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Christmas Day in London: darling, I'm pregnant

BMJ 2000; 321 doi: (Published 16 December 2000) Cite this as: BMJ 2000;321:1539
  1. Guillermo Ruiz-Irastorza, consultant physician
  1. Gipuzkoa, Spain

    In August 1999 I moved with my wife from Bilbao in Spain to start a one year medical fellowship. We had been married for some years, but never tried to have children. Why not while in London? On Christmas Day we had a positive pregnancy test and many hopes about the future. Within the next five weeks our happy dreams had turned sour.

    We booked the first visit with our local general practitioner in the seventh week of pregnancy. His only advice to my wife was to take folic acid, which she was already doing. Apart from that we had a brief chat about Spain. Never mind, we thought, we will soon be able to discuss our questions with the midwife or the obstetrician. We were wrong.

    We would like to point out what a fiasco we found our first experience as NHS patients

    What did the NHS offer my wife afterwards? Basically, unpleasant words. She was rejected from the hospital she was referred to, as it was “fully booked for the period in which the baby was due.” We told them that the delivery would take place in Spain, but this didn't make any difference.

    A second hospital agreed to care for my wife, but the first visit was booked in her 15th week of pregnancy. The reason for such a late appointment, kindly explained by an efficient booking clerk, was that “20% of pregnancies miscarry before the 14th week.” In other words, time and money were spent only on pregnancies with a high chance of viability, and the patient must be aware of this.

    It goes without saying that no visit with the local midwife or the general practitioner was offered before the 15th week. Thus, the information about nutrition, life habits, risk of infection, screening for fetal abnormalities, and whatever a woman in her first pregnancy wants to know about had to be obtained from alternative sources.

    Instead the word we heard most was “pay.” Both hospitals let us know their serious concern regarding the bill, although we are—and they knew we were—European Union citizens for whom free medical care is guaranteed in all union countries. When we asked about the nuchal scan for Down's syndrome it was suggested that we should have it done privately.

    We were unhappy about my wife not being seen by any professional during the first trimester. So she arranged an appointment with the midwife at the local general practitioner surgery for the ninth week. On the day the midwife forgot the meeting and did not turn up. No further meeting was possible in less than two weeks.

    Perhaps we were lucky at that point. Instead of the midwife we saw a doctor who had just had a baby. She was the first person to spend some time with my wife and give her some useful information. In addition, she asked for a dating ultrasound scan, which was scheduled for the 11th week of pregnancy. Funnily enough, it was done by the same antenatal service that had previously refused to look after my wife.

    The scan confirmed two things: it showed that she had had a missed abortion and it showed the efficacy of not booking pregnant women before the 14th week.

    What had seemed impossible when the pregnancy was still viable became easy when the miscarriage was known. In less than 10 minutes we were with an obstetrician. But the scene that followed was bizarre. It included a sort of psychotherapy to prevent us feeling guilty, and then we were advised that the uterus should be evacuated under a general anaesthetic because of the risk of cardiorespiratory arrest during cervical handling. Fortunately, they left the door open for a later evacuation if we preferred to let nature take its course. Finally, when we complained that my wife had previously been rejected by the hospital, the obstetrician said, “We are victims of our own success.” Success?

    After all this we decided to go home to Bilbao. After dilation of the cervix with topical prostaglandins, a clean and quick evacuation was done in 10 minutes with no need for intubation. My wife was discharged in six hours, and in one week we were back in London.

    We do know that, as the booking clerk warned us, first trimester miscarriages are common. Therefore we are not blaming anyone for the result of this pregnancy. But we would like to point out what a fiasco we found our first experience as NHS patients: cosy surgery, nice general practitioner and nurse, fantastic propaganda showing how well things are done. But, on the other side, no attention, no explanations, no respect at all.

    Perhaps Britain's public health system is in crisis. Perhaps we are less European in Britain than the British are in Spain. Perhaps it was just bad luck. At the end of the day, however, it was us and not others who were victims of the NHS's “success.”

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