Daisy was my first midwife at the London hospital where, upon finding out I was pregnant, I’d planned to have a straightforward, perfectly average birth with lots of euphoria-inducing drugs and expert medical attention. That, of course, was before I knew anything about the NHS and its methods.
My 12-week appointment was arranged through my GP. After sitting close to three hours in a waiting room filled with sweaty pregnant women who looked as if they might kill each other for a sandwich, I was shown into an office by a large 60-something woman in a blue smock holding a clipboard with my notes on it. She wore a name tag but did not introduce herself.
First she instructed me to stop taking Pregnacare antenatal vitamins, the bestselling supplement on the market, as they were, in her opinion, ‘complete rubbish’. Then she asked if I’d been drinking.
‘Hardly at all, since I found out,’ I said. This was true — although my English boyfriend offered to pour me a gin and tonic every night after work and rolled his eyes when I declined. His new nickname for me was ‘Health Canada’, a reference to the austere government ministry where my sister worked back home. ‘I’ve had the odd glass of wine but obviously not every day,’ I told Daisy primly, ‘and never more than one at a time of course.’ I watched as her eyes widened and a look of horror spread slowly across her face.
She raised her voice to the pitch of someone commanding a very bad dog. ‘NOT. A. DROP. Do you understand me? This is very important.’ Still shaking her head, she began pelting me with questions: ‘Do you smoke?’, ‘Have you ever engaged in recreational drug use?’, ‘How many units of alcohol a week do you normally drink?’ and finally, ‘What is your faith?’
I laughed, until I realised she wasn’t joking. So I said that I practised yoga. Daisy stared at me with a look of pure pity, then explained that things had been much easier during her pregnancies since she was a Muslim and ‘Muslims don’t drink to begin with’.
At this point she launched into a lecture about the genetic defects my baby might have as a result of the five or six glasses of wine I’d consumed in the first trimester. These included, but were not limited to a ‘10-to-15 per cent reduction in IQ’ and late-onset penile cancer. At this point I’m ashamed to say I began to cry. Not a big blub, just a hot-faced moistening at the corner of my eyes, but tears all the same. Daisy, to my relief, either didn’t notice or pretended not to. She was too busy telling me about the breakdown of her marriage, her alcoholic chain-smoking neighbour and the 53-year-old IVF mother she was treating who in her opinion ‘needed to do something about her face’. Once I’d calmed down about giving birth to a dim-witted future penis cancer sufferer, I thought it best to change the subject.
‘What about the birth?’ I asked. ‘What about it?’ ‘Well I guess I’d like to know what my options are to, you know, make a birth plan.’
Hearing the words ‘birth plan’, Daisy sighed like Gordon Brown confronted with a voter wanting to lecture him on asylum-seekers. ‘There’s no point in talking about it at this stage,’ she said. ‘It’s too early. If all goes well come back at 20 weeks and we can discuss it then.’
I realise she meant if I didn’t have a miscarriage. This — the spectre of my already apparently ill-fated foetus’s death — was enough to finally make me angry. I sat up straight and tried to look as intimidating as possible, despite being queasy, sniffling and about half Daisy’s size. ‘When am I going to see the doctor?’ I demanded. At this, she smiled a broad, self-satisfied grin. ‘Never, unless of course something goes wrong,’ she said. ‘And you should be glad about that. Midwives give much better care.’
In his New Yorker essay ‘Like a King’, the Canadian writer Adam Gopnik compared the experiences of women having a baby in France and America. ‘In New York, pregnancy is a medical condition that, after proper care by people in white coats and a brief hospital stay, can have a “positive outcome”,’ he observed. ‘In Paris it is something that has happened because of sex, which, with help and counsel, can end with your being set free to go out and have more sex.’ Here in London, I’d say, pregnancy is an inside joke — a fundamentally absurd and mildly embarrassing state into which a woman is, tellingly, said to have ‘fallen’ as if down a rabbit hole, and for which she is encouraged to repent by navigating a health system so coded and thorny that only those who bother to learn the secret handshake are assured decent care. While pregnant British women are no longer forced to hide their shame under corsets or slave in Victorian laundries for ‘fallen women’, we have a more modern form of social penance: the cult of natural childbirth.
On the NHS antenatal website, under the heading ‘pain relief’ there are several options listed in the following order: 1) self-help, 2) hydrotherapy (being in water), 3) gas and air, 4) injections, 5) TENS, 6) epidural. In Britain’s public health system, as opposed to say, the French or Canadian ones, pregnant women are encouraged to ‘go natural’, i.e. to work from the top of the pain relief list downward. At my hospital, for example, those who choose to eschew drugs are segregated into a separate antenatal stream and given the option to have their babies in a specialised ‘birth centre’, a bright, airy wing with large rooms filled with comfy beds, heated pools, Space-Hoppers and lots of natural light. Those who opt for a ‘medical birth’ are sent down to the labour ward — a decidedly less atmospheric environment with a single advantage: the good drugs are on tap.
This class system is mostly about cost-effectiveness as opposed to safety. In France, where medicalised birth remains unquestioned, infant mortality is significantly lower than in the UK (in Canada, where babies delivered by doctors and epidurals are the encouraged norm, the rate is roughly the same). More alarmingly, in Britain it has created a system in which only those expectant mothers ‘in the know’ (i.e. the grasping, entitled middle-class ones willing and able to work the system — like me) end up getting the best care. In this sense, NHS antenatal care is a typical British story.
While I understand my experience with Daisy was anomalous when it comes to public midwives (few, it must be said, are outright sadistic), my next antenatal appointment, a few weeks later, did not go much better. As someone who comes from a country in which the public health system that ensures continuity of care by a trained Ob-Gyn (a doctor specialising in obstetrics and gynaecology) for all pregnant women, I was stunned to find out that in the UK, you are unlikely to ever see the same person twice and given no choice or control over who delivers your baby. This wouldn’t have been so bad if the hospital midwives I did see hadn’t seemed so uninterested and harried as to make me feel ashamed to be demanding their attention at all. When, after three hospital visits, six hours of waiting and several lost letters I had still not been weighed, physically examined or thoughtfully counselled on my options, I informed my English boyfriend that I was going back to Canada to have our baby delivered by a Jewish feminist with a medical degree in a nice clean Toronto women’s hospital.
While he looked crestfallen at the idea of his child being delivered on non-British soil, he couldn’t deny the syst em had its failings. But the next evening he returned from work triumphant. ‘I’ve figured it out,’ he said. ‘You’re signing up for a home birth!’
‘The hell I am,’ I told him.
‘No, no, it’s just a ruse,’ he explained. ‘The mothers at the office told me it’s how clever women get the best antenatal care. You just pretend you want a home birth, then change your mind at the last minute and go to hospital. All perfectly proper. Gin and tonic?’
The next day I went to my antenatal yoga class, which wasn’t really a yoga class at all but an excuse for pregnant women to sit around discussing the pros and cons of pre-labour colonics while eating biscuits. About half the women in the class were having their babies privately and the rest of us were at the same hospital. As usual, the conversation turned to breastfeeding. One woman, who had breastfed her first two children past the age of three ‘for the natural antibiotics’ and was about to have her third, told us a story about how, while at boarding school with David Cameron’s sister, she’d learned that the entire Cameron family had not been breastfed. Everyone in the yoga class nodded solemnly: clearly, this was what was wrong with the country.
When I brought up the topic of home birth, the instructor brightened and clasped her hands in prayer position. ‘A totally valid choice,’ she said. I was surprised when three other women in the class piped up to say they were planning to give birth at home as well. One came up to me afterwards and admitted she had had her doubts but that the antenatal care had been ‘totally worth it’. After that, I heard about the ruse everywhere I went — from my hairdresser to my spin instructor to journalist friends. Everyone, it seemed, knew someone who had faked a home birth and been pleased with the results. As one of my girlfriends put it, ‘It’s like one of those bespoke personal concierge services, but free.’
I was sceptical, but at this point willing to try anything. So the next day I rang the hospital’s natural birth centre and told them I was thinking about giving birth at home. Within a couple of hours someone named Melissa called me back and arranged to come over later that week to ‘discuss options’.
When a pretty young red-haired woman in a black motorcycle jacket and jeans arrived on my doorstep exactly on time I couldn’t believe my luck. Melissa was helpful, articulate and seemed genuinely interested in the fact that I was pregnant — exactly the opposite of the midwives I’d so far been exposed to. We went over the risk rates of home vs hospital births (virtually the same), options for home pain relief (water pool, gas and air and discretionary measures of good house wine but alas no epidurals) and the care I would be assured (bi-monthly in-home visits from Melissa at my convenience for the rest of my pregnancy, plus an assisted birth, several follow-up visits and free lactation consulting). By the time we were done I was sold — not just on Melissa but on home birth itself. My ruse had turned into a bona fide birth plan, and I had only my lovely community midwife to thank for it.
Now before you tell me I’m crazy to attempt to have a baby with no pain relief on my living-room floor when I live a seven-minute drive from one of the best maternity hospitals in the country, consider my options for yourself: I could either a) endure nine months of substandard antenatal care with impatient strangers only to turn up at the hospital to be treated by lord knows whom, or b) have Melissa over for tea and a chat every other week until the day when she arrives (with an assistant) to deliver my baby, in the comfort of my own home, in a birthing pool that Rob will assemble. And if I freak out at the last minute Melissa has agreed to call me an ambulance and accompany me to the hospital, where I’ll be drugged into happy oblivion, no questions asked.
Given that the NHS makes it as painful as possible to have a pain-free birth, my choice was simple: go natural or suffer the consequences. In truth, my ideal birth plan would involve a morphine-laced epidural administered by Javier Bardem in the rock-star suite at the Ritz. But given that this is not on offer, I figure, why pay for parking?
It is a ludicrous failing of the system that, in an era when pregnant women should have every medical option open to them, I have ended up choosing a drug-free home birth (something I never would have opted for in Canada or, for that matter, France) simply in order to receive adequate antenatal care. But desperate times call for desperate measures, and I feel confident that with the help of Melissa, my English boyfriend and an enormous glass of wine, I can get through anything.
Wish me luck. I have this funny feeling I’m going to need it.