25 February 2011

Pregnancy: US vs UK

In talking to my friends in the US, I'm always amazed at how differently pregnancy is treated in the US as opposed to in the UK.  This came up most recently when I was in a conversation and insisted that pregnancy is not a medical condition or disease, and another woman countered that if it isn't, then I should make sure I don't have the fasting glucose test or see a doctor or take vitamins and remember not to smoke or drink.  I'd like to address some of these things now.

        Good nutrition is not exclusive to pregnancy and isn't something that should only be followed when pregnant, trying to conceive, or breastfeeding.  I don't think you necessarily need vitamins, provided you're eating a varied diet and getting plenty of sunshine, but if those things aren't happening, by all means take some vitamins, pregnant or not.  Good nutrition should be a healthy lifelong habit, and it is much easier to follow good nutrition during pregnancy if it's already a habit.  This does not make pregnancy a medical condition any more than all of our life is a medical condition.

-Glucose Tolerance Test
        The fasting glucose test, or GTT (glucose tolerance test), seem to be routinely done in the US, despite ACOG mentioning that gestatinal diabetes only occurs in 2-10% of the pregnant population, but are not here (at least not in my city).  Until recently, these tests were only done on those women who are at a higher risk of becoming diabetic, though that may change.  I find it interesting, though, that this site mentions that there aren't false positives for the oral GTT, unless one already has certain conditions, with pregnancy being one of them.  To me, that sounds like pregnancy can cause false positives on the GTT, though I don't know how often that would occur.  Though the guidelines on appropriate glucose levels have been updated, so maybe that will help with the false positives.  I'm not saying that gestational diabetes should simply be ignored, but it seems to make more sense to me to screen those women who have one or more risk factors, or who have higher sugar levels show up in their urine samples, instead of testing all pregnant women.  Of course, I'm sure part of my reaction comes from knowing that my blood sugar is generally on the lower end and that I'm fairly evil and feel very ill if I don't eat, meaning a test like this would be quite an ordeal for me.

      This one wasn't mentioned in the conversation, but my friends in the US seem to get weighed at every antenatal appointment, with their providers remarking over whether their weight gain was at appropriate rates or not.  My mother-in-law mentioned that with one of her pregnancies, she was advised not to gain any more weight during the last couple of months!  I honestly cannot tell you how much weight I gained, because I was only weighed once or twice with both pregnancies: once at the booking in appointment at the hospital, and once at the GP surgery (only with Charlotte - I don't think they weighed me at that initial appointment with Kieran).  In both cases I was told I might have to see a nutritionist because of a low BMI, but that didn't end up happening (I'll spare you my rant on BMI for the moment).

-Cervical checks
       While this wasn't directly mentioned in the conversation, I wouldn't be surprised if the other lady had assumed they were included in the monthly antentatal checks.  This may be an incorrect assumption, but it bears mentioning anyway since internal checks are often done in late pregnancy in the US.  As you may have guessed, they are not routinely done here, and so I've only had two cervical checks during pregnancy, both when I was in labour with Kieran.  So why aren't they done during pregnancy here?  Because they can introduce a risk of infection, and because they don't provide the midwives or OBs with meaninful information.  Yes, they can tell you how dilated you are, whether the cervix is posterior or anterior, or how effaced you are, but none of that information can tell the woman or care provider when she'll go into labour, or how much longer labour will last.  Some women can be dilated a couple of centimetres for weeks prior to labour, and others don't dilate at all until transition.  The position of the baby can also be determined without a vaginal exam (and a vaginal exam doens't guarantee the provider will recognise that the baby is posterior, from personal experience).  A good run-down on these reasons is given here.  Again, I'm not saying that cervical checks don't have their place, and they can be useful, but I see no reason for them to be done routinely.

-Group B Strep testing
        Again, this wasn't specifically mentioned, I'm again assuming it was included in the mention of antenatal appointments, since it is routinely done in the US, but not in the UK.  It is interesting to see the different approaches and conclusions with the CDC & ACOG versus RCOG.   GBS infection in the newborn is serious, I agree, but I still am not convinced that the US approach is best.

-Smoking & Drinking
       Smoking is associated with health risks whether one is pregnant or not (though there are some risks of smoking that are specific to pregnancy) and does not make pregnancy a medical condition.  Drinking, on the other hand, isn't as black and white.  Studies have shown that moderate alcohol consumption has health benefits, even in pregnancy.  Drinking too much, however, can have a negative impact on health regardless of being pregnant, and shouldn't be done at any time.

I'm sure you can guess which approach I prefer, and I stand by my statement that pregnancy is not a medical condition for the majority of women, and therefore shouldn't be treated as such.  I'm grateful for the medical professionals who are here to treat pregnant women when a concern or condition is present, of course, I simply disagree that all pregnant women should be treated as if they have a medical condition.  Of course, this is just my opinion, and I have no medical training, though I do try to educate myself on these things as much as possible.


  1. I just starting taking folic acid - I hadn't been before, but I think it's a good idea.

    Also, we didn't do the Group B strep testing, but the cervical checks? Woo boy! Like you said, I walked around 80% effaced and 2 cm dilated for 3 weeks before being induced. I will be requesting less next time, if we're ever so blessed again.

  2. And I got discouraged after the first cervical check. I was in active labour, had been for a bit, and was either already saying "I can't" or close to it. I was 3cm. I was pushing an hour later or thereabouts. I just don't dilate until transition. When I was pregnant with Charlotte I asked the midwife if she was OK with not doing any internal checks during labour, and she said that was fine and that she could tell where I was by watching me.