Giving Birth in a Public Health Care System Showed Me What’s Wrong With US Health Care
I gave birth to two children in two cities, New York and London. The care I received through the UK’s National Health Service showed me the serious limits of even the best private health care in the US.
Two years apart, I gave birth to two children in two cities, New York and London. During my first pregnancy, I was living on the Upper East Side of Manhattan, settling into our new duplex apartment when I received a phone call asking me whether I wanted to book myself in for a hospital tour. For me, the idea that you would tour a hospital before giving birth — as if it were a hotel into which you were deliberating checking in — sounded absurd. What could I possibly need to see? I was raised in Britain during a period in which the National Health Service (NHS) was still well funded, and a “one-size-fits-all” approach in which hospitals provided everyone with the best possible service predominated. Surrounded by the glitz and the glamour of American private health care, my European sense of bewilderment soon gave way to excitement at having the power to influence the delivery process of my first child.
As we walked around Mount Sinai West — an imposing ten-story building on Tenth Avenue on the West Side of Manhattan — the tour guide delivered a pitch. The hospital, she told me, was ranked highly for maternity outcomes, and the labor suite was designed with creating a comfortable family environment in mind.
This certainly seemed better than being told by a doctor which underfunded hospital to deliver at in Britain, as was the experience of my peers in the UK who had recently given birth. What the tour guide didn’t realize was that she didn’t need to go so hard on her sales pitch — the hospital, with its sparkling white floors and spacious bathrooms, spoke for itself. The look of the place made it that much easier to picture our first moments as a family of three. The cost of giving birth in the hospital equivalent of the Ritz-Carlton was, unsurprisingly, not cheap: staying over would cost me a hefty $900 a night, excluding all of the other costs for the delivery and aftercare.
Two years later, amid a pandemic, I stood inside a bathroom in Chelsea and Westminster Hospital barely large enough for me to swing my arms around. The building in which I waited for my first appointment looked dated; it had none of the glitz of Mount Sinai West. I was weeks away from giving birth and had decided to stay put in the UK, where my immediate family lived. My husband and I could not fathom the idea of managing an energetic toddler and a newborn between us.
As I lay on the bed to be examined, I was horrified when the midwife pulled out a tape measure to do a growth check. I felt like I had gone back in time: Wasn’t there anything less analog that could do the job? Prior to this, I was used to having a routine scan for all of my appointments. I was shocked to learn that in England, on average, patients received merely two ultrasound scans over the course of a pregnancy. This was a huge contrast to New York, where my pregnancy was completely managed by a doctor I had found after hours of research, reading reviews and comparing qualifications.
Since I delivered Mohsin vaginally, I had presumed that I would do the same the second time around. The first had been straightforward, so this time would be absolutely fine. Women, poorer and much less healthy than I was, used to routinely birth eight, nine, or even ten children without the assistance of drugs. What did I have to worry about? However, as the birth date approached, I recalled that I had previously incurred something known as a fourth-degree tear after giving birth to my first child. A piece of paper, which had been crumpled up or filed away, held this information. It was six weeks after I gave birth to Mohsin, during my postpartum checkup, that I learned of the injuries I had sustained during childbirth. Certainly, I had no recollection of anyone in New York sitting me down to discuss the related long-term implications.
In London, as my midwife looked over my pregnancy history, she paused when she realized the extent of my injury. Gently, she reassured me that my notes would be discussed with a team of doctors. A day later, I was called by an anxious registrar explaining that they wanted to urgently do a scan to assess how much tearing had taken place. This would be the best way to assess whether a vaginal delivery would be safe. Upon hearing this, I was very surprised that such a scan existed. If it did, then why had the team under a private system not mentioned it? In the UK, despite the health care system being heavily underfunded, the principle that guided whether doctors performed scans was the needs of the patient. In the United States, in contrast, it was the demands of the patient for the right kind of customer service, and the coverage of their health care plan, that decided what procedures they received.
September in London was gloriously and surprisingly sunny. This was great, as it meant that Mohsin could continue to spend time outdoors, playing in Redcliffe Gardens or following my husband or mom around Chelsea and Fulham doing errands or meeting friends. Although there was a week to go before my due date, I was already preparing for the delivery. Mohsin was born a week early, and I didn’t want to be caught off guard.
Right on cue, exactly one week before my due date, my contractions became more frequent. I spent the day pacing the beautiful gardens in our building to ease the pain before my water inevitably broke. With my hospital bag already packed and ready to go, I picked up the phone and dialed the hospital. “My water just broke,” I calmly explained. I emphasize “calm” here because, although this was our second child, my husband still hadn’t realized that quite some time could pass between water breaking and giving birth. “Okay, we shall be expecting you shortly,” a softly spoken midwife replied.
As I hugged my mom goodbye, my husband hailed a cab despite the hospital being within walking distance. Unlike in New York, I did not have to carry a printout of a detailed birth plan. All I knew was that I wanted to give birth naturally, but the scan results had not yet arrived by the time I went into labor, so there was no way of knowing how safe it would be to do so.
I lay on the hospital bed with my jaws clenched as the hospital staff tried to determine how far dilated I was. The contractions worsened. I closed my eyes, muttering any prayers that came to mind. Suddenly, two doctors nervously appeared by my bedside. They told me that they had some test results to discuss with me. I glared at my husband to make them disappear, but they said that it was vital to discuss the results right then and there.
According to the scan, I had sustained a fourth-degree tear, the most extreme possible, during my last pregnancy, and another vaginal delivery could have serious lifelong implications for me. My head was spinning. All I could hear was that a C-section was strongly recommended. Ultimately, the doctors told me, it was up to the patient to make the decision. So I decided: no, I did not want to be cut open. The young, Australian registrar sighed as she looked at her colleague — they both agreed to give me some time to think about it.
When they came back ten minutes later, I had not budged. Time was ticking, and if a C-section was to be performed, I had to make the decision immediately. I looked at my husband, who remained quiet. His tense body told me what he feared. Was a natural delivery really going to make me a better mother? Or, for that matter, prove that I had given birth?
I shook my head and restated my decision to be allowed a vaginal delivery. It was my life, and I would ultimately suffer if things went wrong. A flashback of New York City came to mind; I had typed up in capital letters that I should not be given an epidural and that I wanted a very natural birth. Despite this, I recalled being challenged by the nurse on what I was trying to achieve, as she had not dealt with a patient who didn’t want to be alleviated of pain. While that was a much smaller-scale decision, I realized that, although elective C-sections were possible in the UK, funding constraints meant that doctors did not offer them unless they thought there were good reasons for doing so. I really did need a C-section, but when I declined, the nurses and doctors respected my decision.
An agreement was then made that an epidural would be essential in controlling the outcome. I lay on my side as an anesthesiologist directed me to tense my body as the needle went in. Fifteen minutes later, I couldn’t feel a thing. I dozed in and out of sleep as I envisioned the light at the end of the tunnel drawing closer. Within two hours of being admitted, I was fully dilated. The Australian registrar took it upon herself to ensure that she could control as much of the process as possible to get the baby out. Gravity would do its magic; all she asked me to do was to lie there and let the baby move down naturally as much as possible.
A part of me wondered whether I was taking up too much of the medical staff’s time. Surely they would need to move on to other patients? However, the other part of me admired the dedication the team demonstrated. I had gone against the advice that was given to me, and I was still at the center of care.
And just like that, the controlled pushing started and stopped — Mustafa was born on Friday, September 10, at 4:10 a.m. My body had miraculously survived — with nothing more than some stitches. My eyes began to look at the newly renovated labor room in a different light.
Looking back, the decision not to have a C-section was probably not my brightest one, and I was very fortunate that I dodged serious injury and lifelong health complications. However, the support and care that I received during the birthing process was beyond what I had imagined.
By the time I had showered and changed my gown, it was 8:30 a.m., and I started my move to the postpartum ward. One of my main reservations was having to share space with five other women and five newborns. I recalled struggling to share a room with one other mother at Mount Sinai West who was constantly shushing me anytime she felt inconvenienced. As I sat on the fresh new linen, the head nurse came over and introduced herself. She congratulated me and told me that every staff member was trained in helping new mothers with breastfeeding. When I asked her about being discharged, she looked puzzled. There was no urgency, she told me. I should stay until I felt comfortable and ready to leave.
At Mount Sinai, it had taken hours for a specialized lactation consultant to finally visit me, and when she eventually did, she spent only a brief time coaching me on what to do. She didn’t seem to understand that I was a new mom, I didn’t know how breastfeeding worked, and I had a raw body that was in an incredible amount of pain. Looking back, this explains some of the breastfeeding challenges I faced with my first child. I spent three months trying to combine breastfeeding with formula before finally giving up.
In London, I stayed in the hospital for four nights after giving birth. During this time, I didn’t think at all about the costs I was incurring — there were none. Instead, I focused my attention on getting well and being a mother. In the ward, I enjoyed three meals a day with a starter, main course, and dessert. Wasn’t this closer to a hotel experience than the glossy-floored New York hospital in which I gave birth to my first child? From doctors to nurses, there was a line of people available for support. The hallway had multiple showers that were cleaned on a daily basis. It was far from the chaos that I thought I had signed up for.
As we got ready to be discharged, I was given the charmingly outdated baby red book to record immunizations and health care records in. I chuckled to myself about how this red book system had not been updated to reflect the digital era we are now living in.
Discharged from the hospital in Chelsea, I thought back to the cold January in New York City when I dragged myself, limping, out of the house for Mohsin’s day-two pediatrician visit. I hadn’t realized that there was no concept of health care providers coming to you, as is the standard in the UK. Even today, as I discuss this with American friends of mine who are also mothers, they are surprised to hear that, across much of Europe, nobody is expected to take a newborn anywhere.
Each time Mustafa was due for a visit, a nurse would call me in the morning to confirm a time window during which they would stop by. The system was genius. I was able to comfortably stay in my home, be observed feeding him, and ask anything about myself that I was concerned with.
It’s hard to know how much harm is done to the millions of women across the United States and the world who must combine the stress and emotion of childbirth with inadequate health care. The problem with low expectations is that they also deprive people of ways of thinking of alternatives. I was so impressed in New York by what I felt to be the best possible health care available, care that was better than that experienced by many other Americans. But so many basic services, such as a bed that I did not have to pay for, didn’t even occur to me as possibilities in the moment. It just felt normal. It was only after giving birth in the UK, a country with a functioning (albeit badly funded) public health care system, that I got to experience a genuine alternative. It made clear to me the value of publicly funded services: they free us from the terror of having to count the cost of our most basic needs.