Beyoncé announced her first pregnancy live at the 2011 MTV Video Music Awards. At that moment, Twitter experienced an unprecedented spike: 8,868 tweets per second, the most activity ever recorded. In an instant, Beyoncé’s became the most famous fetus in the world.

It’s small wonder that Beyoncé’s baby took her first breaths in a birthing suite entirely unlike those available to the rest of us. That’s because the Knowles-Carter family shelled out the cash for a VIP labor experience at New York City’s Lenox Hill Hospital, where, for $2,000 a day, you can deliver your little one in a bubble, thoroughly insulated from the usual dangers of American childbirth.

For those with the means, seeking high-priced alternative care is a rational response to the state of maternal well-being in the United States. Between 1990 and 2015, while maternal mortality rates dropped precipitously in most of the world, pregnancy-related death rates for American mothers rose by more than 50 percent. By 2013, maternal mortality was more prevalent in the United States than in Iran, Romania, or Vietnam.

Almost 1,000 American mothers die from pregnancy-related causes each year, and 65,000 more come close to death. A recent study by the Centers for Disease Control found that almost 60 percent of these incidents are entirely avoidable — the result of inadequate medical care.

Beyoncé’s delivery would suffer from no such negligence. The New York Daily News compared Lenox Hill’s executive delivery suite, freshly renovated in anticipation of Beyoncé’s visit, to “the top-dollar accommodations at five-star luxury hotels.” It reportedly included multiple bedrooms, a kitchenette, four tele-visions, “a sweeping view of the tony Upper East Side,” “cozy mahogany walls,” “colorful abstract paintings,” even “Formica-top coffee tables topped with crystal candy bowls.”

Beyoncé reported feeling “a very strong connection” with her daughter during labor. “It was the best day of my life,” she told the Daily Mail. Such a worry-free birth is a blessing in New York City, where black women experience life-threatening complications at a rate of 387 per 10,000 — “roughly comparable to complication rates in Sierra Leone,” according to a 2018 New York Times editorial.

Later, Lenox Hill came under scrutiny for its special treatment of the celebrity couple. The hospital administration admitted that Beyoncé and her family did receive a standard of medical care normally unavailable to other expectant mothers. But they insisted that the treatment wasn’t “special” — it was just expensive.

Beyoncé was “billed the standard rate for those accommodations,” their statement insists. Beyoncé may have been the first to use them — “the stars really did align,” commented the hospital’s executive director — but “our executive suites are available for any patient, including the food service and amenities provided to the Carter family.”

“Any patient,” of course, means any patient with deep pockets.

No one can blame Beyoncé and Jay-Z for skirting the dangers of American childbearing by retreating into a gilded birth-bunker. But it’s clear that the Knowles-Carter family was a beneficiary of an outrageous fact — safe and comfortable medical care is available to those who can afford it, but denied to those of us who cannot.

The hospital administrators were true to their word: their Beyoncé-christened executive suites remained open and available for use, with names like the “Park Avenue Studio,” the “Premium Executive,” and, of course, the “Beyoncé Room.” Having earned a reputation as the palace that birthed Blue Ivy, the hospital had no trouble attracting affluent mothers.

This luxury maternity floor is “a different world,” according to the Daily News. “The smallest ‘deluxe private’ room goes for $850, the larger ‘premium deluxe’ goes for $1,400, the biggest one — the Beyoncé Room — goes for $1,750. And that can be expanded into two suites for a cool $2,400 per night.” All of these prices are in addition to normal “medical care costs,” of course, but they do get you high thread-count sheets, a concierge service, and, most significantly, “close to the bedside” nursing.

“Close to the bedside” means you get your own nurse. Upstairs, in general maternity, nurses were expected to care for up to eight patients at once. Downstairs, in the executive birthing suites, managers maintained a one-to-one nurse-to-patient ratio.

If an executive patient went into labor unexpectedly or scheduled an induction on short notice, a nurse from the general maternity ward would be moved downstairs to tend to the personal needs of the VIP. This led to frequent nurse shortages on the budget ward — one night a single nurse was left to supervise eighteen infants while her colleagues assisted an executive guest downstairs.

During union contract negotiations, an anonymous group of nurses took their worries to the New York Daily News. The day after a strike authorization vote, that paper’s morning addition ran with the headline “‘Beyoncé’ rooms for affluent new moms at Lenox Hill Hospital are putting newborns at risk.”

The article describes “institutional linoleum floors and harsh white lights” giving way to “lush gray carpet in the softly lit fourth-floor hallway,” which leads past delivery rooms with dark cabinets and “blond wood floors.” “They’re trying to make this the Ritz,” one nurse said. Another, who had worked at the Lenox Hill maternity department for decades, warned that the hospital’s efforts to provide individualized care to high-paying patients while cutting nursing costs put lives at risk: “It’s incredibly stressful. You have too many babies. You can’t do all you need to do for them.”

As far as we know, the Beyoncé Room is still open for business at Lenox Hill, though the hospital did come to an agreement with the nurses’ union in 2012, avoiding a strike. The most recent data on maternal mortality in New York City comes from 2012, so it’s impossible to say for certain if things have gotten any safer for expectant mothers since then. But they’ve likely gotten even worse.

New York City hospitals have been closing at an alarming rate, leaving many without a reliable place to seek urgent care. About twenty of the city’s hospitals have closed their doors since 2000, including sixteen public hospitals that disproportionately served working-class patients. In New York City and across the country, high-quality medical care is becoming harder to come by for expectant mothers and their children.

Not for Beyoncé, though. In 2014, when she was expecting twin boys, she jilted Lenox Hill and opted to deliver at Hollywood’s Cedar-Sinai hospital. There, the “deluxe maternity suite package” ($3,600–5,100 a night) can you get a hair stylist, a personal doula, manicures and pedicures, two big-screen televisions, three bedrooms, two bathrooms, a full bathtub, and a refrigerator, stocked with chilled juices.

Can we imagine providing this level of luxury to every expectant mother?

In Sweden, where you might be charged a day rate of about 100 kroner ($12) for the hospital stay, all patients receive one-on-one attention from a licensed midwife, who works in tandem with a doctor. After the child is born, both parents are entitled to stay in a “patient hotel” — the Scandinavian alternative to uncomfortable (and often unsanitary) hospital wards — where meals are provided and nurses are available 24/7 to assist with swaddling, breastfeeding, burping, and the like.

Recently, Forbes published an interview with Emma, an American woman living abroad who had delivered a child in Denmark. In the early stages of her labor, Emma revealed, she was given the choice of soothing herself with a hot bath or shower — typical amenities in Danish birthing suites. During the birth itself, which was performed by a mid-wife with a doctor assisting, the lights were dimmed and candles placed around the room (“It was so cool.… The most amazing thing”). After the child was safely delivered — and after hospital staff had brought a tray of jam and cookies, decorated with a miniature Danish flag, to the new parents’ bedside — Emma, her partner, and their son were admitted to the hospital for an additional five days, where they were provided with a king-sized bed to share, three meals a day (“it was delicious”), and a breast pump to assist with feeding. The whole thing cost them nothing out of pocket.

Denmark and Sweden are able to offer stellar care, but they’re not radical outliers in the developed world. Here in the United States  — with our inflated prices and dismal outcomes — our new goal is simple to express: no mother should be forced to give birth in conditions Beyoncé wouldn’t accept for herself.