With our first baby, I remember thinking how absolutely impossible it seemed to me that babies can be born in nature, without any healthcare system. With our second, I can very much believe so. I am surely glad we had a healthcare system seconds away prepared for all complications, but I appreciate why it was kept around the corner out of sight to let nature play its hand first. To empower the mum to give birth if she can.

Our first son was born in the USA, almost 3 years ago. Our second in Copenhagen 14 days ago. My wife and I spoke at length about the differences. Overall, in the USA the mum is serviced through a tight process as patient, while in Denmark she is supported in her own process.  I believe this is a fundamental attitude shifts with many benefits for the baby, the mum and even the healthcare system.

In the USA we were given a whole array of comprehensive interventions, checkpoints, ranges of good results, and decisions to make. It mostly was the healthcare system setting the stage, cadence and expectations against the schedule. In Denmark, it mostly was whatever the mum wanted. There was a very minimal interface with medical personnel and instruments. They were there but all along the mum was clearly the driver. They told her what to expect, what was normal, what not, what options she had, but she was clearly in charge. In the end they collected a similar amount of datapoints from the mum and baby and I’m sure that if there were any complications, the system would resemble more “healthcare patient” service, but overall, the mum was empowered and at the center. For example, mum weight gain with our first felt like a stresful narrow band between too much and too little. With our first baby, stress and high blood pressure were issues that kept us in check the whole time. In Denmark it was managed, and I’m convinced that a big part of it was the focus on the mum at the center, not the system.

Cost: In the USA we had a fancy top healthcare insurance from my fancy job for the first baby. For the second we were visiting in the USA when we found out, and I was unable to find travel healthcare insurance that would cover pregnancy so we returned to Europe ahead of time. In Denmark we had nothing other than the public system (I was freelancing, and my wife did not work). In the USA we kept receiving unexpected bills months after the birth for overpriced items and services like paracetamol or a dinner she did not have. In Denmark we did not pay for anything. (Well, we do pay more than 50% income tax).

Checkups: In the USA we saw our doctor roughly 20 times for checkups, there were a similar amount of tests (blood tests, stress tests, glucose test, echos, DNA, … ). Each time we drove 15 min to the hospital and waited ~20 min for a 5 min doctor chat. In Denmark we only saw a doctor once, the rest were midwives that followed her pregnancy and did less than 5 tests. We took public transportation, waited less than 5 minutes, and sometimes stayed 30min talking with the midwife.

Delivery room: In the USA we had a delivery room with all medical equipment prepared for both the mum and baby. In Denmark we could choose a similar one but were offered the “low risk” room with zero medical equipment and could perfectly be a large fancy hotel room with a big bathtub, snacks, drinks, and cozy lights (there was a medical operating theater 20 seconds away down the corridor).

Labor and Birth: In the USA we went through a cascade of advised choices triggered by elevated anxiety of the mum and slow progress: Foley, brushing of membrane, breaking water, Oxytocin injection, epidural. A nurse was with us the whole time and up to 20 people participated (anesthesia, doctors, nurses, …). The mother was told at every step what to do (stand, push, rest, …), her IV port needle in the hand, and many tests to ensure the baby was ok. In Denmark we did not see a doctor. After 4 calls to the dedicated number and a visit where they told us to go back home, we were told to go to the cozy delivery room, where a midwife received us. After setting us in and a quick check, she left and was next door. My wife kept asking permission if she could or should do this or that (stand up, move around, go into the bath, put music, push …) The midwife answer was always to follow her intuition. She explained what was going to happen in a very calm and relaxed conversation. She used a phone-like device to check the baby’s heart a couple of times. When the contractions came regular and strong, she stayed with us and mostly told the mum to do as she felt like doing. Another midwife arrived for that part. Only when the head of the baby came, the midwife became more directive and asked the mum to stand up and do some positions to help the baby come out fully.

Post-birth: In the USA, when the baby came, there were more than 6 people. We had the baby for a few minutes and they took him to do some tests on a table next to the mum. The doctor, nurse and other people stayed until the placenta came, did some stitches to the mum and we stayed in the room for an hour or so. In Denmark, only the main midwife stayed with us until the placenta came, the mum had the baby the whole time (mum helped take the baby out with her hands (the position doing so also helps delivery). When babies are born in the bath, they come bluer and more lethargic, so the midwives nudged the baby until she started breathing and moving (10-20 seconds or so). It was this phase, with the midwives taking over telling the mum positions, nudging the baby, that it became clear to me that they had been actively nonparticipating but evaluating and ready). The mum and baby moved to the bed, where the placenta came, the midwife did a stitch (with a headlamp to not break the cozy easy lighting in the room). Because I am who I am, I asked a ton of questions about the placenta and the midwife even showed me where the baby goes inside the sack. After seeing that the baby was moving, breathing and already latched, they just did a quick prick on the baby’s feet for a test, and left without taking her at any time. They brought a light post-partum dinner and told us to rest until we were ready to go a room.

First hours: In the USA we were moved to a nice room where several nurses came to do some tests, check on the baby and mum, and we slept there. They had to see our carseat and then we drove home the next morning. In Denmark, we had a similar room (with a better second bed for me :) ). They only came once to do some tests. There was a free snack bar in the corridor. We were told we could stay up to three days but could also go home after the night. We left after lunch.

First 2 weeks: In the USA we drove back to the hospital a few times for tests, to measure the baby and check on the mum. In Denmark we also went to the hospital, but a nurse also came home 2 times to check on all of us, answer questions and make sure we were all ok. The hospital even creates groups of mums with similar delivery dates to support each other.

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Our experience while anecdotal, sits well within the widely reported sad and chronic reality that the USA health care system is not working for most people, and specifically for pregnant women and newborns. To quote the NAS report: “The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women”. And specifically on birth centers (the cozy room in our case), the study highlights lower intervention rates and benefits when part of an integrated system (like here in Denmark).