America vs. Britain: Which Country’s Better For Expectant Mothers?

Which side of the pond is better for expecting mothers? (Press Association via AP Images)

Reassuringly, whichever country you pick to pop out a little person, it’ll most likely go well and you’ll come away with a healthy, fat newborn.

But if you’re a bump-bearing Brit settled in the U.S., you might find yourself simultaneously reassured and irked by what you’ve heard about having a baby in America. Possibly, it’s your friends and family back home who’ve got you panicked. After congratulating you and offering unsolicited advice, perhaps some of your blunter Brit associates started with the Yank-knocking. “Oh, so you’ll be having a C-section, then,” one friend informed me over Skype when I first announced I was pregnant. “I’ve heard that American doctors are way too worried about getting sued to let you have it the normal way.”

Although she drastically overstated it, my friend did have a point. The Caesarean rate is significantly higher in the U.S. than in the U.K. — one-in-three births compared to one-in-four. Most U.S. births are attended by a physician, so if you want a midwife, you’ll need to seek one out. American obstetricians tend to be — and I’m generalizing here — more risk-averse than your average NHS midwife or GP. In the U.S. you’ll likely have your first ultrasound at your first six- or seven-week check, while in the U.K. they’ll probably leave it until 12 weeks. And it’s normal here for your doctor to perform a pelvic examination on your first visit, whereas at home they tend not to “interfere” with your innards at such an early stage of the pregnancy.

If you prefer your medical personnel cautious and somewhat overbearing, you’ll get on great in America. As a borderline hypochondriac, I’m always quite grateful for the extra attention. But being bundled off to see a cardiologist in my 30th week because I reported breathlessness (a normal third trimester symptom) was, I suspect, overkill. On the plus side, I got to watch my (perfectly fine) heart do its thing on a screen, and who doesn’t want to see that?

Think carefully about how you’d like to proceed with the birth itself and pick your practitioner accordingly. U.S. doctors and midwives have privileges at certain hospitals in the area (usually one or two), so if you’ve got your heart set on a specific venue, you’ll need to find a practitioner who’s allowed to deliver there.

But you may decide a hospital birth is not for you. Hospital staff here are more likely to steer you away from non-medical pain relief options, like water birthing or intermittent monitoring, which allows you more freedom of movement during labor. That these routes aren’t readily available in hospitals might help explain why the epidural rate is higher in the U.S. compared to back home (nearly 40 percent in Britain versus 50-70 percent in America). So if you’re determined to have a drug-free delivery with all the non-pharmaceutical frills, you’ll probably do best in a birthing center. Some hospitals have them attached but most don’t.

Britain gets another big tick in its baby box for offering good old-fashioned gas and air (a blend of nitrous oxide and oxygen) as first-resort pain relief; the vast majority of American hospitals do not offer it. On the flipside, you may find yourself having to ask — or beg! — for an epidural in the U.K., where budget-conscious NHS staff are less willing to dispense the costly good stuff.

Which brings us round to money — yours to be precise. Having a baby in the U.K. is free of charge, unless you opt to go private. In the U.S., what you pay comes down to the type of insurance you have. Some of the best policies will leave you barely out of pocket while others cover scarily little. Depending on what care you and your baby require before and after the birth, your bill could run into five figures. So, check your policy thoroughly before bulk ordering ovulation kits on Amazon.

Have you experienced childbirth on both sides of the pond? Which was the better experience? Tell us below.

Ruth Margolis

Ruth Margolis

Ruth is a British freelance journalist who recently swapped east London for Brooklyn. She writes about TV for Radio Times and is working on her first novel.
View all posts by Ruth Margolis.
  • GardeningMiss

    I’ve had a baby in both UK and USA.

    In the UK I was offered an epidural and encouraged to have it but not in the USA. Of course that was many years ago so perhaps now the UK wouldn’t offer one. I chose not to have any pain meds in the USA and wasn’t required to have an IV because of that which was nice.

    In the UK I was given a list of things I had to bring into the hospital myself. Basics such as nappies/diapers for the baby, clean plastic margarine bowl and cotton balls to wash the baby, my own set of towels and my own nightgowns. I had a private room in the hospital I was at (most hospitals in UK have wards), but no TV or phone in the room. However the baby was with me and never left my room which is different from the USA where a nursery is available for the mother to rest. I had to completely care for the baby with no help from a nurse, even after delivery. As a first time mother I had almost a week stay in the hospital in the UK and that allowed for a mother’s milk to come in and for nurses to encourage breastfeeding. Then upon returning home, a home health nurse visited everyday for the first 2 weeks to check on me and the baby. A service in the UK that was invaluable to a new mother.

    In the USA and a second time mother, I was allowed 2 days in the hospital. I had a private room and all amenities needed to care for the baby and myself. Our insurance at the time did offer 2 weeks of a home health nurse (which I refused) and a community health nurse visited once.

    Both experiences were good, and both had flaws. Overall I’d say the UK looked after first time mothers better and offered greater support in that first year. They also offered Mother and Baby groups which allowed new mothers to bond with other new mothers and that kind of encouragement and support helped to make sure mom and baby got off to a good start.

    In the UK we payed nothing, although National Health Care doesn’t come free as people pay dearly for it through taxes. In the USA the cost of delivery was minimal as I had a short stay in the hospital, a problem free delivery and no need for additional charges of anesthesia or an anesthesiologist. Of course in USA health insurance is both a work benefit and something employer and employee pay into. Costs vary per provider and plan.

  • AJ

    May I remind you healthcare is a business in America, which is why everything is, as you say, overkill.

    • G

      America is not nearly as Marxist as Britain, but we are catching up. I’m sure that eventually all costs of child birth will be covered by the government, after they’ve given you permission to have a baby and issued you a permit.

  • EmmaK

    Well I moved to the US in 2000 while pregnant – which was a disaster because I was in Maryland where pregnancy was at that time considered a pre-existing condition and I could not get medical insurance. In the end I had to pay for the birth out of pocket and well, it was a total nightmare in a lot of ways, overmedicated, overbearing doctors etc etc. On the flip side when I had my next daughter in the USA in 2003 I went completely unmedicated in a birth center in a birthing pool and it was a lovely experience. Can’t compare to UK as have never given birth there!

  • expatmum

    My sister was having her babes in the UK at the same time as I was having mine in the US so we had a lot of time to compare, and yes, there are pluses and minuses to both sides.
    On the whole, I agree that the aftercare is far better in the UK (and why on earth the system is deemed “Marxist” I will never know). My sister had a health visitor for ten days while I had to go back to the hospital (after a terrible c-section) with my newborn to try to figure out why she wasn’t getting enough breast milk. I was kicked out far too early after my first experience and I begged the doctor to allow me one more night (I couldn’t even stand up straight let alone anything else) but she said her hands were tied and it was up to the health insurers.
    On the plus side, I had my own room and the nurses would take the baby so that I could sleep. (In my first case, I was barely conscious so they had no option.) My sister didn’t get a wink of sleep with hers because she was in a room with four mothers, and the babies all screamed throughout the night.
    The biggest shocker in the US is the cost. Even though I had great health insurance (as far as coverage) we still had to pay 20% of costs which amounts to thousands if you have complications. It’s something you have to think carefully about.

  • Brandie

    Seeing a Cardiologist is NOT the norm in America. Maybe if it was I wouldn’t have had my child at 32 weeks & I wouldn’t have been in a coma & almost died after his birth. And I wouldn’t know hundrends of other women who have died from or their children die from PPCM. Maybe you had a doctor who has run into one of those cases. I dont know to many people who get ultrasounds that early either. Most are at 12 weeks unless there is a problem. Other then that I image you are about right with things here.

    • gn

      You know “hundreds of women” who have died in childbirth?

      • Josie

        Since Brandie hasn’t replied, I am only guessing. Perhaps she belongs to a support group since her post suggests she has had personal experience with this issue?

  • Brandie


  • gn

    I have two young children born in the US, while my brother has two born in the UK, so I can offer some kind of comparison. I should mention that I have reasonably good health insurance coverage.

    My first baby was put in the (US) hospital’s intensive care unit even though she wasn’t premature, for what seemed a relatively minor reason (a blood test revealed an infection). By contrast, when my brother’s wife went into labo(u)r many weeks premature, the ambulance had to drive for several hours, through several fairly large towns, to find an NHS hospital with any space for the premature baby in its intensive care unit.

    Another comparison is lactation. My wife received lactation assistance in the hospital for both babies. I don’t’ believe that my sister-in-law did so, and she had some serious lactation problems with her first baby and ended up formula-feeding.

    The final comparison is the cost. We ended up paying only a couple of hundred dollars for the first birth (which ended in an emergency Caesarean). However the **notional** cost of the birth (what would theoretically be charged to a patient paying out of pocket with no insurance) was over six figures!! In fact our health insurance company didn’t pay that much, because all the insurance companies have special deals with the hospitals.

  • niamh17

    Having experienced healthcare in the USA im really glad that I had my four children in England. Yes in the UK we pay upfront in national insurance contributions, but going into a pregnancy the last thing I would want to worry about would be a bill at the end of it especially as I had two very difficult pregnancies which would have been so expensive here. Plus the care and after care in Britain is second to none and I was looked after by some amazing doctors and midwifes. Medical care is great here too but I hate co-pays and all the hidden charges and im told we have excellent insurance so i dread to think how people with rubbish insurance pay for it?

  • Josie

    Infant mortality rates. UK ranks 25th (5.38 deaths per 1,000 live births). US ranks 34th (7.07 per 1,000) behind even countries like Cuba, Croatia, and Cyprus. The best place for baby, statistically, is Singapore (2.60 per 1,000). Perhaps we should all look into what they are doing.

  • KEM

    My daughter, in the past 5 years, has given birth in London and Chicago. Nitrous oxide/ oxygen was a great option in the UK, but she went with no drugs on the 2nd birth in Chicago because the ‘inhalant’ was not available. Both were water births, as sought after in the states. The BEST thing about the UK birth, IMO, was leaving the cord and placenta attached until it stopped beating, about an hour later. In the U.S., it’s cut immediately and deprives the baby of that add’l nutrition. It was wonderful to have in-home visits from midwives, twice in the week following the birth in the UK, answering any questions. In the US, they send you home and wish you luck. I’m an American who is VERY impressed with the UK system and Queen Charlotte Hospital.