As my regular readers will know, I’m 38 weeks pregnant with our third baby, who will be born an American. Our two daughters, now aged 5 and 3, were both born in London. A lot of people have asked me how the experience compares between the cities.
While no two pregnancies are ever the same, I thought it worth a blog post as it’s quite a different experience, and other British families moving here may find themselves in the same boat.
Here are the main things that spring to mind:
- Health insurance is king. No NHS here, people, it’s all about what your health insurance will cover. On getting three positive pregnancy test results (got to be sure), literally our first call was to our health insurance company to get a list of local obstetricians (OB) that they would cover. I checked out their websites and proximity to our home, and picked one.
- Remember the quality Katherine Heigl film, ‘Knocked Up’, which showed endless OB interviews and then a last minute panic when their chosen doctor was out of town for the birth? This really spooked me so I asked about it. My health insurance would only cover one initial consultation, meaning I couldn’t spend ages shopping around unless I had serious misgivings about the first. And as for the birth, the system – at my OB at least – is that you see the same doctor for the first two trimesters, then after that you see a different doctor each time. The theory being that at least this way you’ve met all the doctors at least once and won’t get a surprise when you go into labour.
- No midwives here! For some reason I found this really hard to get my head around, as it’s ALL about the midwives in England, isn’t it? At every appointment, you’re seen by a fully qualified OB specialist (though they get nurses to weigh you and take your blood pressure and urine sample before they breeze in the room). A nurse will also help you to deliver, apparently your doctor only comes in for the final push…
- There are a lot more ultrasound scans here. In the first trimester alone, I had more ultrasounds than for both T and B’s entire pregnancies in London. Not that I’m complaining, it was actually v reassuring to have so many checks, especially as the ultrasounds were done at my OB’s office so I didn’t have to trek to the local hospital.
- There’s also a lot more blood tests, for an astonishing number of diseases and chromosomal abnormalities. This was actually quite stressful since our health insurance did not consider the vast majority of these as ‘medically necessary’. This meant we had to choose whether to pay the $400-900 per test, or decide to skip it. We tried to loosely match what the NHS would test for, and trust in that. It felt v alarming to have to refuse tests earnestly recommended by the OB, but at those sorts of prices, you really have to draw the line somewhere. That said, we did find that some of the blood test laboratories would offer a reduced bill if you told them you were paying personally, rather than through insurance.
- Your OB will take really great care of your health. I got a flu vaccine several months before it was available at the Pediatrician for the kids, and they gave me all sorts of tests throughout including group B streptococcus last week.
- Our OB is affiliated with one specific hospital, and that’s the one you have to give birth at. You have to pre-register with your expected due date, and then hope that they can handle your health insurance. (see this blog post for my accute irritation about being kept standing for more than half an hour on swollen, painful legs while they insisted they’d never heard of my European health insurance and made me sign various forms promising to pay them myself). I’ve now called the hospital’s OB Pre-Admitting Specialist (yes, apparantly that’s a thing) three times to make absolutely sure they’ve now sorted this and are not going to make me go through that again when I’m in labour *she types with eyes narrowed ominously*. For our experience rushing B to an out of hours emergency hospital, where they again made four phone calls about our insurance before asking us what our daughter’s name and medical issue was, click here.
- The hospital organised a 90 minute PowerPoint presentation from a specialist nurse, on what to expect when you go into labour. It was unbelievably thorough, and raised all sorts of things that hadn’t occured to us. For instance:
- Call your health insurance in advance to check if they will cover any anaesthetics, as these are not part of the main hospital costs. Eh??
- Choose a Pediatrician for your newborn baby, and check if they “have privaleges” with the hospital. Ours does not, so cue another call to health insurance to check they’ll cover the hospital’s own inhouse Pediatrician
- Make sure whoever will be in the labour room with you has been fully vaccinated, especially against Tdap (whooping cough) and rubella
- When you think you’re in labour, the protocol is to call your OB’s hotline and speak to the doctor on duty. If they agree you’re probably in established labour, they will call the hospital to alert them you’re on your way, while you scrabble around sorting childcare for your older children (at least in our case) and frantically re-checking the hospital bag you’ve had packed and ready to go for two whole months.
- Once you get to your hospital, you’ll have to show photo ID, a copy of your health insurance, and sign shed loads of paperwork before they admit you. This cannot be done in advance as they need it signed and dated at admission, but they have been encouraging me to read all the forms in advance (haven’t bothered yet, I probably should).
- Once the baby’s been safely born and the cord cut, your birth partner is encouraged to rush to the department desk and put your name down for a private room (that’s if it’s covered by your health insurance, naturally). You can also tick a box saying whether you want your baby to sleep in your room with you or not! I’m actually quite excited by the thought of a private room. With both T and B I was in a large maternity ward with just blue curtains separating you from the 10 or so other mothers and babies. I remember listening to an extremely peeved new mother calling all her friends and family saying “It’s a boy! They told me it was going to be a girl! What am I going to do with all the pink sh*t now??”
- You get to stay in hospital a bit longer than with the NHS (I was home in time for tea after having B in the small hours). Depending on what time you deliver, you will be discharged at precisely 10am two days later; or three if you had a c-section. You will be discharged by your OB, but your newborn’s discharge is handled by the Pediatrician.
- All the medical staff will keep asking you if you plan to have your newborn son circumcised. Apparently it’s quite standard here.
- The hospital will organise your baby’s birth certificate, so you need to agree on the the name PDQ!
- There’s no equivalent to London Transport’s fabulous ‘Baby on Board’ badge, so I’ve just worn it anyway and waited for the penny to drop when people stare at it. Especially necessary during the winter months when I was encased in the biggest Eddie Bauer coat available, and they couldn’t see the baby bump.
- Then there’s the more emotional, less medical side of being pregnant in a new country away from your family. No grandparents, uncles, aunts and godparents you can ring and beg to come and help out with the kids’ supper-bath-bed routine that gets more and more exhausting in direct correlation to your inability to bend. Also, with both T and B I was working in my PR agency job right up to 38 weeks, and then went on a year’s maternity leave. Having given up the job when we moved here, there’s this strange sense of just chugging along until the baby makes an appearance. No more excited counting down the days left in the office for the next 52 weeks allowed under British maternity leave laws… It’s a big relief to be spared the American maternity leave laws which are astonishingly stingy compared to the Brits’. Here, new moms are allowed 12 weeks, unpaid, as long as they’ve worked at a company larger than 50 employees for at least a year. Perhaps unsurprisingly, you sometimes see the tiniest babies being dropped off at daycare by tearful new parents. I found it hard enough going back after eleven months, I can’t imagine how tough it must be to leave such a small baby.
That’s all that springs to mind. I’ll report back post-birth (edited highlights, naturally). It goes without saying that all these points are very much my own personal experience, and that different women with their own pregnancies, doctors, hospitals and health insurance plans will all have their own experiences. I’d be interested to hear other expat parents’ stories of their overseas pregnancies. How did they compare?
This week’s Highs & Lows:
- T has really stepped up and started helping me out more. Never the most charming in the mornings (ahem), I’m really struggling to keep it together while getting the girls up and out by 8am to be in time for school. This morning alone, T defused two Major Mummy Meltdowns. I was astonished, and so grateful. “Leave this to me, Mummy. B, you said you wanted raspberry yogurt. Do you actually want strawberry flavour? Yes? Well pass me that and I’ll switch it for you.” Then 15 minutes later when I’d managed to clear breakfast, empty the dishwasher and get their teeth brushed, B started weeping about putting her socks on in their bedroom rather than with me in the hallway. Just as I was starting to get seriously annoyed, T stepped in again. “B, are you hoping to put your socks on while you sit on your giant toy dragon? Yes? OK, why don’t we bring your dragon into the hallway so you can still see him?” Feeling v encouraged about how she’ll be with her new baby brother *please oh please don’t be famous last words*
- Eating whatever I feel like. Which generally means an entire packet of Jammie Dodgers / tub of Talenti ice cream / box of out of date mince pies. Needs must.
- Crazy weather swings again. We had snow overnight on Monday, but by the afternoon the girls were charging around the playground in bare feet and t-shirts.
- Trying to keep my impatience and temper in check. It’s not fun for C or the girls. See recent laundry meltdown blog post for more information.
- Feeling generally uncomfortable and lumpy, though not much longer to go now…