Has anyone given birth in the USA?

(20 Posts)
berri Wed 09-Jan-13 20:30:57

Really appreciate all the info, thanks so much smile

mathanxiety Wed 09-Jan-13 07:00:22

Oh and if you ask for it, they are very good at helping you get breastfeeding established.

mathanxiety Wed 09-Jan-13 06:59:53

I had 5 DCs during the 90s and one in 2001 in the US. Mu Dsis had one in Dublin.

Differences:
Nice clean hospitals and chance of a private room with a private ensuite bathroom that is clean. Bliss.
Decent food and menu to choose from but bad tea.
Depending on the hospital, nursing care can be really excellent.
Some hospitals have birthing centres where part of the service is a nurse visit once you're home. Most hospitals do not provide this service and local health departments do not send HVs. Basically once you're home with the baby you're on your own and the only contact you'll have with health professionals afterwards is the pediatrician's office, for the 2 week checkup and then the checkups where they start immunisations.

Pre natal care managed mostly by OB/GYN not midwives although there are midwife practices and some OB practices have midwives on staff.
Your own doctor or midwife usually attends your delivery and if not then a hospital resident (if teaching hospital) will do it.
You choose your own medical team.
You choose a pediatrician, not a GP for baby and child care. Smart to ask the hospital pediatrician for a referral or ask if the hospital pediatrician has an office him or herself. I chose to go with the hospital pediatrician, and luckily he was on my insurance preferred provider list. He developed a great relationship with my family. Sadly dead now but very fondly remembered.
When choosing a pediatrician, ask about how knowledgeable the office nursing staff are and whether the office prefers to deal with issues over the phone or have you drag children in. My office liked to weed out potential sick visits over the phone and saved us a fortune. They can do nothing for a virus and no point in going in -- you have to pay and you are wasting your time.

Insurance pays a proportion of your tab and pays separately for the baby. Usually 80 insurance/20 you. Insurance pays nothing if you don't have specific maternity coverage. Don't assume maternity coverage is standard with general health insurance.
Maternity insurance normally assumes well baby care/standard newborn nursery care but you need to check these details. Check also for coverage of care for a baby needing more than normal care.
Check this very important detail and apply for state coverage for pregnant women and newborns if you find you don't have coverage. Even non-citizens are eligible.
Insurance doesn't cover doulas iirc.
Check also that your insurance covers well child care (immunisations and routine visits for checkups) as otherwise you'll pay a lot.
You will get separate bills from hospital for you and the baby, a bill from the anesthesiologist, one from the doctor/midwife and one from the pediatrician, and also from any specialist involved in the care of the baby.
You will have to bring all your insurance info and identification with you to the hospital and check in with the receptionist no matter how much in extremis you are.

Epidural normal. Not as frightening as MN threads on the subject make it out to be, same goes for episiotomies.
(Nurses may be pushy because there is a window of opportunity after which a canula can't be inserted. No harm in getting the canula in just in case. Nurses may also be aware of how few anesthesiologists are available and may realise it's now or never. Plus, an epidural canula can be used in the event of a CS so you don't have to be knocked out. Wise to consider having it inserted therefore).
IV normal.
No gas and air.
Hardly ever an option for a water birth outside of major cities. If you want this sort of option look for a 'birthing centre' either freestanding or within a hospital.
Normal care assumes a baby will be whisked off to the nursery for observation.
You will be asked if you want to circumcise a son and it will be done by the OB/GYN or midwife if you want to have this done. It is usually covered by well baby/child care.

I had only two scans at most during each pregnancy.
Had several non-stress tests each time at the end as I was always late.
Doctors press for induction quite vigorously if you are late.
Care for conditions like gestational diabetes excellent (my midwife practice had a dietician on staff), but normally insurance doesn't cover testing supplies, neither the machine nor the test strips, and this can be expensive.

stella1w Tue 08-Jan-13 21:53:44

Had gas and air in uk for dc2 and it was terrible. Had doula in nyc and it was money well spent. Had fast delivery and they were demanding my ss number as i was groaning at checkin, in triage they said you are 3cm, i said check again, oops 8 cm, and they wheeled me in superfast! Also ypour ob might be happy with some stuff but refuse to go against hosputal poolicy so check that eg, no videoing.

berri Tue 08-Jan-13 15:58:23

Wow thanks for all the replies, wasn't expecting so many when I logged back in!

Sounds like I'll just need to practise being a bit more firm about what I want e.g. not being on my back if I'm not comfortable etc. Good tip about not turning up too early too, we are only 10 mins from the hospital so I might try to leave as late as possible.

I'm very happy with my OB (recently switched) but decided against going with a doula just because of the sheer expense!! I couldn't believe how much they cost! And if it's likely we'll have to pay a % of the medical bills too, I don't want to get landed with a whopper of the bill at the end of it all.

Stella I'll see if I can find that film, thank you.

I too was shocked when I heard there is no gas & air here - seems strange! I think you can request it at the dentist! But when I mentioned it at the docs when I was first pregnant they didn't have a clue what I was talking about. The conversation about a water birth was similar: Doc "what you mean you have a bath first? What? You give birth underwater?? Why would you want to do that?" grin

CityDweller Tue 08-Jan-13 13:42:48

Far more medicalised, is the short of it. My sister had both hers in the US (California). First in hospital, on back, monitoring, etc, and she found it all a bit traumatic. Second at home, which is considered pretty 'out there' in US - she had to find independent midwife and there were only 2 doctors willing (in the whole of the massive metropolitan area she lives in) to act as back-up obgyn should she need transfer to hospital. But she had v quick, v easy labour anyway.

But, I think it depends on your attitude as to whether you'll find it better than uk. My sis and I both have slight hippy/ natural leanings, but if you're someone who likes and finds reassuring medical intervention, etc, you'll prob like it more. I have to say that in the years I lived in US I found the medical care and treatment I had (not maternity related) excellent.

NatashaBee Tue 08-Jan-13 13:09:17

That's correct AmberLeaf - it's not licensed for use in labour I believe (although I think it can be used for other things).

orangetickle Tue 08-Jan-13 12:31:28

I've been told that epidurals are very easy to get and my doula has warned me that the labor nurses are often very pushy in 'suggesting' them.

Our insurance covers 100% of all costs - we chose this option over those which only pay 80/90% since I was already pregnant when we moved here and so we knew we could face huge bills otherwise. It means we pay more each month, but we think it's worth it, just in case.

I think it is possible to avoid the worst of the medicalised nature of the US, but you have to be prepared. Choose your OB/midwives with care, ditto hospital, and consider a doula to fight your corner/support you. Ask around - ask other moms about their experiences and go on recommendations. I think the key is not to be railroaded into what 'always' happens (eg at my hospital - putting you on an IV the moment you present in labor).

My doula also suggested presenting at hospital as late as possible. If you turn up in late active labor, they are obviously much less able to have you on your back for 10hrs, hooked up to monitors and a drip than if you arrive at the first contraction. Obviously depends on what type of birth you have, but this is my plan - leave it as long as (safely) possible and turn up literally just in time to push.

ihearthuckabees Tue 08-Jan-13 11:47:28

No gas and air, strapped to a monitor, and not allowed to do anything until my own OB arrived (which was several hours in). Lots of paper work, and I remember they kept checking administrative things while I was in active labour! eek. The main thing is to understand how to negotiate all the paperwork, how to find the kind of doctor you want etc, and which hospital you want to give birth in.i was a bit clueless, and ended up in a fairly dodgy part of Brooklyn, NY. In saying that, the doctors dealt fairly well with a complicated birth. The after care nursing was pants though. Don't be afraid to speak up for what you want.

Also, bear in mind that there isn't any after care home visits from health visitors. It's up to you to find a paed or GP and sort out all the vaccinations etc.

AmberLeaf Tue 08-Jan-13 11:37:46

I have no personal experience.

But I was shock to hear that Entonox [gas and air] isn't available!

That would be a deal breaker for me! grin

NatashaBee Tue 08-Jan-13 11:33:48

Our maximum deductible is 1k per person, per year, so our share of the cost was 2k. Make sure that the insurance cover tests/ circumcision/ which scans they will pay for though, I've heard of people getting hit quite badly with unexpected bills.

detoxlatte Tue 08-Jan-13 03:37:14

Also had dd in NYC last year. Cost wise total bill was around 55k, of which our copay was 10% (would have been capped at 10k had bill been higher). I was in labour for about 17 hours, then EMCS. Four nights and five days in hospital.
This was my first childbirth so nothing to compare it to, but I have had hospital experiences before. My observations are that they were quick and generous with pain relief, that the ante natal treatment was very laid back (up to you to do whatever research you want, organize whatever help you want etc).
Overall it was fine.

stella1w Tue 08-Jan-13 02:56:26

Had dd1 in nyc... No pain relief, they insisted on cfm, but no iv, just the port. I was flat on my back, but had doula and all went much much better than dc2 born in London! I don,t think they like you going overdue by more than a week. The film the business of being born is worth watching.

deleted203 Tue 08-Jan-13 02:46:06

Will you have to sell your first born child (or give up a kidney) to pay for the treatment? That would always be my fear in the States. A friend of mine who is from Minneasota said her brother broke his leg playing football in college. It cost him over £35,000 and he is still paying it off about 15 years down the line.....shock.

berri Tue 08-Jan-13 02:42:09

Thanks for the info smile

So you can register the birth with the British Embassy without getting a passport? Will look into that.

Also, do you mind me asking about the insurance - you said it was mostly covered - how much roughly did you have to pay out of your own pocket? Feel free not to answer of course! Just wondering whether we need to be saving, especially as DS needed 3 weeks in the nicu, could work out expensive shock

Yes I've been offered a c-sect too, I have to say I'm tempted as my previous labour was awful, but I'm hoping I can have an epidural this time & it'll be better....

I'm also thinking of doing a hypnotherapy course!!

NatashaBee Tue 08-Jan-13 00:24:00

Oh, and your baby will automatically be a US citizen, make sure you understand their obligations regarding tax returns and get them a US passport sorted, US citizens are only meant to travel in and out of the US on US passports. For that reason I haven't bothered getting DS a UK passport yet as he'd never use it, but I have registered his birth with the British Embassy.

NatashaBee Tue 08-Jan-13 00:20:52

Yes. Lovely hospital room to myself, room service from a menu, great facilities. No 'in-between' pain relief options though, so it was an epidural or nothing really, and they do like to keep you flat on your back so you can be constantly monitored, water births are not common here. I was warned that they would give me an episiotomy automatically and circumcise DS unless I made it clear I didn't want those options.

Final bill was 58k (mostly covered by insurance) because DS was in NICU for 4 or 5 days due to low blood sugar and oxygen levels. Make sure you know exactly what your insurance will cover.

Antenatal care tends to be done by doctors rather than midwives/ nurses. Personally I liked that and was very happy with how thoroughly they checked everything arse covering but I know some people would prefer a midwife led, intervention free birth which is considered quite radical here - I don't think home births are legal in some states and I don't think midwives really exist, or certainly are quite common.

C-sections are pretty common, I was offered one as I mentioned my mother was coming over and they thought I might want one to ensure the baby came at a convenient time confused

berri Tue 08-Jan-13 00:04:36

<waves> hello! Congratulations, not long to go for you!

I know what you mean about the scans, I think I'm on my 7th or 8th now and I'm only 23 weeks grin

But they are covering their arses quite a lot as DS (2008 in UK) was prem, so like you said they are being very intervention friendly already.

Has anyone talked to you about epidurals etc?

maximusminimus Mon 07-Jan-13 22:44:32

I'm about to... DD was born in London in 2010, and I'm due in February with #2 over here (NY).

The experience so far has been very different. Very much an attitude that you are sick unless you can 'prove' otherwise. So lots and lots of tests, scans at every single appointment etc. In a way this is good (I like being scanned regularly), but it's also quite difficult to go from this to believing that I can give birth naturally without shedloads of interventions.

There's also a huge choice of care providers: OB (doctors/consultants), midwives (who are often quite different to midwives in the UK), hospitals, birthing centers etc. People regularly interview care providers before registering with anyone, since attitudes towards care and labor/birth differ so much.

Actual labor care is also likely to be different. My hospital routinely puts everyone on an IV, uses continuous fetal monitoring etc unless you opt out (which I plan on doing). C-section rates are much much higher, as are intervention rates overall. As a result, we're using a doula this time around to try to keep things as 'natural' as possible.

Hopefully someone will be on soon who's actually come out the other side already!

berri Mon 07-Jan-13 17:28:31

I'm pregnant at the moment so DC2 will be born here. Just wondered if anyone had any experience of childbirth over here compared with at home?

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