Differences so far…

Differences so far…

Wow, I’m not even sure where to start here. There have been A LOT of differences so far between American midwifery and British midwifery. Here’s just a small sampling.

First, abbreviations. Some of them are the same, most of them are completely different. In the US, an IUD is an intrauterine device (i.e. contraception). In the UK, it’s an intrauterine demise (stillborn baby). BIG difference there. In the US, taking a medication twice a day is BID (“bis in die”, Latin for twice daily); in the UK, it’s just BD. QID = QD, TID = TD. In the US when I see PE on a chart, I would think Physical Exam. Here it means Pulmonary Embolism. In the US, contractions are measured on a tocometer, or abbreviated as “toco”. Here it’s abbreviated as CTG (meaning cardiotocograph). FHHR is fetal heart rate heard regular, rather than just FHR (Fetal heart rate). Small things like that, but it adds up.

The antenatal visit schedule is very different as well. In the US, pregnant women can get anywhere from 12-14 prenatal visits through the course of their pregnancy. Here, a nulliparous woman (first-time mom) will only have 10 visits total with her midwife, and a multiparous woman (second-time mom) will only have 7 visits total with her midwife. In the US, generally the longest time between visits would be 4 weeks, but here there can be up to 6 weeks between midwifery visits. I can see how this might be a much more efficient schedule and use of resources (and the NHS is all about using resources wisely), but I wonder if there is flexibility in this schedule for the mums that may have a lot of issues going on and might actually needs more frequent follow-up. I wonder how that works with the overall schedule, and I wonder how midwives get around that (extra sonograms in place of visits, maybe?). This will be a very interesting area to learn more about. According to NICE guidelines for antenatal care, the schedule looks like this: Initial booking appointment with the midwife by 10 wks if possible, 10-14 wks: ultrasound for gestational age (but no midwife visit), 16 wks: midwife, 18-20 wks (ultrasound for fetal anomalies/ anatomy scan, but no midwife visit), 25 wks: midwife (nullips only), 28 wks: midwife (nullips AND multips), 31 wks: midwife (nullips only), 34 wks: midwife (nullips & multips), 36, 38 wks: midwife (nullips & multips), 40 wks: midwife (nullips only), 41 wks: midwife (nullips and multips, to discuss postdates options). And that’s it, folks.

The screening schedule is slightly different. For instance, in the US an initial visit usually involves a pap smear and a test for gonorrhea and chlamydia. Here in the UK, these are not routinely offered. Pap smears are done routinely by a GP (rather than OB/Gyn or midwife or women’s health NP) on a different screening schedule (every 3 years), so ┬áthere’s no need to try to catch up on smears at an initial pregnancy booking. In the US, since many women don’t have access to routine care, it’s sometimes been years and years since they had a pap smear (and sometimes they’ve *never* had a pap smear before), and because pregnancy is actually a time in a woman’s life when she accesses care, the US system is designed to try to take advantage of this and do a lot of catch-up primary care/ health promoting tests at the same time as the routine prenatal care. But thanks to the beauty of UNIVERSAL health care, routine health promotion practices are already in place, so pregnancy care is exactly that: *pregnancy* care. Also interestingly enough, there is no vaginal/ pelvic exam at an initial pregnancy visit here, and many of the British midwives I have spoken to are very puzzled by the need for one. “Why would you routinely do an invasive, uncomfortable exam at an initial pregnancy booking on all women?” Well….because….well….I don’t really have a good answer to that. Because in the States this is something we’re taught to do: pap/ gonorrhea+chlamydia test/ vaginal exam/ bimanual exam/ pelvimetry, at every initial antenatal visit. But in a healthy, low-risk woman who’s already had access to regular check-ups and care, is all of that really necessary? Paps are routinely screened for in the general public by GPs here, and there is a national screening program for all women under 25 years of age for chlamydia, so again chlamydia is already being routinely screened for in the most at-risk population. There is no mention of gonorrhea testing as a routine part of antenatal *screening*. I guess this means that GC/CT are screened for only if there is an indication through the woman’s personal history? Again, this is something I’m going to have to learn more about. Also very interesting is the fact that Group Beta Strep is NOT routinely screened for in all pregnant women at 36 wks here. Which is rather mind-blowing to me. But in a less litigious, more resource-efficient society, perhaps this makes sense too. And it would drastically cut down on the overuse of antibiotics and antibiotic resistance (not to mention the damage routine antibiotic use is doing to our collective human microbiome on a population level). Again, this is something I’m going to have to learn a lot more about.

And finally, ANATOMY is different here. I kid you not! I thought surely the Latin names for muscles and bones and organs and structures would be the same. But no, lots of new names I’ve never heard of before. For example, I would call it the rectouterine pouch. Here it’s call the Pouch of Douglas. What I would label the pubococcygeus muscle (in the levator ani), the Brits call the pubovisceral muscle. What I would call the puborectalis (again in the levator ani), the Brits call the puboanalis. Lots and lots of little things like that. Very similar, but not quite 100% the same. Which means that even though a lot of this material is familiar, I can’t assume that I know it. I don’t know it (and I had forgotten most of the names of all of these muscles anyway). So I am having to study it all again as if I’m learning it for the first time. Time to hit the books!

 

Leave a Reply

%d bloggers like this: