option, our society does not make it very easy to do home birth, but if that's what you believe is the best choice for you, there are people out there who will support you, and it's not too hard to find them once you go to start looking.


CATHERINE:  There's always a way.


KAREN:  There is always a way. Like I said, this is going to be one of the most important days of your life; both for you and your child. And to give it less attention than it deserves is really selling a whole lot of you short – your whole family.


CATHERINE:  Yes. Thank you so much Karen for being with us today. Is there anything else you'd like to say before we go? Appreciate the time you've taken away from your boys to be with us.


KAREN:  Well, I just hope that more people understand that home birth is a safe and viable option, and that it's been incredibly peaceful and powerful way to grow your family.


CATHERINE:  Well I hope that they will. Thank you so much Karen for being with us today.


KAREN:  You're welcome.

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