Pregnancy is an important stage in the life of a family, especially when it happens after a move to the United States. Expectant parents have not only to prepare for the birth of a child but to make sense of a new healthcare system, health insurance, choosing a doctor and arranging the birth. For many immigrants it is medical questions that turn out to be among the hardest in the first months in a new country.
The American system differs from the one many people know in the CIS countries and Europe. Here most medical services are provided through insurance companies and private clinics, so the cost of treatment depends directly on the cover you have chosen. That is exactly why it is important for expectant parents to understand in advance how the medical care system works, so as to avoid unexpected costs.
When to see a doctor
After a positive pregnancy test, do not put off the first visit to a doctor. The first consultation is usually arranged at 6-10 weeks of pregnancy. That is when the dates are confirmed, the mother's health is assessed and a plan for further care is drawn up.
At the first appointment the doctor:
- takes a medical history;
- asks about chronic conditions;
- orders tests;
- works out the expected date of delivery;
- explains the schedule of care from there on.
The sooner an expectant mother registers, the easier it is to monitor the pregnancy and pick up any complications in good time.
Who provides care during pregnancy
In the United States pregnancy care can be provided by different specialists.
The commonest are:
- OB-GYN — an obstetrician-gynaecologist;
- Family Doctor;
- Certified Nurse Midwife.
Most women are cared for by an obstetrician-gynaecologist. If the pregnancy is progressing without complications, part of the care may be provided by a midwife. Where there are chronic conditions or the pregnancy is at higher risk, the woman is referred to high-risk pregnancy specialists (Maternal-Fetal Medicine). Before choosing a doctor it is best to make sure they take your health insurance.
Health insurance
Insurance is one of the most important subjects during pregnancy. Without insurance the cost of pregnancy care and delivery can run to tens of thousands of dollars. Even an ordinary vaginal birth can come to over 15-20 thousand dollars, and a caesarean section considerably more.
Most insurance policies cover:
- consultations with a doctor;
- laboratory tests;
- ultrasound scans;
- hospital admission;
- the birth;
- postnatal care.
Almost every policy has its own terms, though.
Before care begins it is advisable to establish:
- the size of the deductible;
- the amount of the copay;
- the out-of-pocket maximum;
- whether the hospital you have chosen is in the insurance network.
Some families are eligible for the state Medicaid programme, which covers medical costs during pregnancy wholly or partly.
Which examinations are carried out
Over the course of a pregnancy the mother-to-be has a large number of examinations.
In the first trimester the following are usually done:
- a full blood count;
- a urine test;
- blood typing;
- screening for infections;
- the first ultrasound scan.
In the second trimester there may be genetic screening, a detailed ultrasound scan of the baby's development and further laboratory tests. In the third trimester the doctor regularly monitors the baby's growth, its position, its heartbeat and the mother's condition.
At around 24-28 weeks almost all pregnant women are given a test for gestational diabetes. If necessary, examinations may be arranged more often.
How often the appointments are
The schedule of visits to the doctor changes gradually.
Care usually looks like this:
- up to 28 weeks — roughly once a month;
- from 28 to 36 weeks — every two weeks;
- after 36 weeks — every week until the birth.
Each visit includes checks on weight, blood pressure, the size of the abdomen and the baby's heartbeat, and a discussion of how the woman is feeling. If there are any concerns, the doctor may order further examinations or change the plan of care.
Preparing for the birth
Most expectant parents take special preparation classes in advance.
They cover:
- how labour begins;
- when to go to hospital;
- what methods of pain relief there are;
- how to breathe;
- how recovery goes;
- how to care for a newborn.
Many hospitals arrange tours of the maternity units. Expectant parents get to see the rooms, the equipment and the rules of the stay in advance. A few weeks before the expected date of delivery it is advisable to pack a hospital bag, get the documents together and think through the route beforehand.
Where births take place
Most births take place in hospitals. On admission the woman is examined by specialists, who assess the dilation of the cervix and the baby's condition and decide how labour will be managed from there.
Many hospitals provide separate delivery rooms where the woman stays until the baby is born. Having a partner present is normal practice. A husband or another close person can be there for practically the whole process.
Some families choose a Birth Center — a specialist birth centre geared towards as natural a birth as possible. Home births are also possible, though they are much less common.
Pain relief
The mother-to-be decides about pain relief herself.
The commonest options are:
- an epidural;
- intravenous medication;
- breathing techniques;
- changing position;
- a warm shower or bath.
The doctor explains the advantages and the possible limitations of each method in advance. If necessary the decision can be changed during labour itself.
After the baby is born
Once the baby arrives the medical team carries out an initial examination straight away. If there are no complications the newborn is usually handed to the mother immediately for skin-to-skin contact. That contact helps breastfeeding get off to a good start and helps the baby settle faster.
During the first day the baby has the required examinations, and the first preventive procedures and vaccinations may also be given. Before discharge the parents are given advice on caring for a newborn and a schedule of the first visits to a paediatrician.
Recovery after the birth
After a vaginal birth the stay in hospital is usually 24-48 hours. After a caesarean section the woman stays under observation somewhat longer.
Before discharge the doctors explain in detail:
- how recovery goes;
- when to contact a doctor;
- how to care for the incision (after a caesarean section);
- advice on breastfeeding;
- how much physical activity is acceptable.
A follow-up appointment with the obstetrician-gynaecologist is arranged a few weeks later. If pain, a temperature, heavy bleeding or other worrying symptoms appear, you have to seek medical help immediately.
The child's citizenship
A child born on United States territory automatically receives American citizenship.
After the birth the following are obtained:
- a birth certificate;
- a social security number (if needed);
- the child's other documents.
The child's citizenship does not, however, give the parents any automatic right to reside in the country or to obtain immigration status.
What a birth costs
The cost depends on a great many factors.
The price is affected by:
- whether there is insurance;
- the hospital chosen;
- whether it is a vaginal birth or a caesarean section;
- complications;
- how long the stay is;
- additional examinations.
Even with insurance, part of the cost may have to be paid by the family. That is exactly why most families establish all the financial terms in advance.
Useful advice
During pregnancy it is advisable to do the following in advance:
- choose a doctor;
- check what the insurance covers;
- get to know the hospital;
- gather the documents;
- pack a bag for the birth;
- keep the contact details of the medical services.
If the family has recently moved, it is worth finding out about local support programmes for pregnant women, new parents and children.
Pregnancy and birth in the United States call for good preparation, but the medical system itself provides a high standard of care and modern conditions. Choosing the right doctor, understanding how the insurance works and preparing the documents in good time all reduce the stress considerably and let you concentrate on what matters — the health of the mother and the baby.
The sooner expectant parents learn how the American healthcare system works, the calmer the whole journey will be, from the first weeks of pregnancy to coming home with a newborn.
End of the article.
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