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- Meghan Markle delivered Archie in the UK and will deliver her second baby in the US.
- The countries differ in maternity care costs, birth attendants, and prenatal and postpartum care.
- The UK tends to have better outcomes, but the US excels in more specialized care, an OB-GYN said.
- Visit Insider's homepage for more stories.
After giving birth to son Archie in the UK, Meghan Markle's second child will be born in the US – a royal rarity.
While her resources may shield her from some of the downfalls of the American maternal healthcare system and allow her to capitalize on its benefits, the differences between pregnancy and childbirth in the US and UK can be stark.
From the cost of care to how much attention moms receive postpartum, many aspects of birth vary depending on which side of the pond you're on.
Insider talked to two American sisters who had babies weeks apart – one in the US and one living in the UK – about the main differences between their experiences, and asked OB-GYN and global women's health expert Dr. Taraneh Shirazian to compare the countries too.
The UK system provides free care, with fewer interventions
All UK citizens and visa holders have access to free, comprehensive healthcare through the National Health Service. That includes screenings and shots, dental care, mental healthcare, hospital visits, and, yes, maternity care.
The vast majority of the population uses it exclusively; only about 10% of residents also pay for some private healthcare coverage, according to The Commonwealth Fund.
The NHS is "one of the systems that people are most fond of, and it's one of the things that people contribute towards in their taxes," Claudia, the sister who recently delivered in the UK, told Insider. (She and her sister, Louise, asked to use their middle names because they didn't have approval from their companies to speak to the media.)
"So when they have births here they want to take advantage of that because they've been paying for that healthcare their whole lives."
That care, which Claudia calls "very good," is more standardized and low-cost than in the US. Healthy pregnancies are attended by midwives, and involve few interventions like epidurals. OB-GYNs, surgeons, and anesthesiologists only get involved if there are complications.
"If you're a healthy, low-risk woman, you'd typically give birth in a birth center, which is basically a drug-free experience," Claudia said.
There are more options, and disparities in care, in the US
In the US, there are many more options in how people pay for and access healthcare - from out-of-pocket to private insurance to government-funded programs like Medicare. That range gives privileged Americans plentiful access to top-notch, specialized, but it also deepens racial and socioeconomic disparities.
"The issue for the US is making sure everyone has access to extraordinary care," Shirazian, who directs the Division of Global Women's Health at NYU Langone Health, said.
For Louise, who delivered her son in Atlanta, Georgia in December, the US system worked. She has good insurance through her employer, and used the same OB-GYN she's been seeing since age 17. She knew she could get an epidural if she wanted.
"The control and picking the experience that you want to have was really something that was important to me," said Louise, whose son was born in December.
In the UK, Claudia saw a different midwife each time she went to the hospital for prenatal care. In retrospect, she said, "it brought a lot of undue stress" on top of the stress being pregnant in the pandemic in her non-native country.
Two weeks before her delivery, Claudia switched to a private hospital because her baby was breech and she needed a c-section. While the NHS can handle c-sections, the pandemic meant surgical patients couldn't have guests. At the private hospital, which Claudia US-based company mostly paid for, she was able to have her husband, who's British, by her side. She delivered a healthy boy in January.
The US values prenatal testing and the UK emphasizes post-natal attention
Because the UK's system is built to minimize cost while maximizing outcomes, pregnant people there tend to have fewer prenatal visits and tests than in the US, where "we're looking at how can we pick up any possible thing that could be an issue," Shirazian said.
Markle - whose age puts her in a higher risk category, as does her first birth (reportedly intended to be at home but ultimately in a hospital) - then will have more blood tests, more ultrasounds, and more screens than she would at a standard UK facility, Shirazian said.
In the postpartum phase, Markle is likely to receive less attention than she did after Archie's birth. Shirazian said only 30% to 40% of Americans return for their postpartum visit, which is "a unique opportunity to identify any ongoing issues for the mother" like postpartum depression and breastfeeding complications.
In the UK, however, "community midwives" pay new moms a visit in the days after birth to check in and make sure everything's OK. "That was a really nice experience," Claudia said.
New moms also see a "health visitor," or registered nurse-midwives trained in community public health nursing, regularly. "They're basically there to talk about your emotional experience, what your experience breastfeeding is like," Claudia said. "It's another really wonderful free service."
Finally, she said, there's a free community service just to provide new moms with breastfeeding support.
Maternal mortality rates are bad in the US, but worse for Black women in the UK
In the UK, 8.9 new moms out of every 100,000 live births die from related complications. In the US, the rate is almost 3 times that - 25.1 women per 100,000 births, ProPublica reported in 2017.
That makes the US one of the deadliest developed country in which to give birth. About one in 3 women in the US have c-sections, which come with their own risks, compared to one in 4 in the UK.
Experts point to the UK's model, which minimizes interventions and standardizes care, to help explain why some of its outcomes are better.
But it's complicated, especially when race is involved. In the US, Black women are three to four times more likely to die in pregnancy, childbirth, or immediately postpartum than white women. But in the UK, Black women's maternal mortality rates are five times higher than white women.
Both countries have a lot of work to do to improve outcomes, but Shirazian - a US-trained doctor - said the US excels at caring for complicated pregnancies and births, and turning around medical emergencies. "I believe in our healthcare system, and as an individual person, there's nowhere else in the world I would prefer to deliver," she said.
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