10 Things to Consider Before Getting Pregnant in America

Two lines = Positive! (Photo via Babymed.com)

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?

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.
  • gn

    California, and possibly a few other enlightened states, mandate some paid paternity leave.

    If you want a cot/bassinet on Virgin Atlantic, you need to request it beforehand __and__ check in early at the airport. They won’t guarantee the seat until you are actually physically at the airport.

    My wife flew transatlantic when she was around 32 weeks pregnant, and no one made a fuss about doctor’s notes (although we did have one just in case).

    Doulas are great. We had one for our first baby and she was a huge help through a difficult delivery. Although doulas are not medically qualified to deliver a baby, they will usually have a large amount of medical knowledge about childbirth, and will probably be familiar with the location (and possibly the doctors/nurses) where you are giving birth Obviously, you have to pay.

    If you give birth in a hospital, be sure to take advantage of the lactation assistance available there before you leave. There will probably be lactation consultants available to help get breastfeeding started.

  • Nicole

    I was newly engaged to my British husband and I was moving there to be with him. We found out soon after the engagement that we were expecting and England took care of me four thousand times better than the US has. Since we have moved here to the states, I have lost three babies and all I have to show for them besides painful memories are ASTRONOMICAL medical bills. I wish the job situation was better in England cause I sure as hell would go back!!

  • Arakiba

    My advice to Brits would be to wait until they return home to have a child. In addition to the lack of job security for pregnant women, the cost of American healthcare, and the general lack of leave after giving birth, there are some states where doctors aren’t permitted to tell prospective parents if there is a fetal abnormality. This is a Republican strategy to attempt to decrease the number of abortions. There are also some American hospitals (usually Catholic hospitals) that won’t intervene to save a woman’s life if doing so might lead to a miscarriage. Yes, they will let women die to further their ideology, so think twice before deciding to have a baby in the US.

    • gn

      When my brother had his second baby (in the UK) his wife went into labour prematurely. He and his wife had to drive for over three hours, through several cities, to find an NHS hospital with any space in its premature intensive care unit. This was in the densely populated, prosperous south of England, not the remote highlands of Scotland. My wife and I could hardly believe the story when he told me.

      Some aspects of the birth process are undoubtedly better in the US (provided you have insurance).

  • Melinda

    I just gave birth to my third child in the US, and even though we have “good” insurance, we still had to pay over $3,000 out of pocket, and that is just for the hospital bills. It does not include all of the after care the baby gets at the pediatrician. The costs to the civilian is insane. Stay in Britain where you don’t have to worry about paying for your baby for years to come.

    • expatmum

      You took the word’s out of my mouth. I would definitely advise even people with the “best” insurance to check out the deductibles and co-pays etc Many insurance coverage will still leave you with quite a bill. In my case we have a high deductible (because we’re the employer, therefore technically self-employed) and we also have to pay 20% of all bills. With my last c-sections the bill was eye-watering.

  • Alison

    To clarify, if a woman opts for an out-of-hospital birth and decides the pain is too much, she can absolutely choose to go into the hospital to get pain meds. I’m a home birth midwife in the US, and it is ALWAYS an option, though very, very rarely does someone choose to go in during labor just for pain relief.
    Also, many of us do the entire prenatal care, labor, birth, postpartum, and newborn care until the baby is 6 weeks old for less than most people’s co-pays at the hospital.

  • Gilbert

    And of course any child born in the USA is automatically a US citizen

  • Tara

    I’m on the opposite side of this matter, a US citizen living in the UK, and I must say I agree with many of your points.

    1. Good insurance is very important while living in the US. Insurance can be pricey, but it is worth it.

    2. Couples should always consider who will be able to stay home with the new baby prior to ttc. For many couples, they might find it more cost effective and mentally satisfying for one of them not to return to work. A good daycare is expensive.

    3. Paternity leave is still catching on in both the US and UK. My husband will not be getting much of anything here in the UK if we decide to have a baby. Sadly I think most of society still views having children as a woman’s responsibility.

    4. The lack of a pediatrician is terrifying to me. Bringing a newborn into the clinic for checkups is disgusting. No clinic I have seen here has a separate area for well or sick care. In the States my pediatrician’s office had a section for well children, a section for sick children, and a section for newborns. The sick care section had its own door and reception area so they weren’t exposing the other children to illness. Also adults and children require different care and different approaches to collecting data. Not all GPs are great with children. I honestly prefer the US style care for this aspect.

    5. Good point about not being able to travel home for an extended period of time.

    6. Hopefully by the time you decide to ttc, you will be settled enough in your new area and have made a few friends. It will be hard without someone your very close to and trust, but there are ways of making things work. I am hoping to have my parents for the first 2-3 weeks stay with us.

    7. Excellent point! I don’t think it ever crossed my mind to think about my visa when considering having a baby. I will definitely keep that in mind until I have my ILTR.

    8. After watching One Born Every Minute I told my husband there was no way in the world I would have a child here in the UK. It was terrifying! I in no way want a nurse delivering my baby. Sorry, I know there are some excellent midwives out there, but here in the UK you don’t really get to choose who you get, and seeing that show scares me to death I will end up with one of those morons. I think there was one in the episode that I thought was competent. (I am a nurse myself BTW) I don’t want someone talking to me like a moron. I don’t want them to tell me I don’t want an epidural. Excuse me, but nitrous oxide is for the dental office where you get your teeth work complete not for having a baby. I want the strong stuff and I don’t want my wishes questioned. I saw one midwife on that show tell the woman in labour she was fine with the gas when she asked for an epidural. YIKES! I also want a doctor to deliver my baby in case there are complications. I don’t want to wait for a midwife to have to phone a doctor when an emergency arises. I want a clinical birth not a hocus-pocus holistic one. Also, I see far too many forcep births. We are looking into private healthcare here, but even that seems to be all midwives. I refuse to get pregnant here in the UK unless I am certain my child will be delivered by a doctor. It sounds nuts, but the thought of someone other than a doctor delivering my baby causes me to have panic attacks. Seriously it makes me feel like I’ve moved to a third world country with the hoops one must jump through to see an actual doctor instead of a nurse. (This is not just an issue with childbirth but healthcare in general here. I think many Americans would be shocked to make an appointment with a GP only to see the Nurse Practitioner.). –Sorry for the rant, but this is so scary and bizarre to me

    9. While I think having a doula is a nice thing if you can afford it I don’t think it is that important that is requires careful consideration prior to ttc. I do not know anyone who has actually used a doula. Your spouse or partner can easily take the doula role to support you during childbirth.

    10. I think this one is fairly easy going the opposite way. The US government does not provide any of this, and a non-citizen isn’t entitled to anything here in the UK other than healthcare, even if your spouse and child are citizens. (please note I could be incorrect, but I am going by what the visa office stated to us)

  • K

    Just a note, you do not HAVE to go to a pediatrician. I have gone to a “family doctor” my entire life and it worked out very well for my parents–I did not have to switch doctors when I turned 18, and my mother and I could both get a check up in the same appointment.

  • MLK1

    I unexpectedly found myself pregnant, aged 42, a mere 6 weeks after moving to the US to be with my US citizen husband. I was a high risk pregnancy and had amazing medical care all the way through.
    My husband saved his leave so that he could stay home with me for 2 weeks following my c-section to help with the baby. The lack of paternity leave can be worked around, if your other half can be flexible about when he takes his annual leave (and if he’s entitled to any annual leave in the first place!)
    The one thing the article doesn’t mention is the time lapse between receiving your medical care and when the bills arrive. We got hit with a huge one more than a year after the procedure itself was carried out. We have a low co-pay but even so costs really do add up.
    The most negative aspect of birth in the US vs UK for me was the lack of follow up, no health visitors come calling. I was left caring for my newborn, myself post c-section and dealing with my already chronic ME all alone with no family support beyond my husband. The hospital call you a week later to ask if you are OK and give you a number to call if you think you may be suffering from post partum depression.

    I’ve coped, but it’s been really tough going.

  • Caren

    You get a year off! I got 6 lousy weeks with no pay at all plus a promise of dismissal if I didn’t “get my ass back in here”. Stay in the UK and enjoy the baby.