No Room at the Maternity Ward

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Health Care

The British National Health Service has big problems that, as I understand it, stem less from the system itself than from massive underfunding of the system. Brits are trying to get by on the cheap, and it shows. To illustrate, here is Figure One from the University of Maine’s “The U.S. Health Care System: The Best in the World, or Just the Most Expensive?” (PDF).

The figure shows spending for health care per capita in various nations, in 1998. I added “USA” and “UK.” In 1998, the U.S. was spending $4,178 per capita and the UK was spending $1,461 per capita. I understand that in recent years the Brits have been increasing their spending on NHS, but it takes a long time to make up for years of underfunding.

I bring this up because one cannot fairly compare the U.S. and U.K. systems without considering the funding issue. This does not, of course, stop righties from comparing them.

Today some righties are hyperventilating about a story in the Daily Mail — “Father delivered baby after partner was turned away from NHS hospital – TWICE.” A laboring woman was sent home because, she was told, there were no beds available in the maternity ward. Eventually her husband delivered the baby at home.

John Hawkins writes in “Will Hillarycare Mean Delivering Your Own Baby?“:

The Left’s push for socialized medicine in this country shows how dogmatic, impractical, and incapable of logical thinking that they have become. After hearing horror story after horror story like this one coming out of nations like Britain and Canada, why in the world do Democrats like Hillary Clinton want to emulate the health care systems that produced them?

Actually, no one I know of, including Senator Clinton — well, maybe Dennis Kucinich — is talking about emulating the Canadian single-payer system or the British NHS system, both of which have some snags. Senator Clinton’s health care proposal is entirely different; similar to the “Massachusetts” plan, which I understand is also similar to the way Switzerland handles health care. I still say the French model is the one to follow, however.

But I do love the way righties can’t let go of Canada and Britain whenever they go on a health care rampage.

Don Surber asks, “What kind of country has hospitals that turn down a pregnant woman like that?”

FYI, it’s standard procedure in most, if not all, U.S. hospitals to send laboring women home if the birth is judged to be several hours away. Women are told they will be more comfortable at home, but the real reason is to prevent laboring women from taking up too many beds. And sometimes, the hospital is wrong. This public attorney documents a District of Columbia case:

A pregant woman came to the hospital with labor pains and intermittent contractions. She was sent home and returned about two hours later in active labor. After she returned, there were signs of fetal distress. Experts for the family testified that patient should never have been sent home because the fetal monitor strip was nonreactive and that an emergency cesarean section should have been done when she returned to the hospital.

If you just start asking mothers about their childbirth experiences, it won’t take long before you hear the story about how she was sent home from the hospital, then went back later the same day to have the baby. It happens all the time. And sometimes they don’t make it back in time, and the baby is born in the back of the station wagon at the intersection of First and Pine.

Knee-slapper of the week: Kim Priestap writes at Wizbang:

Thank God I live in America where access to health care is plentiful.

LOL! Oh, that’s good. (Wipes eyes.) Those righties have some sense of humor.

Let’s talk about the number of hospital beds per capita, which is a nice indicator of who’s got “plentiful” access to health care. In fact, I found another chart.

Who’s Number One? Switzerland, with 18.3 hospital beds per 1,000 people.

France is #9, with 8.4 beds per 1,000 people .

The UK is way down the charts at #23 (4.1 per 1,000 people), followed at #25 by Canada (3.9 per 1,000 people).

And I’m proud to say the U.S. is, um — wait a minute, where is the U.S? — oh, there we are. Number Twenty-Seven. The U.S. has 3.6 hospital beds per 1,000 people.

You’ll be glad to know we beat Turkey and Mexico.

I’m so sorry that, as a leftie, I’m so dogmatic, impractical, and incapable of logical thinking on health care. I lack the clear-eyed vision of righties, which tells them “US Good, Everybody Else Bad.” That does make it simple. I have this compulsion to look at actual facts and data and stuff, which always confuses issues.

BTW, if you want to know how the Brits view our health care system, see Suzanne Goldenberg, “Expensive and divisive: how America is losing patience with a failing system” from The Guardian, September 13, 2007. Be sure to look at the pictures, too.

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22 Comments

21 Comments

  1. PurpleGirl  •  Oct 18, 2007 @11:11 am

    I have friends (APA mates) in England, Canada and Australia, among a number of other countries. Health care has become a major topic of discussion. None of them (including a couple who are American expats) would trade their current healthcare systems for what we have here.

  2. joanr16  •  Oct 18, 2007 @1:18 pm

    Fact-based reality isn’t even a speed bump to some people. But boy, are they clever with the derogatory nicknames. “Hillarycare.” That’s about as witty as a rightie can get; which is to say, not in the slightest.

  3. felicity  •  Oct 18, 2007 @3:08 pm

    Well at least the righties are consistent when it comes to the quality of their arguments for or against anything – consistently fatuous.

    Do the righties say anything about the study a while back that found the US 35th in the world in the quality of its health care?

    Sidelight: In 1955 I went into the hospital on Saturday evening to deliver my first-born and stayed there until he was born late the following Sunday night. Maybe it was a slow weekend at the hospital or maybe there were enough beds?

  4. maha  •  Oct 18, 2007 @3:27 pm

    felicity — that was 1955. I bet you got to stay in the hospital a whole week after, huh?

    Here’s a sobering stat — “Recent national data indicate
    that 35.9 percent of enrollees in commercial plans were discharged within one day after delivery, compared with 57.7 percent from commercial health maintenance organizations (HMOS).” (PDF) In 1955, it would have been outrageous to send a woman home within one day of delivery. Now, it’s common, although it depends on whether you have “gold plated” insurance or not.

  5. grannyeagle  •  Oct 18, 2007 @4:21 pm

    I know I will get a lot of flak for my opinion on this but why do women have to go the hospital to have babies? It is not a sickness, not a disease and imo, the hospital procedure is unnatural. We need more midwives who are trained and can deliver babies at home. One can always go to the hospital if difficulties arise.
    Having said that, I do agree that we have a pitiable health care system. I worked as a RN for 30 yrs. so I saw all the failings from the inside. For that reason, I stay away from doctors and hospitals as much as I can. It just isn’t safe.
    BTW, I had my children in the hospital because I didn’t know any better, it was in the late 50s, early 60s. Maha is right, I think I stayed 3 days but it wasn’t necessary. I could have went home the next day.

  6. maha  •  Oct 18, 2007 @4:58 pm

    I know I will get a lot of flak for my opinion on this but why do women have to go the hospital to have babies?

    My Ma was an obstetrics nurse, so I grew up in a home generously littered by obstetrics and nursing journals, meaning I got an early education in what can go wrong. My understanding is that 90 percent of the time women could give birth just about anywhere and be fine, but the stuff that goes wrong with the other 10 percent is stuff you don’t want to know about. Some of it’s not predictable, and some of it requires immediate emergency treatment that can be done only in a hospital.

    So I think the decision about whether to go to a hospital or somewhere else is a highly individual one, to be made with medical advice. The ideal, IMO, is a homey birthing room attached to a hospital, which is something like what I had with my second baby.

    When to go home is highly individual also. I felt I was sent home way too soon after the first baby, and that was something like 48 hours. It partly depends on whether you’ve got help at home or not. Especially if you’re going to breast feed or have a proclivity toward depression you need to be able to rest and let other people do the shitwork for at least a week, IMO.

  7. You don't know jack  •  Oct 18, 2007 @5:24 pm

    Nice try on SOP. They were told: “Sorry we are full. Come back later.”
    Life expecvtancy has little to do with health care. Cancer survival rates do. Post them.

  8. maha  •  Oct 18, 2007 @5:32 pm

    They were told: “Sorry we are full. Come back later.”

    Did you not see the chart about funding? I didn’t say there weren’t problems with health care in the UK.

    Life expecvtancy has little to do with health care.

    Actually it does, but I know righties don’t like to admit it.

    Cancer survival rates do. Post them.

    Translation: Treating cancer is one of the few things the U.S. health care system generally does better than Europe, which is why cancer survival rates have become the leading indicator of quality health care in the U.S. in Rightie World. We do a better job of delivering drugs that extend a cancer survivor’s life by three or four months. However, we suck at pretty much everything else.

  9. dr. luba  •  Oct 18, 2007 @7:45 pm

    One can always go to the hospital if difficulties arise.

    Maha is right. Most women could deliver safely at home, but not all of them, and it’s hard to predict which ones won’t.

    I’ve worked in India, where a lot of women still deliver at home for economic reasons. By the time the midwife (or family) figures out that something is seriously wrong, often the baby has died or been seriously brain damaged, or the mother has seized or stroked or bled out. I’ve seen ruptured uteruses with dead babies when families try to deliver at home with a prolonged labor. It’s not pretty.

    When something goes wrong, every second counts. I can have a baby out by C-section within minutes of deciding a patient needs one emergently, if she’s at the hospital. If she’s at home……..

    Then there is the risk of infection, intra and post partum, in mother and baby. The results can be catastrophic if not diagnosed and treated promptly.

    What we in the West have forgotten is that the medicalization of pregnancy, although it is much complained about, has lowered maternal and infant mortality rates significantly. 500,000 women still die annually from complications of pregnancy….but not in the West. We have forgotten this, and thus romanticize home delivery.

    BTW, the current standard in Michigan is discharge on the second postpartum day for vaginal deliveries, and on the third for cesarian sections, barring complications. Some mothers do opt to go home sooner, but not many. As I recall, it took legislation on the national level to enforce this, as, back in the 90s, many insurers were enforcing 1 day discharges for vaginal deliveries, and 2 days for cesarians. (Government interference at its finest.)

    WRT admissions for labor–unless there are other indications (high blood pressure, bleeding, worrisome fetal heart tones, infections, etc.), women are admitted when they are in active labor. Latent phase (early) labor can sometimes go on for days, or stop completely, so, unless someone is having strong, regular contractions and making cervical change, most hospitals won’t admit them and tie up a bed. Insurance won’t pay for it, and the beds are needed for laboring patients (we’re #27, after all……)

  10. goatherd  •  Oct 19, 2007 @9:33 am

    I found Grannyeagle’s and Dr. Lubba’s comments particularly valuable.

    My wife is a Certified Nurse Midwife (CNM). She is at work now and would probably love this post and comments. After experiencing what I could from her educational process and 17 years of hearing labor and delivery stories (no personal information included) I am very concerned with healthcare issues, particularly regarding birth and disability (I had many years experience with people with spinal cord injuries and head injuries.) I also have just returned from the South of France and my wife once received medical care in France. She was very impressed with her care.

    It might just have been the joy of escaping Bush’s America, but the average person in rural France seemed much healthier, happier and secure thanpeople here in the rural South. Here obesity and poor dentition

  11. goatherd  •  Oct 19, 2007 @9:54 am

    Sorry, I accidently hit the submit button before reading and editing my comment above. How embarrassing, I would have cut a ot of that out!

    One problem with our system is that our citizens are very poorly educated about how to maintain their health and how to use healthcare sensibly. This creates a lot of waste as when follow George Bush’s advice and “go to an emergency room” for non-emergent illnesses. They probably don’t have an affordable alternative and they probably don’t realize the huge expense of emergency care.

    I really enjoy your posts on Healthcare.

  12. aimai  •  Oct 19, 2007 @10:15 am

    I’m equipped to comment on this having had one three day hospital labor and delivery and one ten hour at home/midwife delivery. Maha is right that women are turned away routinely until just the moment when they look like they might start pushing the baby out and that historically that has led to plenty of women delivering at home or in cabs or (in one case I know of personally) in the hospital parking lot.

    Not only are you discouraged from laboring at the hospital for cost and efficiency purposes but if you *are* laboring in the hospital because they’ve put you on pitocin to induce the labor the other labor saving/bed saving rules still apply to you and the actual monitoring is almost entirely done by volunteer labor (your spouse or doula) and machines. The nurses are forced to “monitor” your labor from down the hall by occasionally glancing at a print out of the wires attached to you. Fetal distress is what they are monitoring for, not maternal distress, and c-sections are routinely done (sorry dr. luba) for the convenience of the doctors and staff and because temporary signs of fetal distress are taken as serious even though, certainly, my own doctors told me that there were no good studies of what normal fetal patterns during a normal labor looked like so they were just guessing about what was real distress.

    Look, I’m not complaining about the good faith or other of doctors. I’d do c sections every chance I got if I were a doctor and faced with a messy, tedious, long term thing like actual labor where I wasn’t getting paid to sit around and wait for the woman and hold her hand. But I live three minutes from a hospital and when I decided to go for a home birth the second time I knew for a fact that I could get to the hospital and into surgery *as fast* from my house as I would have from a labor and delivery room in the hospital. Hospitals are not particularly efficient places when it comes to moving patients between specialities or rooms or floors.

    WE have good data on the home births in the netherlands and adjusting for other factors there is no reason most births shouldn’t take place at home. The standard of care for the woman in american hospitals is absolutely shocking. It might be the best for the fetus/child for a few hours before and after the birth but the woman around the child is treated like a balky cow who is goign to be slaughtered anyway.

    aimai

  13. A Canadian Reader  •  Oct 19, 2007 @12:47 pm

    This topic drives me crazy!

    You can’t discuss universal health care with right-wing zombies. They love eye-catching headlines (like this story) but can’t see beyond them to–for instance–the millions of women who every year throughout the civilized world (Canada, the U.K., France, Germany, etc., etc.) deliver safely and without having to mortgage their homes or go without proper pre-natal care.

    Here in Canada, we do indeed often have long waits in the E.R., there are people who can’t find a G.P. and there can be long waits for elective surgery. BUT, if you think I would give up my universal health care to move to the States, I’ve got a bridge in Brooklyn that I’d be happy to sell you. In other words: NOT.

    I could personally regale you over a nice meal and a good glass of wine with my good and bad experiences in the Canadian health care system, but once again, I would never, ever consider moving to the States and give up what is essentially an excellent system.

    I would consider moving to France for a number of reasons (and that fact that they have great health care would be one of them). But the States, jamais de la vie! (never).

  14. aimai  •  Oct 19, 2007 @2:46 pm

    I waned to add that a close personal friend in England whose children have, variously: cleft palate, autism, asthma etc…can’t believe how hard it is for me to get good, consistent, health care for my ashtmatic child in this country. The NHS has done splendidly by her and she knows that every time her children need something no one is trying to figure out how to cut them off the insurance rolls. Whatever problems she has with the NHS as an adult (she works in the field of grants to cancer care workers) she has none with the care of children.

  15. dr. luba  •  Oct 19, 2007 @3:15 pm

    “I’d do c sections every chance I got if I were a doctor and faced with a messy, tedious, long term thing like actual labor where I wasn’t getting paid to sit around and wait for the woman and hold her hand.”

    I guess we should all be glad that you didn’t go into medicine. I’m an OB/GYN, and have been out of residency for 20 years now. It’s a good thing that I, and most of my colleagues, have more patience than you do. While labor can be long and tedious, most of us try to do cesarian sections for actual obstetric indications.

    Note that I said “most.” Yes, there are some lazy docs who are quick to cut. Some of the recent increase in the cesarian rate, though, is patient driven–mthere are many women don’t want to labor and come to the doctor’s office asking for cesarians. Another part of the increase is due to studies which show an increased risk of uterine rupture in women with previous cesarians who choose to labor in subsequent pregnancies. Many doctors and patients are unwilling to shoulder such a risk.

    As for fetal heart rate monitoring–its use has not decreased the rate of cerebral palsy, it is true (which means that most CP is a “pre-existing condition”, and not the result of labor). But it has decreased the rate of intrapartum (during labor) fetal death, and acute neonatal asphyxia, both the result of sudden catastrophic events. Having a nurse monitoring the heart rate every five minutes with a fetoscope or doppler would be as effective, if hospital budgets would allow for one-on-one nursing. They don’t.

    There are many people who can’t intepret FHTs properly. We do know what normal fetal heart tones look like during labor–when it comes to “abnormal” tones, though, there is a high false positive rate (normal babies with abnormal tracings). But catastrophically bad tones almost always bring about catastrophically bad outcomes unless an intervention is performed.

    As for moving patients from a labor room to an OR–in most hospitals, the obstetric OR is part of the labor area, so this takes moments. No matter how close you may live, you can’t get from home to an operating room as quickly. If you were to experience massive intrapartum bleeding, as with a placental abruption, this could be the difference between life and death.

    Anyways, for location of births, the US is not an outlier in the western world. The Netherlands, which strongly promotes home birth, has about a 30% rate. The next highest rate is in the UK, which has a home birth rate of about 2%. The rest of the West, us included, is in the less than 1% category.

  16. maha  •  Oct 19, 2007 @5:50 pm

    Some of the recent increase in the cesarian rate, though, is patient driven–mthere are many women don’t want to labor and come to the doctor’s office asking for cesarians.

    They should be required to spend a couple of days observing postpartum women on a maternity ward.

  17. Mo  •  Oct 19, 2007 @10:19 pm

    What a lot of nonsense. OK, so this Hospital made a bad mistake and the tabloid papers needed a story for the day! The UK National Health Service may be flawed and stretched at times but it gives universal health care for all from the cradle to the grave. Nobody loses health care if they lose their job or has to sell their house if there is a serious illness in the family. It even looks after visitors from abroad free of charge if you become ill while here. “Socialized” medicine, works very well in most industrialized countries and you can take out extra private health insurance if you wish.

  18. Lucy Kemnitzer  •  Oct 20, 2007 @12:31 am

    I just don’t know what to say when people say that birthing is not a medical situation and women should just have their babies at home anyways. If I had stuck to that idea I would very likely have died, or been seriously damaged, and so would my first child. Instead, I had the benefits of a midwife and a doctor, which meant that I went to the hospital, had some serious interventions — along with the kind of attention to the process that goes with the midwife approach — and I lived, and so did my child (who is now in medical school in an East European country).

    Yes, birthing is natural. But so is dying in childbirth. It’s not acceptable to me to reject the help that modern medicine can give to a difficult and often dangerous process.

    On the other hand, women are misled when they are told that a cesarean is an easier way to go, all other things being equal. Just the greater risk of infection ought to be enough to deter a mother from choosing a cesarean she has no special reason to need. I narrowly got to avoid the cesarean in my second, also high-risk pregnancy, and the recovery was much easier in every way. A doctor who does more than — is it 20%? — of cesareans, unless he specializes in high risk pregnancies, is probably out of line, and is not doing all his patients a favor.

    Back to the point at hand: I thought I had read an article a while back comparing in detail what USians get for their healthcare money, showing that we spend a hell of a lot for not much, compared to other people. And, hell, arguing by anecdote might be good for the arguer’s blood pressure (whoops, isn’t that what I just did?), but for policy decisions, I want science and principle, not stories and bombast.

  19. Scott  •  Oct 20, 2007 @7:02 am

    As Steven Colbert says…

    The facts have a well known liberal bias.

    Nice research.

  20. Jesurgislac  •  Oct 21, 2007 @4:54 pm

    FWIW, the standard in the UK now is supposed to be that every pregnant woman gets to decide for herself whether she wants to have the baby at home or in the hospital. Obviously, some women should go to hospital to deliver, or with some pregnancies, should: but that is a matter of medical advice between physician (and midwife) and the woman herself.

    Practically speaking, of course, areas vary, and doctors sometimes recommend a hospital delivery mainly because it’s going to be easier for them rather than because it’s medically necessary. But post-partum infections tend to be a lot lower with home deliveries*, and post-partum depression rates tend to be lower, because the woman feels in control of delivery.

    *In a hospital, you’re encountering everyone else’s germs. At home, it’s just yours and your family’s, and you’ve likely already got immunity to them which you pass on to your infant via breastmilk.

  21. Elena Thomson  •  Nov 14, 2007 @11:16 am

    I am a US citizen, but reside in the UK. I recently gave birth to my first baby here in the UK. I would like to say that the NHS provides EXCELLENT maternity care. I was seen regularly by my GP and a midwife for prenatal care. I was referred when necessary to specialists in a timely manner. I was given an amniocentesis at my request and the procedure was carried out by two competent specialists. Results were given in a timely fashion. My baby was born by emergency c-section and I could not have felt more confident in the care I was given. Postnatal care entails a midwife visiting the house daily for the first two weeks after discharge from hospital and then a health visitor comes for another month. After that there are health clinics in each area of the city that mothers can bring their babies to and seek advice from two nurses on duty. All prescriptions for the baby are FREE as well as dental care until the child is 16 years old. In addition, all medication for the mother during pregnancy and for one year after the baby’s birth are also FREE. AND I am off on 6 months paid maternity leave and will take another 6 months unpaid – which is my statutory right in this country. I found much to complain about in the UK until I had my baby. Now I am very grateful and proud to be living in a country that takes such good care of its people. I plan to become a UK citizen and my experience with the NHS is certainly a contributing factor in this decision.

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