From labor through birth to runway ready within sixteen hours.  Fit for a Duchess.

A major difference in US prenatal-birth-postnatal health care and that offered by the NHS in the UK is the role of professional midwifes.  Through the entire process, NHS midwifes are integral participants.  For uncomplicated, vaginal deliveries, services from an obstetrician/gynecologist are limited to none.  And the NHS midwife’s duties continue after the birth and release from the hospital/clinic.

While what the NHS spends on maternity/delivery/follow-up care may be a difficult number to obtain, the alternative private care cost is defined.  As reported by The Guardian  

The duchess, who received a 10% discount on the £6,000-plus fees at the Lindo wing as this was her second birth there, was looked after by consultant obstetrician Guy Thorpe-Beeston, surgeon-gynaecologist to the royal household, assisted by Alan Farthing, the Queen’s surgeon-gynaecologist.

Apparently, it was midwives Arona Ahmed and her boss, Jacqui Dunkley-Bent, Professor of midwifery at Imperial College Healthcare NHS Trust, who together delivered the Princess. …while the team of suited male surgeons, led by Mr Guy Thorpe-Beeston, Surgeon Gynaecologist to the Royal Household, looked on.  Okay, a degree of elite privilege for the Duchess, but the actual delivery and post-birth care is the NHS standard of care.  Healthy new mothers and babies go home a few hours after the birth.

The US NIH does recommend the NHS model of care for births.  However, most US births follow the hospital/doctor model and on an aggregate basis midwifery is a minor component.  Since close to half of US births are covered by Medicaid and with the expansion of Medicaid and introduction of ACA subsidized health insurance policies (and not even factoring military and Tricare covered births), a minority of US births will be paid for by the private sector and individuals.  That’s fine (a 100% would be fine by me), but dare we ask if those public dollars are being spent wisely: maximizing the health and well-being of mothers and infants and minimizing the cost?

Medscape: The Cost of Having Baby isn’t insignificant.

Medicaid payments for all maternal and newborn care involving vaginal … childbirths were $9,131 …

That’s Medicaid.  More than the private care cost of the new UK princess.  

The aggregate US C-Section rate is 32.7% and not noticeably different for Medicaid covered births.  It’s lower, but still high, in England at 26.2%.  This suggests that midwifery managed maternal care is helpful in limiting the c-section rate, it doesn’t explain why the rate has increased so quickly in the UK and why it’s now significantly higher than it is in Nordic countries where it’s below 20% (only 6.6% in Finland and Norway, both also with low infant and maternal mortality rates).  There are numerous health related reasons why high c-section rates are problematical, but along with aggregate poorer health outcomes, they cost more.  (There’s no big mystery as to why c-section rate are high in the US and UK and low in countries like Norway and Finland.  But we don’t like to talk about what that is.)

While IMHO, dispensing with monarchies and royal families would be beneficial, they aren’t going away anytime soon and in the interim some can be helpful because commoners have long attempted to emulate “royal” standards and practices.  To their detriment for centuries on the matter of maternal and infant practices.  From Queen Eleanor of Aquitaine to Queen Mary of Teck, breastfeeding just wasn’t done.  The “Queen Mum” brought changed that.  The Duchess has followed the lead of her husband’s mother, grandmother, and great-grandmother in breastfeeding and birth delivery health care.  The difference is that the royal family has been a bit more open with the public as to the Duchess’s choices and she’s made public appearances within hours of the births.  The latter to much acclaim and envy.  

But how Kate did it is within the ability of most women.  (Okay, not the $4,000 silk Jenny Packham going-home-from-the-hospital dress.)  So, why aren’t more doing it?  Would public dollars be better spent helping them to do so and leave hospital/birthing centers within a few hours and looking great?

Healthy, including healthy weight, and fit pregnant women would be beneficial to them, their babies, and aggregate US measures of health.  Midwifes and birth centers are preferable to doctors and hospitals for uncomplicated births and cost much less (and midwifes are on the front line of initiating breastfeeding).   Vaginal deliveries are preferable to c-sections (see Michael Pollan on bacteria) and cost less ($4,459 less for Medicaid).  A post-delivery two-night stay in a hospital instead of twenty-four hours or less, doubles the number of maternity rooms a hospitable has to operate, and easily doubles the number of family and friends showing up to see the mother and baby and increasing the microbial and bacterial count in a hospital.  

What’s wrong with spending a few hundred dollars (including a pretty new going-home-from-the-hospital dress) to pamper responsible new mothers?  Oh, I know.  Rightwingers couldn’t possibly handle seeing public dollars spent on nice things for poor women.  Doesn’t matter if those “nice things” are an effective incentive for women to manage their pregnancies and deliveries more responsibly.  Or that those incentives save all consumers money and cost fewer public dollars than the no nice things alternative. Just as they’d rather bitch endlessly about all the children poor women have and also blocka successful program that reduces the number of poor children having babies.

Sadly, “Do it like Kate and not Kim” will only work with a small sector of the public and most of them are probably already “doing it like Kate.”  A hospital birth (and even c-sections) and a couple of days of post-birth hospitalization offers more pampering and status than Medicaid beneficiaries experience in their day-to-day lives.  If anything, they’d like another day or two in the hospital.  So, they’re aren’t going to be clamoring for midwifes, birthing centers, and ten hour post delivery care.

The US dysfunctional, disjointed, and very expensive health care quasi-system will lumber along.  

0 0 votes
Article Rating