Giving birth in the US vs UK?

[Fannibal]

DH, the DC's and I will be moving to the US at the very beginning of April (visa approval pending)

I will be 29 weeks pregnant with DC3 at this time.

Does anyone know how different the whole process of labor/delivery is in the US, anything I should be aware of or things they don't offer in the US that they do here? Obviously aside from free health care!

I'm really nervous about it, my biggest fear being my sister not flying out in time and having to give birth alone as there will be no one else to look after the DC's.

Any advice, experiences would be really appreciated

What is your insurance situation? What does it cover and do you have any crazy deductibles? That's the first thing to look at.

Apparently (from what I have gleaned via the medium of MN) they don't have G&A in the US. I loved my G&A and got through 3 labours on it - I couldn't imagine not having it. Not sure if that's an issue for you though

You also need to consider the citizenship question. If your child is born in the US, s/he will automatically acquire American citizenship.

Not sure that's true anymore Scone..? Probably wrong!
I once read a quote that said something like " having a baby in France is all about the mother, in the UK it's all about the baby and in the US its all about the insurance. "
That's all I know! Also, from the very scientific sample of the Mindy Project, the doctors in the think midwives are basically witch doctors..

US hospitals tend to monitor labour more closely, so you tend to go in to hospital when contractions are 5 minutes apart and have a foetal monitor on your bump, which is a bit more medicalised than things are over here. Prenatal care is often overseen by a doctor rather than a midwife, but this is something that would depend on what is available in your area. In the US hospital, they also tried to vaccinate one of my babies when he was one day old, but that was 17 years ago.

I had dd in the US and ds in the Uk.
No gas n air in the US. Pain relief is a bit all-or-nothing. The nurse encouraged me to have an epidural as soon as I was in active labour in the US.

It really depends on the hospital in the states. There's probably not many more generalisations. Most people have an obstetrician but you can have a midwife if you prefer. There are also plenty of midwife led birthing units, depending on where you are and your insurance. If you have an ob, a nurse will stay with you during labour and the Dr just rocks up for the birth, unless complications or elcs.

Many hospitals in the US still take newborns off to nurseries too. Not sure if that happens in the uk. You might need to be firm if you want to keep baby with you.

I had a great experience in the US. Lovely nurses. Every nurse in the post-natal ward was a bf peer supporter, I co-slept, could order shit loads of food (nearly starved in the uk two bloody slices of toast? I needed a 2000 calorie meal after giving birth).

Dads can usually stay in the hospital with you too (dh had a fold-out bed) Maybe look into childcare when you get there in case your sister doesn't make it in time? Or check your insurance cover for a home birth?

Ah yes - baby will be a U.S. citizen. Can be dual nationality though. Easy to apply for British birth certificate through the embassy in wash dc.

You also need to register the birth before you leave the hospital. This means you need a name for baby before you can go home normally. Might vary by state.

Yes, like most developed countries except the uk, in the us baby Gets a hep b vaccine straight after birth. You can refuse if you like of course.

I think the only exception to US birthright citizenship applies to children born to foreign diplomats.

Yes, your child will be an American citizen but dual nationality is not a problem. It could create an issue in the future for your child's children if they are also born abroad.

Strep B is also routinely tested for in the US, unlike the UK.

Thank you for the replies everyone.

Insurance all being sorted by DH's company but I have a call with them later in the week to see exactly what that will cover etc. They seem to think I'll be covered well though so not worrying too much over that side of things (yet!)

It's all a bit rushed and I have general anxiety disorder so I'm beginning to panic a little bit about the whole situation. It's an amazing opportunity for us though.

Just be sure that everything will be covered and that you have all that in writing. Come back and post after you talk with them to see if any Americans can flag up anything problematic. Don't assume anything is covered unless it's in writing! eg make sure antenatal, labour and delivery and postnatal are ALL covered.

My sister is a midwife, and I hear things are really quite different.

It used to be common practice to give a stearate preparation of prophylactic erythromycin to newborns born vaginally, in case you had chlamydia. It is swiped into their eyes at birth, and is a bit of an irritant. Historically they used to do this whether you had an STD or not, but I'm not sure what they do currently.

They are usually VERY reluctant to let you go over term. They'll book a CS for you, unless you strongly protest.

It's very rare to give birth at home.

Midwives don't really exist. You also have an OBGYN rather than an obstetrician.

Epidurals are very common, and encouraged.

Babies are often taken off to a nursery, you may have to insist if you want your baby to stay with you.

Hope that helps, and good luck!

Thanks all.

Any idea what specific questions I should ask about health insurance, just to make sure it's all covered. They're a good company and DH has a good relationship with them but I don't want any surprises. So anxious about the whole thing!

I think scone is right about citizenship.

I haven't lived in the US for a long time but here's a guess at least:

Make sure that all antenatal and postnatal care is covered, in addition to everything related to delivery and hospital care

Your deductible is how much you have to pay before the insurance kicks in, find out what this will be

Your co-pay is how much you have pay per visit even after you have met the deductible, see what that is for both doctors and hospitals

Make sure there are no waiting periods or anything else that will disqualify you from being covered

The most important thing is to see something in writing, don't rely on what they tell you over the phone.

Try not to worry about the actual care you will receive, it will probably be very good especially if you have good insurance, you just don't want to end up paying a lot of money unnecessarily (you can negotiate for better coverage before you go if you need to).

Honestly I'd come back to the uk to give birth!

Some people may be 'fans' of the U.S. system if that's all they've known but for all its faults I'd rather 100 Nhs births than 1 in the us.

It depends what kind of birth you want and what your obstetric history is.

They have dangerously high c section rates. It's all much more medicalised than here- frequent internal vaginal examination all through pregnancy, for example.

Pain relief is epidural or nothing. It is much more common to have continual fetal monitoring and be expected to lie on your back throughout with your feet up in styrrups.

Of course all this medicalisation costs more and leads to more complications which cost even more which is why there are stories of people with insurance who still face bills of thousands. If your baby ends up in nicu the bill could be in the tens of thousands.

I found the terminology a bit complicated. OBGyn's, Preferred providers, deductibles etc, etc. It might be worth familiarising yourself with the insurance policies.

I found giving birth a bit more clinical in the US but much the same as the UK. Everyone was friendly and helpful but it felt a more disjointed service than the UK.

My DD was born very quickly and it did seem like the staff were more concerned about getting me to sign bits of paper than dealing with the issue of DDs impending birth. I wasn't in position to sign the bits of paper - eventually they got my DH to sign on my behalf.

One of the things that bugged me was that while the nurses were trying to be encouraging I got to the point where I was ready to deck the next person who said Good Job to me

I thought I would try and make some friends before the birth through joining a Lamaze class. It was a bit of a disaster as I found it too 'American'. Everyone was sooo sincere and serious about it all. It wasn't for me. I would have much preferred a UK type baby group. I'm sure they exist in other parts of the US but I couldn't find a local one in LA.

After the birth I joined a baby and toddler group which I also found to be very American. There was a constant steam of 'good jobs' and 'wow, that's amazing' Talk about PFBs . It did feel surprisingly foreign iyswim
Anyway, even though it was a bit gushy I settled in perfectly well and made some nice friends.

I've lived in a number of overseas countries and I still find it suprising at how different the U.S. is to the UK.

I had two babies in the US and a lot of the things LemonDrizzle and JackieHarris said were definitely not true for me. Both my sons were 2 weeks overdue, and one was induced when he was still not coming at that point. At no point did anyone suggest a CS.

Both were vaginal births, no stirrups at any point, epidurals were offered when I had been in labour for over a day (epidural was not pushed in any way, and was GREAT when I had it), No one tried to take the babies to a nursery unless I wanted that (one baby slept in the nursery as I had been awake for 48 hours, but was brought to me as soon as he woke). I had intermittent foetal monitoring, which was annoying, but they were flexible about it and I had a hospital based midwife with one of the babies.

Home birth is very rare in the US, and I was not offered G and A, though there are alternate forms of pain relief (other than epidural).

My birth experience in the UK was great because I had access to a tiny cottage hospital with a birthing unit and a great midwife, but that was because I am living rurally whereas in the US I was in a big city.

On balance, I preferred my experience here, but only because of the specialness of my tiny birthing unit. I have heard plenty of horror stories from people in busier places.

The US tends to be more medicalised, but there is a lot of variety, and I think many people exaggerate this aspect of the system over there. Since you have already had several children, you will be able to explain what you want. I really think that unless you are very unlucky, you might have a fantastic experience: very cushy!

I had a normal birth too. Mostly on all fours with only a little fetal monitoring. I only had gas and air as it was a quick birth. The baby wasnt taken away at any point.

It didn't feel any more 'medical' than the UK. As Claraschu says I think it will help That its your 3rd child.

re: the US Citizenship thing, might want to look into how DC gives that up before turning 18 as tax implications thereafter

I had an EMCS recently in the US. I have to say the staff were absolutely fantastic. I was in a state, as you can imagine, and everyone was reassuring and kind. The care was amazing. I couldn't fault it at all. I happen to have the bill from hospital here, and the Csection itself was $12k. Total bill I have from hospital was 48k for a week (I was in for other complications). But I only have to pay 1k of that.

I'm still waiting for another invoice from hospital and the Dr's as well. Here the hospital staff are only the nurses and admin. The Dr's that work there are then consultants and charge directly to the patient. Then there are separate costs for all the medical equipment, lab testing and drugs administered.

If I had actually had my planned VB, my OBGYN charges 2700 for attending the birth and 2 postnatal appts. I only had to pay 10% of that cost as my copay. The hospital, and any other dr that may have had to attend would then bill separately. She charged another 300 or so if it was a C-Section.

As it was she didn't have priveleges at the hospital I was in, so had another OBGYN look after me there.

Main things to check are the co-pays. My DH's insurance here has an out of pocket hospital visit of $5k per family member per year. I think mine is less, but I haven't checked it out.

If you are moving to the Houston area, I can recommend my OBGYN wholeheartedly.

Midwives most certainly do exist in the US. My neighbour is training to be one. They are just less commonly used, that's all.

OP, choices really do vary depending on where you are and what insurance you have. If your insurance is normal to good, you'll probably have an excellent experience here - they have lots of choice and you can go to a birthing unit, or a hospital, or whatever else you have in your area, if it's covered. You'll need to ask them though and not us! Lots of silly horror stories about US medical care from people outside the US.

The practice of midwifery is primarily governed by state law in the US so what roles they play will vary by state.

Hmm, I was pro-natural birth when I was pregnant with DS and would have been a bit snooty about these American practices. When I gave birth last year though, apart from the nursery, the UK hospital I had to give birth in sounds just like what is being described, right down to the stirrups.

When various complications in my labour occurred I was given an epidural, and actually, it was amazing. If I have a labour which isn't textbook normal again then I would definitely want one.

The flip side to all of this "oh they give epidurals a lot in the US" is that if you actually WANT an epidural, in the UK you might not get one because there is usually limited anesthetists available in UK hospitals (and other women needing EMCS's taking priority), I often hear of women not being able to have them.

I also had a bad experience with my midwife care, so actually reading this thread I wouldn't really mind at all if I had to give birth in the US as long as I was sure my insurance covered me fully.

I would personally stick to UK - based on the fact that you've given birth before so know one "system", and that you have an anxiety disorder. We had the option to move to the USA before or after birth if DC2 and I went with UK birth because of what I initially read as the differences between the two countries - namely over medicalising and having to wrap my head around a totally different system. But then I had a brilliant home birth in the UK which I would have struggled to have had here and I, for lots of reason, really didn't want to go to hospital unless it was absolutely neccessary.

FWIW I live in California and know Brits and Americans alike who've given birth here. In our small area there are three hospitals, one of apparently horrible, one is very into OBGYN's being in charge and booking in C-Sections early, the other has midwives attached so is most like a UK experience. But midwives are still optional, OBGYN holds all control and power and pregnancy is treated like an illness. It is a bit of a lottery, not dissimilar to the UK.

No Gas and Air here but if you have a great insurance company you might end up with a lovely private room and very good food and comfortable beds.

First step is to find out your deductible, as a PP said. You will be out of pocket regardless, how much is important - your birth will not be "free". Most of my friends who have had complication free births, easy labours with no issues at all AND great insurance plans have still ended up having to cover $2-3K (insurance covers 10x that to put it into perspective). I know one person who had a homebirth and had to pay the whole thing because insurers wouldn't cover it at all.

The USA has the best healthcare in the world - if you can afford it.

It also depends how organsied you can be, understanding the system, making the move, and preparing for birth itself. For me it was overwhelming so I just made it as easy as possible for myself. My only other very small consideration was one DC would have dual citizenship and the other wouldn't.