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If you’re a British couple planning to start a family in the U.S., here are some problems to ponder before you start stockpiling tiny clothes.

1. Whether your insurance cover the cost of your pregnancy and birth
Without the NHS to pick up the check, you’re looking at an average cost of around $10,000 from conception to birth – possibly much more if you have a problematic pregnancy or you’re based in an expensive city like New York. This is simply not feasible for most expat couples, so before you ditch the contraception, call your insurance company and find out exactly what will be covered. Don’t just assume that every scan, check-up or hospital stay will be free. Be especially vigilant if you discover that your employer (or your partner’s if you’re using his plan) is preparing to switch insurers during your pregnancy. In these circumstances, pregnancy is sometimes classified as a pre-existing condition and you won’t be covered.

2. How you’ll cope financially and emotionally with American-style maternity leave
Unlike the U.K., where all employed new mothers have a statutory right to 52 weeks leave (much of that paid), U.S. companies tend to be a lot less generous. The benefits you’ll receive depend on the law in your home state and your employer’s own policy, but it’s more than likely that you’ll receive merely the minimum 12 weeks unpaid leave prescribed by the 1993 Family and Medical Leave Act. New mothers will sometimes be able to pad out their time off by claiming sick leave, short-term disability, holiday and personal days, but don’t assume that you’ll be entitled to any of this. Schedule a meeting with your boss or your company’s HR department to discuss your rights.

3. Whether your partner is entitled to paternity leave
Again, there is no fully comprehensive law that demands employers provide time off for new dads. Your other half will probably have to give up valuable vacation days to see you through the birth and recovery. He may also be entitled to some unpaid leave. If not, you might want to be clever about how you use those precious days off. Possibly, it will make more sense for him to go back to work almost immediately post-birth, if you’re going to be looked after in hospital for a few days anyway, and restart his leave when you’re back home. You’ll appreciate his help much more when there are no more nice nurses to take the baby off to the nursery so you can get some sleep.

4. Signing up with a pediatrician
Back home, your child will only ever see a specialist if they’re referred to one by your general practitioner. Here, however, your offspring will see a pediatrician from the beginning. This means you need to hunt out a good one and sign up at least a few months before your baby is born. Many practices host regular open days where you can meet the doctors and determine whether their style suits your family. Incidentally, for the duration of your hospital stay, your baby should be covered by your existing health plan. You’ll only be able to add your new arrival to your policy once he or she has a social security number. The forms needed to apply for this will be handed out during your hospital stay.

5. Limiting your trips to the U.K.
Most British and American airlines require a doctor’s note stating that your pregnancy is low-risk for you to travel beyond 28 weeks, so you’ll most likely want to schedule your last trip home a while before the cut off. And quite possibly you won’t fancy flying again until your baby is at least a few months old and you’re fully recovered. Usefully, some airlines such as Virgin Atlantic provide in-flight cots (cribs) that bolt to the bulkhead. These are free (though you will need to request one in advance) and suitable for babies weighing up to 19 to 24 pounds, depending on the aircraft.

6. How you’ll cope without the support of your U.K. family and friends
It’s only natural to want your friends and family nearby when you’re pregnant or a terrified new parent. But for many expats, this isn’t possible so you could find yourself relying heavily on new parent groups and post-partum carers such as lactation consultants and doulas. For others, meanwhile, you might find that your loved ones make too much of an effort to be close by. If your well-meaning parents or good pals invite themselves to camp out in your tiny apartment post-birth, you should let them know as early as possible that this isn’t going to work, if that’s how you feel. Perhaps suggest they arrange to stay somewhere locally or see if a kind, local friend is prepared to put them up.

7. Whether your visa is still valid up to and beyond your due date
Make sure you’ve nailed down any visa issues before you become pregnant in the U.S., if you’re planning to give birth here. The stress of battling extreme bureaucracy or potential deportation while pregnant could harm you or the baby.

8. Care by obstetricians, not midwives
In the U.S., a baby doctor and specialist nurses, rather than a midwife, will most likely provide your prenatal care and deliver your baby, although midwife-attended births are on the rise in the U.S. So, if you’d prefer a midwife delivery you may be able to arrange one. Some Brits, however, might find they’re actually happier with the traditional American approach. Whichever method you chose, be aware that, unlike in the U.K., there are no in-home checks post-birth as standard. It’s also worth noting that Americans seem to put much more of a separation between “medical” and “natural” childbirth. Both are readily available but if you opt for a drug-free experience in a birthing center, even if the facility is within a hospital, you may not be allowed to opt out and get the strong drugs if the pain gets too much. Though, of course, you will be transferred to hospital if complications arise.

9. Should you hire a doula?
Perhaps because midwives attend so few births in the U.S., doula-assisted birthing is massive in America. In case you’re unaware, a doula is a paid birthing partner who has no medical training but is there purely in a support capacity. There are also doulas who provide post-birth support to new parents. Some do both.

10. Forfeiting British benefits
If you give birth in the U.S., you won’t be able to take advantage of everything the British government provides to pregnant mothers, including free prescriptions, dental care, statutory maternity leave and pay (or maternity allowance). What’s more, if you’re planning to raise your children over here, you won’t be entitled to Child Maintenance payments, even though you and your offspring are British citizens.

Do you have any advice for expecting expat parents?

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Filed Under: Pregnant in America
By Ruth Margolis