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Living overseas

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Giving birth in the US vs UK?

92 replies

Fannibal · 20/01/2015 14:02

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 Smile

OP posts:
AmericasTorturedBrow · 20/01/2015 21:19

although another positive to USA is you can cherry pick your hospital, OBGYN, midwives etc...if your insurance is PPO

claraschu · 20/01/2015 21:35

Everything depends on your insurance plan. We didn't have to pay anything at all with our US insurance.

GenerationX2 · 20/01/2015 21:51

Check with the HR Benefits people that your pregnancy will be covered and will not be considered a pre-existing condition which would preclude you from claiming any benefit.

Different states have different laws about this so make sure they provide you with the SPD (Summary Plan Description) for the benefit plan. Also get a number for the carrier and call them directly to confirm everything the internal contact tell you.

One thing I have learnt is you need to be your own advocate and you need to get everything in writing.

mathanxiety · 20/01/2015 22:14

I had five babies in the US in the 90s and 00s, four with an OB/GYN practice and one with a MW practice, and in two different hospitals. I recall charges similar to HerRoyalNotness's even back then.
I don't recognise Jackieharris' or LemonDrizzle's description of maternity care at all.

I had one experience of stirrups - after delivery - to allow a good angle for the stitching I needed. I had one epidural -- I would have liked to have at least one other but that hospital was overstretched on the day. One baby came too fast to even sign papers, and the last two I just said what the heck and proceeded without any pain relief bar a shot of phenergen.

It has also been my experience that the care you receive has nothing whatsoever to do with the quality of your insurance. I have given birth with private insurance and as a public patient, and there was no difference in care at all. Private rooms were allocated according to availability in the hospitals I was in, with no wards. Non private rooms had two beds. Both private and otherwise had ensuite bathrooms so clean you could eat your meals off the floor. Food was great and plentiful and nurses were lovely.

No gas and air, but do take advantage of having the epidural cannula put in when offered. It doesn't hurt and then it's in place if you decide to have the pain relief. It is also in place if you wind up needing an emergency CS, and you can be awake to see the baby emerge as they use the cannula for partial anesthesia. There are no medals for endurance.

You may have a drip inserted in the back of your hand or wrist as a matter of form, as it may be hospital policy to put women on fluids for labour. The drip can be used also for pitocin and for pain relief/medication for relief of nausea as labour progresses, and also in case you need a transfusion. I recommend your wrist instead of the back of your hand -- and insist they use novocaine to numb the area before inserting the large bore IV needle.

If you are overdue you are more likely to be induced than to be booked for a CS. How long overdue you go depends on the doctor and of course if any problems are detected you will be advised to take the plunge asap. The last month and any overdue weeks involve lots of testing.

A lot of American hospitals concentrate on good nursing care in the maternity area and this makes a huge difference. I have only my sister's horror stories from Dublin to compare with plus some stories from friends in the UK, but my perception is that my US experience of post natal nursing care left theirs in the dust.

If you move at 29 weeks you will have plenty of time to find neighbours or babysitters to take care of your older children while you are in labour. When I was having DD2 I had DD1 and DS at home and got a teenage neighbour to stay with them for the day (a Saturday) but I had two other neighbours who said 'Just call me and I'll drop everything and take the kids in for the day or night' and they meant it..

Insurance:
Make sure you have specifically maternity and newborn insurance, not just regular health insurance with 'family' coverage as they are often separate.
Find out your deductible. 20% is an average percentage iirc.
Ask if PPO (preferred provider organisation iirc) or HMO (health maintenance organisation) or EPO (exclusive provider organisation). PPO gives you more freedom to choose a provider from an insurance company list or from outside the list. Staying in the network/list means you pay less/more is covered by the insurance company.
HMOs have doctors that are like UK GPs - they refer you to your maternity care provider or other specialists.
EPOs are a mixture - you have to stick to the list but you don't have to get a referral.
You need to find out what the out of pocket limit is too, per individual and for the family, and whether that can be set against the deductible and out of pocket limit for the (often separate) maternity coverage if they are separate.
NB: Ask if maternity coverage will cover a pre-existing pregnancy.

Fannibal · 20/01/2015 22:28

Definitely not classed as a pre existing condition in my case as included on DH's group policy.

All the other stuff though I'll have to find out. They have said I'd be fully covered but don't have it in writing as of yet.

Having the baby here not an option really as it would mean our family being separated for over two months and we really really don't want to do that. Plus I really want to avoid flying with a newborn.

OP posts:
Want2bSupermum · 21/01/2015 03:22

If your DH works for an employer with more than 150 employees they can't exclude pregnancy. However get the contract and read it. Call the insurance company and ask them too. Only after doing both would I consider moving over as you don't want that medical bill.

I've had 2DC here in the US and I have been very happy with both births. I had an EMCS with DD after a 22 hr labor where they induced me due to having preeclampsia. They tried everything to get me to deliver vaginally but it wasn't happening. DS came along 18 months later and a CS was scheduled for 10 days past my due date. He came in at 10lb6oz.

Post delivery care was amazing both times. I loved having my own room plus a nursery if I wanted to sleep as DH was at work or home with DD. I had my laptop so spent hours on skype showing off the baby. Oh yea hospital had awesome wifi!

After hearing what my friends have been through in the UK I would have my DC in the US every time. Another bonus of the U.S. system is that you have the option to have the same team care for you through your pregnancy and deliver your baby. This is what I had and am very thankful because they got to know me over both pregnancies. If I have another I have the choice to have the same doctor again.

mathanxiety · 21/01/2015 05:21

That last detail is one I really appreciated. I had the same doctor group for four pregnancies and also four miscarriages. The continuity of care meant a lot. (This is nice if you decide to have another baby in the US)

TychosNose · 21/01/2015 07:51

It really depends where you are in the country and which hospital you choose.
If you have good insurance you might be able to choose an amazing hospital and not have to pay anything. I had 1 co-pay of 20dollars total for my birth. That included all the antenatal appointments (weekly if I wanted), also the birth and all the aftercare and a newborn pack (including a very nice breast pump). The hospital was one of the best for woman's health in the world. Far lower cs rates that the hospital I had ds in in the uk. A nurse visited me at home on days 3and5 post birth (unlike here - I had to drive to the hospital 30mins each way 3days after giving birth). No syrups in sight! No internal exams except to check I was dilated and that was at my request. (though did get one when I went for a smear test there once - bit surprised. Unrelated though).
Another bonus of the U.S. system is a paediatrician and paediatric nurses on hand to help with your newborn. Probably since its your third you'll be fine but for my first, who was CMPI, having decent medical care for my baby was fab.

Fannibal · 21/01/2015 09:28

Thanks all. I will definitely be clearing up the insurance issue tonight.

I'm just so stressed about all of it. Waiting on the visa approval now (l1b) and am terrified we'll be rejected.

It's all taking a bit of a toll Sad.

OP posts:
Bue · 21/01/2015 11:11

Certified Nurse-Midwives (CNMs) exist and are legal everywhere in the US. There are much less common, but available. They do mostly hospital births. OP, coming from the UK, you might prefer having a CNM provide your care instead of an OB, if that's an option where you will be.

It is Certified Professional Midwives (CPMs) who do out-of-hospital birth, whose status varies by area - in some states they are illegal, and they are not as well integrated into the healthcare system.

TychosNose · 21/01/2015 12:36

It is stressful isn't it?
I know you haven't asked about this but I had access to excellent mh care in the states. I suffer from bipolar and anxiety and never really got treated properly until moving there.
Again of course it depends on insurance and location, but it might be worth looking into finding a psychiatrist if you would like help with your gad.

AmericasTorturedBrow · 21/01/2015 15:30

I had the same team and same midwife for both my births in the UK too FYI

It's tough, I think so much will be dependant on your hospital and team in either country. But if you don't want the family Seperated and you're leaving at 29weeks then it sounds like it'll be the Us anyway?

Fannibal · 21/01/2015 16:08

Yes I think it will have to be the US now regardless if the visa goes through. I just thought it worth preparing for any major differences in care. Maybe I'm being a bit silly going over so close to the baby coming but I have a few mh issues and I really don't want to be away from DH for that amount of time if I can help it. I think the DC's would struggle with it as well.

We will be moving to CT and it seems like the hospitals are good around where we're moving.

If my insurance covers everything (more or less) is it then left up to me to call hospitals and try to find an OBGYN etc to oversee my care, or will the insurance company give me a list of doctors they cover etc?

That's interesting about the MH care Tychos. I don't feel like I've ever had very good treatment in this country either. I do think I'll be trying a proper psychiatrist once we're over and settled.

OP posts:
HerRoyalNotness · 21/01/2015 16:20

I found my OBGYN as was having some problems with menstruation and asked other expats for a recommendation.

She sorted out the hospital admission as she had privileges at a certain hospital, as most Dr's do over here. They contract to a certain hospital and can't work at others. I ended up in the main branch of the hospital at a different location where she didn't have privileges and had my care transfered to a different team. She did call me frequently to see how I was getting on, and visited me on the weekend to check up on me also. I'm really glad I found her, she has been wonderful.

mathanxiety · 21/01/2015 16:43

You will find your doctor through the insurance company list even if the insurance is PPO insurance (better chance of insurance paying what they say they will). You check when you call each doctor that he/she has admitting privileges at the hospitals you are interested in. When it comes to hospitals, distance from home and existence of traffic bottlenecks such as a bridge or a ground level railway with gates that go down for long stretches to allow freight trains through are factors to take into account. After accessibility is sorted out, university/teaching hospitals are usually good though you should research hospitals' reputation for post partum nursing care online too.

You will also need to find a pediatrician practice to register your older children and the baby with. What I did was get myself on the books of the hospital pediatrician who checked DD1 when she was born. He was a professor of pediatrics (university hospital) and had a thriving practice. He had admitting privileges with the hospital obv. When looking for a pediatrician practice, ask about size of practice (bigger is better), nursing staff turnover (should be low) and whether problems can be dealt with competently over the phone or if they will have you come in for every sniffle and then pay. I have to put a very good case over the phone with my pediatrician for them to agree to to a sick visit. Most of the time I have had a decent and free diagnosis over the phone and great advice. Imo this is preferable to camping out in a germy waiting room and wasting an afternoon at an office where they will check your child and then send you home with 'It's a virus, keep up fluids and dose with Tylenol' and a $110 bill.

mathanxiety · 21/01/2015 16:44

Or if you like you could find a Family Practitioner (again via your insurance company) who would handle your family's healthcare apart from maternity care. If you have a HMO then this is more or less what you will be doing.

bringmejoy2015 · 21/01/2015 16:50

This reply has been deleted

Message withdrawn at poster's request.

Want2bSupermum · 21/01/2015 17:03

Where in CT - Fairfield county or towards New Haven? There are some excellent options in and around the area.

Here in NJ I had both DC at St.Barnabas in Livingston. I can't speak more highly of the hospital. They have a natural birthing unit with water baths etc. The obn didn't like the position of DD during my 22hr labor and had the chiropractor come over to try and manipulate me/DD to encourage things along. Half an hour later the obn had the acupuncturist arrive. We have amazing healthcare coverage and total cost for delivery was $50. Stay in hospital after was $500 a day.

My births were NOTHING like what people MN here talk about 'American' births being like.

TranmereRover · 21/01/2015 17:05

Consider the citizenship very very carefully - not just for the hideous tax burden that Bringmejoy refers to above, but also in the event that you and your husband disagree on whether to remain in the US / divorce, it is extremely difficult (& in some states damn near impossible) to remove a US citizen from the country without the father's consent. (i have a family member living in hicksville by court order unless / until she marries an englishman - in short supply in hicksville - following her divorce from a fellow Brit who wishes to remain in the US. She is unable to bring her children back to the UK without his consent, which he isn't granting)

Fannibal · 21/01/2015 17:11

The Stamford area, Stamford hospital looks quite nice?

How awful for your friend Tranmere Sad.

luckily I don't fear ending up in that situation. We have two DC's already and I trust my DH implicitly. Can't our soon to be arriving DD renounce citizenship if she wants to at 18?

This is all making me a bit scared. I think I've sort of always assumed it wouldn't happen so didn't think it through enough and now it's happening and happening quite quickly!

feeling very Blush that I didn't know a lot of this stuff.

OP posts:
Canyouforgiveher · 21/01/2015 17:16

I have had 3 babies in the US and a lot of what is spoken of on this thread as standard US care was not my experience at all. I went overdue on my first and had a difficult delivery because my doctor was highly reluctant to do a c-section.

A lot will depend on where you give birth. Big teaching hospital compared to small rural hospital will be very different. My experience on the east coast in a major city was:

Consultant-led care far more likely than mid-wife
Breastfeeding highly encouraged and many US mothers consider b-feeding for one year the norm, even after return to work. Lots of support in the hospital for b-feeding
Epidural the only real anaesthetic offered - have never heard f TENS or G&A here but that might just be me.
If you have a son, you will be asked if you want him circumcised in the hospital (that may be waning now, but circumcision was absolutely the norm for years)
one night only stay in hospital for normal delivery
Your baby will be seen by a paediatrician for well-baby visits, which are scheduled right through the first year etc. My children still have a yearly well-child visit paid for by insurance.
You will have to register the birth in the hospital
Won't be allowed take the baby from hospital (by car) unless you have a properly fitted car seat - nurse/midwife will inspect it.

The single most important thing is to check your insurance cover very very carefully. Do not even consider giving birth in the US if you do not have good insurance cover for yourself and your baby.

Despite a very hard first delivery, I found the experience very supportive, especially around b-feeding.

SoonToBeSix · 21/01/2015 17:20

A US passport is very valuable you shouldn't give that up on your dc's behalf it should be their choice.

SconeRhymesWithGone · 21/01/2015 17:31

I am pretty sure that only the citizen himself/herself can renounce US citizenship. A parent can't do it on behalf of a minor.

mathanxiety · 21/01/2015 17:47

If your DH's visa isn't a green card or a path to full citizenship the question of being forced to stay in the US after divorce shouldn't arise as neither of you will be able to stay indefinitely. Citizenship claims of parents based on their child's citizenship can't be made until the child turns 21.

The tax burden isn't as horrendous as painted. The US and UK have a tax treaty and UK taxes paid are offset against any the IRS may compute. I believe the threshold for personal income tax payable in the US by Americans residing in Britain is pretty high.

TheWildRumpyPumpus · 21/01/2015 18:13

I had DS1 in the US 7 years ago and found it a great experience on the whole. Most of the negative posts I read on MN about US births are from people who haven't gone through it themselves.

I had DS2 in the UK and it was nowhere near the level of care and comfort.

As long as you've got the insurance thing sorted, don't worry about the actual birth anymore than you would in the UK.