Moving to the US when pregnant

[Lolly2803]

Hi, I have 18 month old twins and am currently 16 weeks pregnant. There is a strong possibility we will be moving the the US (L.A) in March which would mean I'd be around 7 months pregnant.
What do I need to do?!! How easy is it to have a baby in the US? Basically am after any advice or help etc! Also any ideas how much nursery is in the US? I assume they have nurseries like here in the U.K.? xx

Make sure you have top notch insurance!

Its easy if you have good health insurance - The first thing you need to do is check what policy you have and when it kicks in - in my experience most new policies provided through a workplace, often have a 30 day exclusion clause before you can claim / see drs in the plan

Its not like the UK where you go through your GP and midwife. You can choose who to go to, and you need access to a decent network and drs who have admitting privileges at a good hospital. You have a dedicated OB-GYN Dr (most of whom do pregnancy and non pregnancy women's health, smears etc) who will 'manage' your pregnancy and be there at delivery with you (or someone else from their practice will be)

It'll differ from state to state, but here in NY, its rare to see home births and midwifes involved unless the Drs work with them, due to potential insurance and malpractice issues if anything goes wrong (altho midwives and doulas can assist if you hire them independently)

Our OB and hospital choices here drive a lot of birth choices - 99% of people I know had a hospital birth, lots were induced (speeds it up so less time insurance pays for in hospital ) my Dr was vehemently anti forceps and didn't use them which is common I think, they also move to a c section quicker than the UK does (from what I've heard anyway)

My OB practice did scans every 3 weeks, and then in the last 4 weeks, one a week (not sure if this is usual - again will depend on what your insurance pays for) to monitor growth, position and anything unusual. In our case I think it probably saved DS's life / stopped there being major complications as they saw I had no amniotic fluid and whipped me straight to surgery

Average hospital stay (again depends on insurance) is 1-2 nights for regular delivery, 3 for a section. I had round the clock nursing care afterwards, was on a dedicated ward (split post and pre natal) which had its own facilities, even down to the fact the food choices were tailored to new mums and milk production. Seems a very different picture to what I hear friends have experienced in the UK - but its cost based!

Two random things to consider on top of this is 1) will they let you fly at 7 months 2) the baby will be a US citizen if born here, will that pose any complications for you

Re childcare; maternity leave isn't an option for a lot of women and people often go back nearly straight away , if you're 'lucky' you'll get between 6-12 weeks off.

This means that people have to sort out childcare from a very early age. Its like the UK in that its offered through child minders / nannies, in home daycares and then nurseries / daycares. Each state has different provision and laws for this so what's on offer and cost differs a lot.

Two years ago, we were paying $2200 a month for infant care (so 6-12months) in NYC and that was 7.30-4.30 /5 and that was with a corporate discount. The going rate for nannies in our area is $20-25 an hour, plus benefits (holiday pay etc) Prices here vary a lot based on location, hours and staff to kid ratios

That's so helpful thank you! I had a c section with my twins and so I'd ask for a c section in the US mainly so I could plan a bit and get my mum to come over when the baby was born to help with my twins.
I won't be working so maternity leave isn't an issue I'll be home until they all go to school. I'll get DH to ask what health insurance the company offers and will need to look into when it starts. I was under the impression you could fly quiet late in pregnancy with a Drs note? It would be L.A we would move to but as to what area again I don't know yet. Do I just contact the hospital closest and ask them for help do you think? Its all so daunting!!

To answer this question fully we would need to know about your financials!

In the US healthcare and wealth are inextricably linked.

Any doctor with sense won't sign you for to fly. They'll do a factual letter and it's the airline to decide if you can fly. I wouldn't plan to fly after 32 weeks assuming an uncomplicated pregnancy.

I think if I’m honest I would stay in the uk and then move out after the baby was born.

if you want a section, you generally (altho again, massive caveat based on ppl I know and our area) won't have an issue getting it

However, if you move out that late on, you'd basically need to be registering with an OB before you even arrive so they can get you in their practice / system and you'd need to be able to bring your notes / records with you.

LA and the surrounding area is MASSIVE so I'd be thinking about where you're likely to live and go from there in terms of hospitals and doctors. You can probably get good solid recommendations on local moms Facebook groups or similar for an OB (our local FB group is certainly peppered with requests for similar recommendations) and hospitals.

Worth noting that your nearest hospital might not be 'the best' and it's definitely worth looking for ones that have good reputations for birth and maternal and infant birth aftercare, as sadly, some places are terrible.

Also note that not all Drs have admitting privileges at each hospital - this basically means your Gp or OB is affiliated with a certain hospital (or maybe more than 1) and they are allowed to practice and see there patients there and nowhere else. If you get admitted to a place where your dr doesn't have this, they can't come and see you there

When you search for an OB you can ask or look for where they have admitting privileges, as this is where you'll deliver.

As a guide, on costs without insurance based on the original bills. My OB practice (so at the drs, not the hospital) charged $350 per visit to them, more for blood tests or additional scans. My straightforward section delivery was nearly $100k when they factored in surgeon, nurses, 3 nights stay, theatre costs, drugs, dressings etc etc. EVERYTHING is line itemed for expenses, down to the disposable knickers - its basically absolutely insane. However with insurance, this was all covered so we paid none of it

These insane costs are the reason good health insurance is a must!

I moved to LA, 7 months pregnant. I had a letter to fly although my doctor in UK was not thrilled I was flying and asked if I could get a boat there! When I arrived I holed up in a corporate apartment and watched lots of a documentary on some channel about having babies till our insurance kicked in. I had a good birth experience- c section. It was a little lonely after the birth not knowing anyone but I made sure I got out and made friends. There is a facebook group called BritsinLA so join that as they are a friendly bunch and there is also a selling group and a housing group. You will be fine. LA is a lovely place to raise little kids- loads of parks/ botanical gardens/museums. I enjoyed a good 6 year plus maternity leave and still miss that time now. No dealing with rain or cold mornings. I have made lovely friends here but do get bouts of homesickness now my kids are older and I ponder on how I will never see them around my family aside from during too brief holidays.

The birth will be far more medicalised and no one will visit you at home after the birth. In fact post natal care is shockingly bad. Any chance you can postpone until after the birth?

Thanks all! So helpful to read all different experiences. Yes there is a possibility we may be able to wait or maybe even get there sooner it just depends. Hopefully we will find out in the next couple of weeks and I can make plans. Likely to live in Marina Del Ray. Does anyone know this area? Our best friends have moved there very recently and it's close to where my husband would be working. I've never been though. Anyone know any Drs or hospitals in the area that are good or whether that's a good family area? Our friends don't have kids. This forum is SO helpful. Thanks so much.

Good point on post natal care. For DS, it was excellent, and in our state you have to resister with a pediatrician and tell the delivering hospital who it will be, and they won't discharge you without one. The pediatrician (kids GP who'll they'll be registered with and use til they're 18-21) does all the weight, height, development checks, vaccines etc

Post natal care for me on the other hand was non existent post discharge, apart from a visit to my OB to ensure my section scars were healing properly. There was no support otherwise (like a HV or similar) unless we hired and paid for a doula or similar.

Worth noting also that as a lot of people have to go back to work quite quickly (if they return) and as a result there wasnt the same network of NCT type groups to bond with, or drop ins etc. Might be local to where I lived in NYC tho.

Other thing worth flagging is how expensive baby related group stuff is - round us there was nothing similar to a church hall drop in coffee morning where you pay a couple of quid. It was quite baby class focused (so yoga, mommy & me classes etc), but it was all upwards of $25 a session and you had to book a block of sessions in advance - hard to plan for when you have a newborn on your hands!

OP, it's no good anyone giving you recommendations for hospitals and drs even if they live in Marina del Rey because you won't necessarily be able to get the same drs or use the same hospitals. You will be restricted to the drs and hospitals of the provider(s) on the insurance plan provided by your DH's workplace. For instance my employer offers two different plans with two different providers but we have to choose which one and we're then locked in to using only the hospitals and drs of that provider. So, say I chose Blue Shield, I have to use Blue Shield facilities, those who chose Kaiser have to use Kaiser facilities. Some employers only offer one provider and until you know who that is no one can recommend specific medical professionals or facilities.

You really need to get your DH to check into all of this with the company HR department so it can all be spelled out for you. You don't want to have a baby or indeed any kind of major medical requirement here without insurance because the bills will be astronomical. Even with insurance you could be looking at a several thousand dollar co-pay depending on the plan. Some employers have a 90 day waiting period for new employees before they become eligible for insurance benefits, most it's at least 30 days which might be cutting it fine if you're around 7 months when you get there. Me, I'd have the baby in the UK and plan to join DH later.

I'm an American but live in the UK. I would strongly suggest that you stay in the UK to give birth. This isn't because I think that American healthcare is poor, but because it is complicated. It seems like you are not familiar with the process, so that's another setback. Seven months is far too late to move and deliver there with everything that you'd need to sort out.

I will find out asap on the healthcare option we have. It's also great to get your advice and I will seriously considering where to have this baby and see how quickly the move could happen. So much to think about!

Another thing to consider is that the baby will be a US citizen and I think will then have to pay US taxes for life.
He or she will also be a UK subject not a citizen and so will not be able to pass on his/her British nationality to future children automatically.

What do you mean the baby would have to pay US taxes for life? What if we came back to the UK?

US citizens must do tax returns forever despite where they live. It is a massive pain. They probably won’t have to pay any taxes, but it is such a fucking headache, and often quite expensive to file.

... and it costs like $2000 to renounce later.

Not related to your original query re healthcare / childcare, but something significant you should be aware of

Your child, if born in America, will be a us citizen. Will have a lifetime of paying taxes to USA, face issue in other parts of the world where banks and financial institutions will not have ghdn as customers (all banking needs, mortgage, pensions etc). Research accidental American, FATCA, FBAR, citizen based taxation. You may seriously wish to delay your move two months.

On the upside your child will have a world of opportunity if they chose to live/work in the US. The US has a tax treaty with the UK so your child would have to make over roughly 100k a year before double taxation would become an issue. And yes they can always renounce.

You do really need a conversation with whomever will be your healthcare provider over exactly when they will begin covering you. I'd want a letter from HR stating that if there is any issue with coverage the company will cover the bill. You could be hit with a HUGE bill if this cocks up.

I can only second (and third, fourth, fifth) the advice to find out about the healthcare insurance. There's no point looking for OB-GYNs and hospitals before that: as people have said, all your healthcare providers will have to be in-network, ie your insurance will give you a list of practitioners and facilities you can use.

Do not get fobbed off by HR. Get everything in writing. Don't be satisfied with 'of course you'll be fine, we'll cover everything': you'll be in a really vulnerable position if you arrive out there heavily pregnant and they start messing around with your coverage. Double check things like:

• is there a waiting period before your insurance kicks in? (when we arrived in LA, we weren't covered until my husband went to his workplace and signed something, AFAIR)

• do you have co-pays? (fixed charges you must make each time you access healthcare, ranging from token to considerable)

• is there a deductable? (e.g. you have to pay the first two thousand of your healthcare expenses per year, and after that the insurance kicks in)

• are you specifically covered for pregnancy and/or other pre-existing conditions? does pregnancy cover start immediately, or is there a waiting period?

• are there any limits on your pregnancy coverage?

Also echoing what others have said, don't underestimate what an absolute headache the US overseas citizens tax situation is. It's completely mad and doesn't just affect high earners or people who work in the US.

Marina del Rey is nice, though!

Oh, and quite far in the future, but if your mother comes to help out with childcare after the birth, make sure she doesn't say that's the purpose of her visit when asked at the airport. Some unlucky people have been denied entry for that, because technically it's work (even if unpaid).

7 months is very late to be sorting this. Is it an option to have the baby here?

Thanks so much I will get DH to check the health care thoroughly and find out all the details. It may be an option to have the baby here we don't know yet which is why I want to try and see what needs to be done incase. Hopefully in the next week we will have more clarity!