I received a letter from my ob/gyn’s office today with an appointment date. I thought it was a mistake until I got a voice mail from the secretary requesting I ring back to confirm the appointment which was based on a referral from my GP’s office.

Sounds standard but just a year late!

I had gone to my GP with a complaint almost a year ago. The same week I got this letter, I also got an e-mail from my mother complaining about the Obamacare website in Maine and how much her policy cost.  I can not even bring myself to investigate the cost of insuring my family over there when we move over since we won’t have jobs for a few months. This all got me thinking again about the differences in healthcare between here and the US.

The main difference is price but the principle of universal healthcare leads to other differences that I am not sure supporters of healthcare reform (particularly liberal, well-educated, middle and upper class urbanites) would be ready to face themselves.  Social policy is personal and when I see FB posts about healthcare reform I chuckle at the thought of my friend’s having babies the Irish way.

I had two straightforward and uncomplicated pregnancies and deliveries and found the mid-wife led service very good but there is nothing dressed up or glamorous about your choices.

For people not familiar with the Irish healthcare system, here are few general points:

• I don’t actually have a ob/gyn – you are assigned one when you are pregnant and she supervised my pregnancy, labour and delivery and post-natal care but I only met her once.
• Your maternity care is delivered by a combination of GP, nurses or midwives, registrars (this is like a resident
• The GP is your first point of call for everything and then you get referred to Consultants (specialists)
• It is not uncommon to wait over 12 months to get an appointment for a consultant
• You can pay and make an appointment with the same doctor directly and it doesn’t take as long
• You get standard red-tape letters about health matters, no phone calls (I always found this disconcerting, impersonal  and kind of inappropriate – what if it didn’t arrive or someone else opened it and you never got it?)
• Because the health system is publicly run (even if you pay you are still using the public health system because the hospitals, doctors and management are all public) it is run by civil servants and in the same manner as say the DMV.

My maternity experiences were very different from my friend’s in the U.S. and I am frankly not sure American’s are really ready for universal affordable healthcare.  It is one thing to be a liberal educated middle-class woman who believes in equal access to health care for all Americans but it is another thing when it becomes personal.  The reality is that you will have the same experience as women who don’t pay and they will be next to you.  In the chair, room or bed next to you as is the case in Ireland.

There was an Irish Traveller in the bed next to me who had just had her 12th baby and was getting given free formula and bottles. I knew the husband from work and know they live in a free house and get a lot of social welfare.  They probably get paid about $2000 per month of universal payments for children alone. The nurses spent a lot of time finding extra formula and bottles for them to take home (for free) but they were in a hurry so the nurses made arrangement for them to collect them later.

You will continue to pay for your healthcare so that other women can receive the same healthcare without paying. You will have limited choices and we know American’s are obsessed with choice (just walk down the shampoo aisle in CVS). My friend’s shopped around for their doctors and their hospitals.  I think this is all just an illusion of choice  because at the end of the day the baby will come out one of two ways and it works the same for everyone but these choices let women think they have an element of control over things. I personally think this pretense that you can control your healthcare is  dangerous expectation that leads to a lot of misinformation and disappointment at the reality of childbirth and beyond.

Has anyone heard of a maternity concierge?? Well, I hadn’t either until a friend living in LA suggested that I look up this reality show called ‘Pregnant in Heel’s’. This show is fantastic.  This woman, a maternity concierge, charges about $500/hour to fulfill your every crazy wish and demand through pregnancy.  I can’t even begin to describe the craziness I saw on the show but much of it makes you wonder how have these people become successful – they are idiots?.

No one here has heard of a maternity concierge and when I try to explain the hilarity of the tv show, they think I am making it all up.  I wish.

I received an e-mail from a close friend right after having her baby in a city in the US. There was a link to a professional photographer’s website to see the results of his photo shoot…in the hospital. The pictures were adorable and the mother looked great except for the exhausted and confused look in her eye. She had clothes on and makeup and jewelry and the baby was in props.  I started looking more closely.  The hospital room seemed to have hardwood floors! There were suggested colors to bring and tips for looking good from the photographer that included clear nail polish.  What?? This was the day after giving birth to your first baby and the hospital arranged for professional photographer’s to visit your room and sell you a photo shoot.  First I had a bit of a breakdown – how could she manage a family photo shoot the day after giving birth when I was barely able to get my son to latch on and nurse without tears (both of ours)? Then I thought, god how awful for her to be forced to present herself like that and forced to make that choice in such a vulnerable moment.

In contrast the labor ward of my local hospital was described to me by a new father as dairy barn with cows trundling up and down ready to give birth to calves. He was describing (complete with agricultural references not really appreciated by my female colleagues) how his wife had to wait until she was fully in labor before getting into a delivery room because they were all full.  In the meantime you walk the corridors.  Up and down stopping for contractions and looking at County football jerseys hanging on the walls.

The mid-wives lead the unit under the supervision of a consultant but I never saw a consultant ob/gyn in my deliveries (thank god) and since there are only three I am sure more often than not, it is a resident doctor.  The mid-wives are great.  They have seen it all and at least one stayed with me the whole time.  They are funny, relaxed, helpful, straightforward, stern when needed and made me feel relatively calm.

Give me an Irish mid-wife over a maternity concierge any day.

Note: Midwifery is a medical profession in Ireland – I realize the term midwife can be used much more loosely in the US and Australia.  I am not an advocate of these self-determined midwifes who are more like doulas that advocate home births. Midwives here are nurses with additional training and experience in pre-natal, labor & delivery and post natal care.