(Editor’s note: This really is the land of Bourbon brains. The boozy-sounding swap of Scotch for Scottish in the old headline is entirely my fault and not the fault of freelancer Amy Miller. Apologies to all. – Melissa Chipman)
Singer-songwriter and accordionist Brigid Kaelin is back in Louisville after a year in Scotland, and she’s frustrated.
One year ago, Kaelin and her husband David were having a baby in Edinburgh, Scotland, where David was earning his MBA. Upon returning to Louisville after David graduated, they began jumping through the bureaucratic hoops of managed care, a frustrating process compared to the socialized medicine they had enjoyed in the UK.
If she hadn’t had a baby and a mortgage, Kaelin doubts she would have bothered getting insurance after they returned home.
Kaelin has been writing about her prenatal and birth experiences under the British National Health Services (NHS) on her blog The Red Accordion Diaries. In two blog series Kaelin calls “Having a Baby Abroad” and “Birth Story,” Kaelin recounts how she discovered everything she had heard or assumed about socialized medicine was a lie.
She says: “I guess I was expecting to have to wait, to not get good care, all the things you hear over here [in the U.S.]. Someone always has a friend who had to wait six months [to see a doctor] for a life-threatening disease, and I never saw that. At all.
“I found everything to be better.”
The first assumption Kaelin had about socialized medicine was shattered before she was pregnant when she and David looked for a general practitioner and a dentist. Kaelin was surprised she could choose her own doctor, one whose office was near their home.
The couple were able to schedule their first wellness exams in a week.
David got a dentist appointment the next day and his exam only cost the couple 19 pounds, about $30.
Several more surprises awaited Kaelin when she began her prenatal care. First, Kaelin was seen by a midwife who came to the couple’s home with a black medical bag, a la “Call The Midwife” on PBS.
Next surprise: the midwife performed routine tests, took a family history, then asked if they would be having a home birth.
The couple tried not to laugh.
Until this point, Kaelin wanted to be knocked unconscious while delivering a baby. She was terrified of giving birth. She also never expected government-sponsored healthcare to cover midwives, let alone home births.
In the US, according to a 2010 Time Magazine article, only 27 states allow Certified Professional Midwives to attend home births. Kentucky is not one of those states. Most states allow Certified Nurse Midwives to attend natural births, but typically these midwives only work in hospitals.
On her blog, Kaelin writes, “Why midwives and not obstetricians? Well, assuming you don’t have any major health issues and your pregnancy goes smoothly, you are tended to by midwives over here [in Scotland] – the way pregnant women have been for most of history. If there are any signs of a problem, you are sent to an obstetrician.”
Kaelin did end up seeing an obstetrician briefly, and her experience was even more surprising than her first visit with the midwife. When Kaelin’s doctor couldn’t answer a medical question, she asked another doctor, who on his lunch break, had the couple sit in his office for an hour while he researched the question and chatted with them.
“It was insane the amount of attention we got!” she says. “There was no, ‘We’ve got 50 patients to see so get out of here.’ I went in with low expectations, but this surpassed those and it surpassed any kind of care I’ve gotten here [in Kentucky].”
The main difference Kaelin sees between medical care in the States versus the UK is that the doctors she saw in Scotland were more relaxed and willing to spend quality time with their patients because they weren’t concerned about billing.
“The focus over there is on wellness as well as illness. Whereas here a wellness appointment takes months to get, over there wellness is every bit as important as sickness and in the long run, it saves them money, as it should. The whole birth and pregnancy was about keeping me well.”
When Kaelin was ready to deliver her baby, she actually was nine days past due. Rather than induce her, the midwife sent Kaelin and her husband to a birthing center.
Not a hospital, a birthing center, where Kaelin soothed her back labor in a warm pool while her midwife knitted a cap for the baby and David sat nearby.
She compares the birthing room to Joseph’s Salon.
“It was gorgeous!”
Kaelin explains that she could have given birth in a hospital, but she’s very happy she chose to have a natural birth in a birthing center. She even admits that if she had been pregnant for two more months, she might have given birth at home.
Kaelin understands why the NHS would advocate for birthing centers. “Because it has better outcomes and it’s cheaper! It’s significantly less than a hospital birth.”
Had Kaelin lived in Kentucky and wanted to deliver her baby at a birthing center, she would have had to travel to Goshen, Indiana.
Clark Memorial Hospital has the Family Birth Place for natural births, but midwives there work hand-in-hand with doctors, and the center is attached to the hospital.
Forty states, including Guam, have independent birthing centers, making Kentucky one of ten states without one.
“I never thought I’d be an advocate for birth in any sense, but hearing my friends’ stories – and even my friends who have good experiences with birth over here – it still seems so insane. Like I have a current friend who is trying to have a natural birth and they tell her that’s fine, but you still have to have an IV hooked up to you the entire time.”
Kaelin found her own birth experience comforting and easy.
Once her son was born, he was given to her to nurse immediately. No cutting the cord. No injections. Something Kaelin says hippie moms call “kangaroo care.”
Kaelin realizes that her birth experience was similar to midwife and doula deliveries in the States, but she worries that American women fight to control the amount of medical intervention in their deliveries.
After Kaelin and her family returned home – only twenty-four hours after her delivery – they continued to receive care from their midwife, who made regular house calls.
Once the midwife was discharged, Kaelin saw a Home Health Visitor, essentially a Nurse Practitioner, once a week to make sure everyone in the family was healthy.
Had they stayed in Scotland, the Home Health Visitor would have visited weekly until Kaelin’s son turned three!
And yes, all of this is paid for by the Scottish government.
But Kaelin did leave Scotland, and since her return she feels like she is constantly faced with the burden of healthcare, despite the family’s good health.
There was a point when Kaelin’s baby was sick after arriving back in Louisville, and she and her husband weren’t sure what to do. Both were working as small business owners and not earning as much as they wanted.
Kaelin confesses that she and David had a difficult decision to make, “Do we go to the doctor or do we buy groceries?”
Kaelin wonders why more people aren’t outraged by this imbalance.
Catch Brigid Kaelin in concert at Headliners on September 1 with Rumors (a Fleetwood Mac tribute) and a late set by Those Damn Torpedoes. Tickets are $10, doors at 8 p.m.