Better Dead than Red? Childbirth in America
Having your baby in the United States of America should, you would have thought, be a pretty safe option. After all, it is the richest country in the developed world; they have the highest health spending per capita and the rights of the unborn child are always at the fore of the political debate. Well. . . .
As I watched my daughter fight her way into the world and into the hands of the attending midwife, time stood still. I held my breath, waiting for the pink and black lump of flesh that had just extricated itself from between my wife’s legs to let out its first hearty cry. After what felt like an eternity, our baby let out a squawk strangely similar to Dick Cheney rebuking an impertinent journalist, and I could breathe once more. Unfortunately, my overriding emotion was relief rather than joy. Our baby had just been born into the American healthcare system and when it comes to childbirth, America does not lead the world. In fact, the USA ranks alongside Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births! Having a baby in the U.S.A. is a risky business. Yet, they have the highest health spending per capita with more neonatologists and neonatal intensive care beds per person than any other western country. So what’s going wrong?
Although you may not be in rude health when you enter an American hospital, your health insurance cover better had be. Without the propper cover you won’t make it past the front desk! Nearly 45 million Americans are uninsured and on the wrong side of that desk. They have no access to healthcare unless it is through the Emergency Room. Although my wife was over five months pregnant when we arrived stateside, we were still waiting for our insurance cover to come through and were, therefore, due to administrative issues, temporarily without any medical cover when we registered with our prenatal clinic.
We offered to pay cash for the first visit, a stiff $250, or roughly £125, for nothing more than a consultation. We were informed that until our insurance could be verified the doctor was reluctant to take us on; she was concerned we “couldn’t afford our pregnancy”! They knew nothing about our jobs or income, but when you consider a few days in hospital for observation can cost thousands of dollars, it’s hard to argue with their logic. According to The RAND Corporation, a nonprofit research organization, “The price of a day in a U.S. hospital has risen tenfold over the past 40 years. In 1965, the real cost per hospital day was about $128. In 2002, the cost had risen to $1,289”. We managed to convince the prenatal clinic of our insurance status, but quite what we would have done if they hadn’t relented, I’m not entirely sure.
Once you have negotiated the labarynth of paperwork and managed to actually attain your healthcare, under the American system you will be worse off than you were before. With the average cost for a family health insurance policy exceeding $10,000 a year, that much is obvious. But, it may not be just your pocket that suffers; frighteningly, your health may suffer too. The gatekeepers of American healthcare may be the insurance companies, but it’s the drug companies that are really making hay. It is difficult to find a medical situation where a doctor or physician won’t medicate first and ask questions later.
In almost every American maternity ward you will find a a huge whiteboard somewhere on the wall. On that board is every expectant mother’s name written up in boxes in colored marker pen. If you look closer, you will see what time they were admitted and, underneath, what time they were induced. Induction is practically standard procedure. When you have a baby stateside, the greatest battle is not your delivery, it’s keeping control of your delivery. Childbirth here is a procedure, carried out by surgeons. There is no ‘natural’ in childbirth in America, there is only intervention.
Over the last 60 years the relationship between American women and childbirth seems to have altered dramatically. They have been slowly brainwashed by the pharmacutical companies to believe chemical medicine is the only option and anything natural is both dangerous and irrisponsible. When the National Health Service in Britain was advising “Breast is Best”, doctors in the United States were prescribing tablets to help dry up mothers’ breast milk, advising new parents formula was a superior option. This belief in chemical over natural is firmly embedded in the medical psyche and runs very, very deep. Natural childbirth is, apparently, something that happens in the third world, not in modern America!
Fentanyl, Demerol, Pitocin, Morphine, Phenergan and the Epidural block! No. this isn’t the opening line from a Hunter S Thompson novel, it’s a list of the standard drugs used in everyday child delivery in US hospitals. When an expectant mother is admitted to Hospital, one of the first things to happen to her is being hooked up to a saline drip. An innocuous act you may think, as the saline drip is to prevent dehydration. But, after a short while synthetic oxytocin (brand name: Pitocin) is added to the saline. The mother is rarely asked or informed of this addition, as this is concidered standard practice. Pitocin is a drug used to artificially induce labour. The reason it is used so frequently is unclear, but as the average stay in hospital is never any longer that 48 hours, it would appear to be something to do with scheduling. Natural births have a habit of happening when they want to happen. This is obviously not good for turnover and therefore not good for business.
As Pitocin is used to promote what they call “a normal labour pattern”, as opposed to the unnatural one your body was going to foist upon you, the mother has to be monitored at all times. She is hooked up to a fetal monitor and quite often an intrauterine pressure monitor too. This, unfortunately, means the likelihood of a crash team careering through the doors is greatly increased as how to interpret the results these monitors produce is hotly disputed. Not only is external electronic fetal monitoring no more accurate in diagnosing fetal distress than periodic manual checks of the baby’s heart rate, it appears to promote overreaction by doctors who interpret the results differently and whose experience of natural childbirth is nil.
When Ricki Lake and Abby Epstein made their wonderfully illuminating film ‘The Business of Being Born’, they interviewed Doctors from NYU Medical Center. Not one of the doctors interviewed had overseen a natural birth. In fact, not one of them had even witnessed or attended a natural birth. Their collective opinion was natural births were dangerous. Perhaps more disturbingly, they saw childbirth as a procedure that should be treated the same as any other surgical operation. The difference between an operating theatre where a patient being kept alive by a team of doctors with an array of bleeping machines and a delivery room where a baby who has been doing fine within its mother’s womb for the past nine months is fairly radical? Shouldn’t a doctor on a maternity ward at least make the effort to watch a video or read a book about mother nature’s technique?
The one calming voice of reason you would expect to hear in this carnival of capitalism is your midwife. Unfortunately, that voice is hard to hear, as unlike most other western countries, the U.S. does not promote midwiffery. In fact, a midwife is almost impossible to find. We struggled to find a hospital that actually employed midwives! The consensus appears to be having a midwife is dangerous; having a doctor is safe. Not taking drugs is stupid and natural is quack. And if you mention a birthing pool or home delivery, you can expect your mental health and ability to be a parent to be called into question.
Although American women are in no way to blame for this debacle, they would appear to be somewhat complicit. According to Gareth S Kantor, MD, Assistant Professor Department of Anesthesiology, University Hospitals School of Medicine, 60 to 90% of American women have an Epidural (even though a general estimate of the overall complication rate of epidural anesthesia is 23%) and close to 30% of American women have a Cesarean Section rather than a vaginal birth. They will, in effect, feel nothing until the “procedure” is well and truly over. America appears to want as little to do with the birth of her children as possible!
Once you enter the delivery ward of an American hospital you surrender your rights to the lawyers, the insurance companies and the pharmaceutical Industry. And you better believe the twin pressures of litigation and financial expedience will guarantee your baby is born on their terms not yours! The American healthcare system is a system that appears to be out of touch with the people it is supposed to help. It is a system run purely for the profit of drug and insurance companies. It is a system that appears completely out of control. But perhaps the most disturbing aspect of the whole American healthcare debacle is if you ask anybody on the street what they think about it, they will tell you the American healthcare system is “the best system in the godamn world”.
So why do Americans believe in their system so completely. The main reason, like so many situations in modern America, is fear. When being questioned about healthcare reform, Presidential hopeful Rudy Giuliani likes to invoke Ronald Reagan and refer, with a wry smile, to the European model of “Socialist medicine”. Unbelievably, this kind of cold war scaremongering scores big out on the stump. The spectre of communism still hangs heavy over the American landscape and the idea of back door communism through “Socialist” healthcare, unfortunately, still resonates. Politicians have been hoodwinking Americans over healthcare with this same message for over half a century. When President Truman suggested his national health program, proposing a single system that would include all of American society, he was denounced by the American Medical Association (AMA), and a House subcommittee went so far as to suggest Truman’s plan was a Communist plot! And we all remember what happened to Hilary Clinton’s healthcare proposals.
However, having had my first child under the care of the British National Health Service and my second under the American healthcare system, I am in no doubt which I would recommend. The United States healthcare system was ranked 37th by the World Health Organization (WHO) in 2000, and the same report assessed Americans’ overall health at 72nd among 191 member nations included in the study. With five deaths per 1,000 births it would appear the old anti communist rhetoric “better dead than red” is more prescient than J Edgar Hoover could ever have imagined.
I only hope come November the American people have seen through the lobbyists’ propaganda and vote for a candidate who genuinely wants to invest in American healthcare and make childbirth in the U.S. as safe as it is in the rest of the western world. Finding a candidate that actually advocates universal healthcare may unfortunately, prove difficult. The word universal is bandied about by many of the presidential candidates. But none of the Democratic front runners actually advocate universal healthcare and of course, with candidates like Rudy Giuliani, the Republicans certainly don’t. I fear that the continual struggle for moral and religious piety, i.e. Roe versus Wade, will once again be higher up the agenda than the care and delivery of the children that are already here.
After being in the country for four months, our daughter was born in Beth Israel Hospital in New York, at 10.56 am on the third of July, narrowly avoiding the embarrassment of being born to her British Father on American Independence Day. It has to be said, the hospital and staff were fantastic. She weighed in at six pounds nine ounces and was delivered in double quick time with a minimum of fuss. We had, after extensive research, organization and belligerence, a beautiful healthy baby girl in the American Healthcare system. Hopefully, she will continue to defy the odds well into her future.