Princely birth underscores how poorly U.S. moms fare in comparison

The birth of Prince Louis Arthur Charles brought joy to the Duke and Duchess of Cambridge, but the regal baby’s arrival also provided cause for harsh comparisons of maternal costs and safety for more ordinary expectant moms on this side of the Atlantic.

Two magazines — Foreign Policy and the Economist — both poked at how much less the fabulously wealthy royals paid for a posh delivery of their baby, as compared with what a typical American mom might. They reported that 24 hours in the luxe Lindo Wing of St. Mary’s Hospital in London goes for $8,900, vs. the $12,900 an American would pay for a routine delivery in a noisy, regular U.S. hospital. And if the royals had gone without the private frills, their cost would have been zero.

If an American woman has a cesarean or any delivery complications, her delivery costs typically jump to almost $17,000, or $30,000, or even more, whereas her British and Canadian counterparts, as Foreign Policy reported, typically “pay nothing for their maternity care and delivery, with low risks of maternal and infant mortality.”

The magazine also jabs at American maternal safety, saying:

The U.S. infant mortality rate in 2017 was 6.1 deaths for every 1,000 births, which is about three times higher than Japan’s and is one of the worst death rates in the entire Organization for Economic Cooperation and Development (OECD). America leads the wealthy world in maternal death rates by far. According to the Institute for Health Metrics and Evaluation at the University of Washington, 26.4 mothers died of pregnancy-associated causes in 2015 out of every 100,000 births, which is three times the rate of the next worst, the United Kingdom, and more than six times the maternal mortality rates of Finland, Denmark, and Italy.

Foreign Policy pours it on:

Prince William is estimated to be worth $40 million, and he stands to inherit some of his grandmother’s estate valued at well over $1 billion just in real estate. He can afford to spend the $8,900 for the best maternity care available in the UK. Sadly, that is a burden few American couples aged 20-24, earning on average $27,300 per year, or 25- to 34-year-olds, with an average household income of $40,352 per year, could manage. But, of course, none of them can hope to find a hospital that will provide such a princely birthing bargain in the first place, as costs in the United States, for everything from basic to high-end care, are far higher. Even if they are fortunate enough to be well-insured through an employer plan, young Americans are likely to face deductibles of $3,000 to $5,000. The results are that the royal couple paid about 0.000025 percent of their wealth to have their third child. For the less grandly wealthy young couples in the U.K., the National Health Service bears most of the costs of vaginal childbirth. Costs for a typical young couple having their first child in the United States are 13 times more than those shouldered by their U.K. counterparts. A typical set of U.S. parents puts out about 10 percent of their wealth to pay the uncovered portion of maternity costs.

You may, of course, recall that Elisabeth Rosenthal — a doctor, medical journalist, and author of “An American Sickness: How Health Care Became Big Business and How You Can Take It Back” — detailed British and American maternal care and their costs and safety contrasts a few years back in a New York Times series. She continues to advocate for major changes in the quality, access, and affordability of American medical services, including with an Op-Ed worth reading on financial rights that every patient should demand.

The focus, thanks to Prince Louis, on disparities in U.S. maternal care could not be more timely and necessary, as just the statistics show. To get a feeling of how upsetting and unfair the care — or lack of it — that all too many American moms get, it’s worth reading a post from the Kevin MD site by Jenna T. Nakagawa, a physician who writes about caring for a mistreated mom recently in an emergency room as the patient started to bleed out after a botched delivery:

She did not go into shock, and she stopped bleeding. It did not take long for my relief to give way to anger. I imagined her delivery. I imagined her pushing through pain and her bravery as she embraced a newborn. I imagined her terror when she, at home by herself, began to hemorrhage and begged a family member to watch her children so she could call an ambulance. I thought about how she trusted her delivery provider. I thought about how, in a developed country  —  where there are prenatal clinics, sonograms, hospitals, blood banks, operating rooms and skilled healthcare personnel  —  no woman should ever die of a postpartum hemorrhage. This one, who did everything right, almost did. My outrage extended beyond her. I thought about all the bad information women are fed, the stories of perfect pregnancies followed by perfect deliveries.

In my practice, I see not only the big harms that patients suffer while seeking medical services but also their major struggles to access and afford safe, effective, and excellent medical care, especially maternal care that can help prevent injuries to moms, babies, and children. It’s unacceptable that expectant American moms pay more for medical services than their counterparts elsewhere in the western industrial world but experience far worse outcomes.

National Public Radio, with the Pulitzer Prize-winning investigative site Pro Publica, reported that  American College of Obstetricians and Gynecologists hopes to improve women’s lot, proposing “sweeping” new standards of care, and “re-imagining of how providers, insurers and patients can work together to improve care for women after giving birth.”

A cornerstone of the medical specialists’ proposal rests on offering women much greater attention in the risk-filled time just after they deliver. Post-partum care in this country too often now consists of one visit, squeezed in at the doctor’s convenience and into a suddenly hectic and uncertain new mother’s schedule. This means that even this iffy appointment may get skipped — and doctors may not see that mothers are experiencing health troubles.

The NPR-Pro Publica also notes that the grand plans for better care from the ob-gyns also would require big changes from insurers, especially Medicaid, which pays for about half of U.S. births. Republican lawmakers have made clear they want deep cuts in Medicaid, which already calls for brief and limited coverage for post-partum medical services for moms and babies.

We’ve got a long way to go to ensure American moms and babies get their best possible care.