UK versus US — Who Provides Better Maternal Healthcare?

What do UK mothers have that US mothers don’t? It turns out — quite a lot.

As our founder, Christy Turlington Burns and EMC staff arrive in London for the Virgin Money London Marathon, we wanted to reflect on the fact that the United Kingdom’s maternal healthcare system delivers better outcomes than the American system does.

According to The World Bank, 28 American mothers die for every 100,000 births — a rate that’s increased in recent years. Only 8 U.K. mothers die per 100,000 births, and that number is decreasing. Here are four differences between the U.K. and U.S. maternal health systems:

• The United Kingdom’s National Health Service provides free or low-cost healthcare to all legal U.K. residents. Women receive free reproductive and maternal healthcare that includes all the tests and treatments available to American mothers including ultrasounds, genetic testing and high-risk maternal-fetal medicine .

In the U.S. women pay for healthcare through private or public insurance or they pay out-of-pocket. Maternity care prices vary greatly between facilities. Prescriptions, additional tests and, treatments and hospitalization cost extra. Inability to pay or to find a doctor who takes public insurance means that many American mothers can’t get the maternal healthcare they need.

• Midwifery Care — Most women in the U.K. see midwives for maternal healthcare, which includes comprehensive health screening including mental health, education, nutritional information, medical treatment and continuous care throughout labor and birth plus follow-up care (often at home) during the postpartum period. Midwives attend most births that take place in hospitals and birth centers. When complications arise patients are evaluated and treated by obstetricians.

In the US., most women see obstetricians, who are high-risk surgical specialists. Obstetricians tend to prescribe more interventions, tests and treatments than midwives do and often have less time for patient education and one-on-one care. Obstetric care is also more expensive than midwifery care. Since midwives aren’t as widely available as obstetricians, many women are unaware of the high quality care they provide and they think seeing a doctor is a safer option.

• More pain management options –In addition to continuous midwifery support that facilitates natural childbirth techniques (including water births), U.K. mothers can use narcotics, nitrous oxide (gas and air) and epidurals. US mothers only have access to narcotics and epidurals (in addition to natural childbirth techniques).

Nitrous oxide is a safe, patient-controlled, combination of inhaled gas and air. It’s appropriate for any stage of labor and is used all over the world. It doesn’t eliminate pain completely, but well enough that many women don’t need epidurals. Unlike epidurals, it doesn’t impact baby’s heart rate, impede a woman’s mobility or ability to push and isn’t associated with prolonged second stage of labor. It was commonly used in American maternity wards until the 1960s when epidurals became popular marketing tools for hospitals.

• More options for birth settings– UK mothers can choose to deliver at home, in low-risk birth centers or hospitals. The National Institute for Health and Care Excellence issued guidelines in 2014 that recommended birth centers and home births for low-risk mothers as safer options than hospital births. That’s because they offer mothers greater chances for normal vaginal birth and less likelihood they’ll need analgesia, C-sections, episiotomies or blood transfusions.

In the U.S., almost all mothers deliver in hospitals. Low-risk birth centers aren’t widely available and homebirth is strongly discouraged by the American medical community.

Jennie Joseph CPM (and founder of Commonsense Childbirth) has practiced midwifery in both the U.K. and U.S. She says, “The benefit of the UK system is the clear and distinct understanding that midwifery is the ‘normal’ and accepted approach for the provision and management of primary maternity care for all women, and obstetrics — a readily available, supportive and collegial specialty — should be called upon only as needed. It’s the direct opposite in the U.S. where highly skilled surgeons and specialists vie for opportunities to attend the mostly normal and straight-forward deliveries of America’s low-risk birthing population.”

Jenny Clarke is a clinical midwife at Blackpool Teaching Hospitals NHS Foundation Trust, and author of the blog, JennyTheM. Clarke describes the thorough care women receive from their midwives that’s often lacking in traditional U.S. care. “A booking appointment (first prenatal visit) involves taking a mother’s history, but we also discuss substance misuse, domestic violence, sexual abuse and psychological issues that may affect mental health. Most UK midwives have mental health training and are aware some women need increased support.” Clarke says that if any complications arise, midwives consult with obstetricians, but patients don’t have to wait for their midwives to make that referral. Clark says, “If a mother is worried at any time she can refer herself directly to the hospitals for what we call ‘a maternal instinct something is wrong’ — like reduced movement of baby, bleeding or simply feeling unwell.”

Clark says, “We have low risk birth centers where women can use pools to give birth and entonox (nitrous oxide) or Pethidine (a narcotic painkiller). We don’t use continuous fetal monitoring, but instead, listen to the baby’s heartbeat every 15 minutes. We teach psychoprophylaxis (natural childbirth techniques similar to Lamaze) and help mothers believe in their bodies. However, we can’t predict how a woman might birth so we take each hour as it comes and always make sure she is happy with where she is at that moment.” If a midwife must transfer her patient to a hospital, she’ll consult with a doctor and the two will work together to provide patient care. Midwifery care is the norm for hospital births as well as home and birth center deliveries and most maternity units are staffed and supervised by midwives.

The UK’s maternal health system isn’t perfect and reports indicate some patients complain about long waits, lack of supplies and poor services, similar to those American patients experience. The UK’s C-section rate is 26.2% (compared to 33% in the U.S.), which is higher than what’s considered appropriate by the World Health Organization. Still, fewer mothers die in the U.K and that may be because they have free healthcare, midwifery supervision for normal maternal healthcare and better post partum and mental health support. The United States could learn a few things from our sisters across the pond.