My family and I went through yet another life changing experience four weeks ago with the birth of our third child here in San Diego, CA. Child #1 and Child #2 were born in southern Germany, both positive experiences, so it was with curiosity and trepidation that I embarked on this experience in a different country the third time around. I began chronicling this experience in a previous post. Here is the rest of the story.
The earliest adjustment I had to make was getting used to no ultrasound at each monthly prenatal visit. There simply was no machine in the exam rooms. So no quick peek to say hello or make sure that everything was OK through this method. Instead, the midwife used a fetal doppler to check the baby’s heartbeat along with measuring the size of my bump during the last part of pregnancy. Instead, there is one long ultrasound (approx. 1.5 hours) when every measurement is made and all parts checked around the 20th week. If a woman has a high-risk pregnancy, than she’ll have more ultrasounds and tests.
Another difference I noticed was the type of glucose tolerance test administered. First, unlike in Germany, this is a mandatory test rather than an optional one taken at the discretion of the patient (and not normally covered by insurance carriers). All pregnant women in America take this test. So, instead of the 3-hour test which is given in Germany, it’s a one-hour test where you drink the sugar drink and have blood drawn one hour after.
As in Germany, most women here take the non-stress test or CTG, where the baby’s heartbeat and mother’s contractions are monitored for about 20 minutes every week during the last part of the third trimester. Happily, I was given the option of opting out of these tests by my midwife, which I eagerly accepted. I’m not sure if this would have been possible in Germany. In both of my German pregnancies, a week 40 CTG and a week 40 ultrasound led to my being sent to the hospital for induction. Luckily, both babies came on their own proving the point that there was nothing to really worry about and an induction would have been an unnecessary intervention.
I remained under midwife care for the entirety of my pregnancy. As I wrote in my earlier post, having a midwife or OB/GYN is an either/or choice in America. Joint gynecological practices with midwives are appearing, but these are less common to find. As in Germany, a midwife delivered my baby in a hospital. I sought out and found a hospital in San Diego where this was an option. Typically, only doctors deliver in hospitals. While I didn’t have a doctor present, there was a nurse. She was who provided me with any needs and comforts such as food, a birthing ball or socks. She also took the baby’s heart rate with the doppler every 30 minutes, even while I stood in the shower. (I was lucky to not have to wear the CTG/fetal monitoring bands during most of my labor this time.) In Germany, there are no nurses in the delivery room. They remain in the recovery ward.
Surprisingly, most of the differences have been positive. In fact, my American experience was less interventionist: fewer tests, fewer ultrasounds. Both countries pretty much offer the same tests, most of which I opted out of, even as a mother with the advanced age of 35 plus. And in the case of the glucose test, though a required test, it is a shorter test here.
On the downside, there are no bathtubs even in the enlightened hospital that I was in. In fact, my midwife revealed to me that they had to fight for showers to be installed in the Labor & Delivery floor. I can attest that those showers were puny at best. How I missed being able to slip into the birthing tub during those last few hours of labor, something quite standard in a German hospital. And, even if there was one, I might not have been allowed to give birth in it.
The other two things that are missing are Rückbildungsgymnastik (pelvic floor strengthening classes) and having a postpartum midwife, both of which are covered by insurance in Germany. These two clever preventive care measures are sorely missed. I have been combing the internet for any sort of substitute here in San Diego, but have come up with nothing. Most postnatal exercise is targeted at getting fit, losing weight, looking thin. They miss the point of taking care of your pelvic floor to prevent problems such as incontinence now or years down the line among other things. Here we encounter the classic American-German dichotomy. Superficial vs. core strengthening. Yes, there is pilates here, but again, Rückbildungsgymnastik is quite targeted at the postpartum woman. And while I am now more experienced as a third time mother, I miss the reassurance of having a midwife come to my house to check on the baby and its weight along with my healing and me. And no matter how experienced you may be, each child is different. The midwife can assist with any breastfeeding issues that might have not been resolved in the hospital or which have developed following discharge, she helps in bathing your squirmy little one for the first time, and she gives tips and homeopathic remedies for common complaints and delicate ailments such as hemorrhoids or constipation.
We’re blessed to now have healthy baby Lenny in our lives. All in all, I think we’ve had a positive experience through this pregnancy and birth here in America just as we did in Germany. And if we were still in Germany, we could now practically live off of Kindergeld.