vendredi 16 janvier 2009

Adventures in Prenatal Care

Because I got pregnant a few months before we left Paris, I was able to experience both French and British prenatal care. My experiences have left me to conclude that the centuries-old rivalry between these two great countries is alive and well.

In France, I was privileged enough to go to the American Hospital, a very swish hospital located in Neuilly, which perhaps colored my experience to a degree. Neuilly is Sarkozy’s old ‘hood, where he was mayor, and is so posh that rather than follow the housing rules requiring it to have a certain percentage of lower-income housing, the city chooses to pay fines for its failure to comply. In my doctor’s office, pregnant women with bellies the size of a Smart Car (the two-seater kind, obviously) still wore their Gucci heels and Prada purses to their visits.

French prenatal care is obsessed with the woman’s possibility of contracting toxoplasmosis. Toxoplasmosis is caused by a parasite found in animal feces, and in the US, women get tested for it if they have a cat (hence the recommendation that pregnant women do not change kitty litter). According to the brochures my doctor gave me in France, to avoid toxoplasmosis, a woman should not eat salad at a restaurant (out of concern that the parasite may not have been washed off properly) and should refrain from eating raw meat and eggs, i.e., French bistro classics. Apparently, French food is in much closer contact with the earth out in the farmland, and the risk of toxoplasmosis is higher.

Pregnant women are therefore typically tested to see if they are immune to toxoplasmosis. A French woman is usually immune to it, probably because she has been consuming steak tartare and undercooked eggs (which taste better than overcooked ones, I must say) since she was old enough to sit at a proper table in a bistro. Like most non-French women, my test showed that I did not have immunity to toxoplasmosis, causing the women at the laboratory where I picked up my results to o-la-la vociferously and declare that I would need to have monthly blood exams to make sure I had not contracted this dreaded parasite.

Mind you, at this point, I did not realize that the concern with toxoplasmosis is a peculiarly French obsession. As a newly pregnant woman, I took everything said to me quite seriously, especially considering the reputable sources of my information.

Before leaving France, I had my 13-week ultrasound, and the doctor who explained the results to me (after also o-la-laing about my lack of immunity to toxoplasmosis), tried to resassure me by telling me that I did not need to worry about this infection in the UK or the US. She explained that “the English boil all their food,” and hence the parasite was not something I should worry about. Now, I know that the English don’t have the gastronomic reputation that the French do, but surely it is a bit overbroard to say that they boil all their food!

In addition to reassuring me about toxoplasmosis, the doctor asked about our ethnic heritage. When she saw that Diego had English grandparents, she became most concerned and stated that as soon as I moved to London, I would need to have the fetus tested for spina bifida, as Diego’s English genes were subjecting our unborn child to a higher risk for this birth defect.

As a newly-pregnant woman, you can imagine how concerned this made me. Indeed, within a week of having arrived from France, I promptly booked an appointment with a GP (although I did not yet an actual address in the UK, which is required to register for health care, my GP’s office quite kindly registered me as a “temporary patient” so that I would be able to receive prenatal care in a timely manner).

At the appointment, I explained to the doctor that I was most concerned about spina bifida as a result of my husband’s unfortunate genetics, and that I would like to be referred for the early spina bifida test. The kind doctor’s indignant response to my new-mother overreaction? “There is always a risk of spina bifida, but it is not because your husband is English!”

Somewhat reassured (though, in typical new-mother fashion, still a bit doubtful), I asked the doctor about other new-mother concerns. Although the doctor in France had said that I did not need to worry about it here in the UK, I also decided to ask about toxoplasmosis, as the monthly blood tests and the o-la-laing at the laboratory and doctor’s office had left me worried. Perhaps seizing on the chance to get back at the French doctors after the spina bifida comments, my English doctor said I did not need to worry about toxoplasmosis here because of the way food is prepared and exclaimed “Dirty French!”

On the whole, the only conclusions I can draw from these experiences is that, to this day, the English and French don’t like each other very much and that each culture (and probably every culture in the world) makes up its own concerns and rules about pregnancy. My only advice for mums-to-be the world over is to take all advice with a grain of salt and to keep in mind that your doctor’s culture will impact his advice.

Take the issues of an epidural and breast-feeding. In the UK, the theory seems to be that if grandma did it one way, we should do it that way today. Never mind that in grandma’s time, women and babies routintely died because of childbirth.

Indeed, most UK mums and midwives seemed horrified when I announce that I want an epidural, going on and on about some supposed list of horribles (I don’t really believe them, though, especially as my own mother had an epidural and is probably one of the few women I know who thought the birth was a breeze). To make matters worse, I have heard of women in the UK not being able to get an epidural because an anesthesiologist is not always necessarily available to administer one, a downfall, I suppose, of a system of truly socialized medicine.

The French, in contast, are very much in favor of epidurals. When I told her of my fear of not getting an anesthetic during the birth in the UK, my doctor in France even offered to schedule an induction at some point after 36 weeks in Paris so as to ensure that I could get an epidural. The French may believe in eating natural food that has been in close contact with the earth, but they certainly do not believe in natural medicine!

Likewise, the French do not seem as concerned with breastfeeding as the English do (in part because breastfeeding ruins a woman’s breasts). The UK system, on the other hand, is positively obsessed with the breastfeeding issue. While I think it is fantastic to be breastfeed if at all possible, I absolutely detest that the UK medical establishment seems obsessed with preaching breast-is-best to mums-to-be. The way I see it, if they are so resistant to letting me choose the type of birth I want, they have no right to dictate my post-birth life (not to mention the overly big-brother aspect of it all).

Alas, if I could, I would choose to have the baby in France (epidural and 5-day hospital stay included). I just hope our little kiddo someday appreciates the fact that I am quite determinedly staying in the UK for the birth, risking having to do things grandma’s way and getting kicked out of the maternity ward a mere few hours after he is born, just so that he may have double nationality and become a little globe-trotting adventurer.

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