I had my first child in the US, under the care of a midwife. At post 40 weeks I was transferred to an OB for an emergency c-section — which was scary only because it was unexpected — but overall the experience in the hospital was really great. With my second child I got pregnant in Beirut, Lebanon, had my first trimester tests with an OB there, then my second trimester was spent in Thailand. More tests. My last trimester and birth was in Mexico under the care of an OB, and because I had high blood pressure (like my first), I was induced at 39.5 weeks, the baby didn’t move down, so I had a scheduled c-section the next day. My second experience was even better than the first, although I had to battle the nurses a bit about breastfeeding (the pediatrician wanted me to supplement with formula from the first hours, and I refused). My milk came in 48 hours after the birth, just like it did with my first and we left the hospital with some pain meds and instructions from the pediatrician to supplement once a day. We just ignored that advice and got a new doctor.
How much does it cost?
My birth in the US cost $3,500 for the midwife (not covered by insurance) and $20,500 for c-section (covered by my insurance — at the time my husband had employer provided US health insurance and I was under his plan, even though he worked remotely and we were traveling). For my second, my appointments in Beirut cost something like $75 including the ultrasound and blood work. My appointments in Thailand cost $20 including some tests like the glucose tolerance test for gestational diabetes. My appointments in Mexico cost about $30 each, and I had to pay for blood work out-of-pocket, which was usually $20-$30. The birth itself, an induction plus a c-section including a three-day hospital stay, cost $2,700. If we ignore the midwife costs in the US, that’s about $20,500 vs. $2,700. I would say that the quality of care in Mexico was on par with what I received in Oregon. By the way, vaginal birth or not using an epidural doesn’t always reduce the cost, it depends.
How do you know which country to give birth in?
In each place that I had prenatal care, I used private hospitals. You can look up the maternal morbidity or the c-section rate by country, but that’s going to look a bit skewed, because while the outcomes are not great in say, rural Mexico, where women can’t always afford prenatal care, its completely different when you’re in a major city with an English-speaking doctor who caters to foreigners and has an office at the sparkly new bilingual hospital by the marina. In general, this is what I look for:
1. Private hospitals (if you’re in an industrialized country, say Spain, I think you can go public, this isn’t a hard rule, but certainly you want the best medical care possible).
2. Doctors who speak English
3. Low costs or an in-country health plan you can buy into as a foreigner
4. Advice from expats who have used the medical system there
5. The name of a specific doctor that expats liked
6. Visa rules that give you at least 90 days in the country or allow you to extend without doing visa runs (you need to plan some time to get your child’s passport).
Some places I would consider: Canada, Mexico, Costa Rica, Argentina, almost anywhere in Europe, Lebanon, Thailand, Australia, New Zealand, (perhaps some other places in Asia like Singapore or Taiwan, but I haven’t researched them). Of course, in each of these places I’d want to be close to a good hospital, so your final location in that country is important too.
Once you have an idea of where, how do you find out more information?
I researched Argentina, China, Thailand, Lebanon and Mexico online, before settling on Mexico. I googled for birth stories in each of those countries. I googled for health insurance plans and costs. For Argentina, there’s an in-country insurance plan, for China the costs are low. In Thailand, I emailed the hospital in Bangkok and they gave me a package rate of $2,100 for a c-section or something like that, with all pre-natal care included (they do a lot of medical tourism so they had brochures ready to go). Lebanon also has an in-country insurance plan, although the prices were reasonable, it was certainly still cheaper than the US, maybe it would have cost me $5,000 for the birth if I didn’t get insurance, but I never got a solid number. For Mexico, another blogger had a birth there and laid out the prices, their experience and the Dr’s name.
Basically: you just dig around. There are expat forums, people have given birth just about everywhere. There are always people talking about insurance and medical issues overseas.
There are two places I would definitely recommend giving birth:
Puerto Vallarta, Mexico – this is where I had my daughter
Dr. Laura García 322-222-188
Jacarandas 273 Col. Emiliano Zapata (She’s in the Romantic Zone)
I used Amerimed for the hospital http://www.amerimed.com.mx/
Bangkok, Thailand – I used several hospitals in Thailand for prenatal care but this is the best one
Bumrungrad International http://www.bumrungrad.com/
I wrote about it here.
Of course, people have babies everywhere, but if you want two solid recommendations, there you go.
Can you travel while pregnant?
That’s between you and your doctor. I traveled into my third trimester with both pregnancies and it was fine — but every pregnancy is different so just talk to your OB.
There is one thing that I ran into with my second pregnancy — I flew from Thailand to China to Los Angeles, and I was very clearly pregnant. I got stopped and asked for my doctor’s note, giving me permission to fly at each layover. In Thailand they made a photocopy of it. So if you’re flying later in your pregnancy just make sure you get the proper documentation from your doctor, because while other times no one said anything (we flew from Oregon to Hawaii with my first and I didn’t even have a doctor’s note) — they can technically refuse to allow you to fly if you don’t have it.
Can you eat street food while pregnant?
I have always been really careful about what I ate when pregnant, so the same rules apply as when you’re traveling. You want to eat at a place that is making the food fresh. It should be piping hot. There should be lots of customers, preferably locals. If you can’t see the steam coming off the food, it’s not hot enough. There were places in Thailand were I ate street food all the time, but I watched them prepare the food, it was super fresh and hot, and I knew it was safe. I actually avoided eating in restaurants in Thailand because you can’t see what they’re making… maybe that green curry is coming from a big vat of it they bought from the morning market and are keeping warm all day. Normally that’s fine, but when you’re pregnant you don’t want to take chances. Other things to avoid: pre-cut fruit (you don’t know if the water used to wash the vegetables was clean), smoothies (again, same thing), and anything sold road side where you can’t see the preparation (like empanadas).
This should be straight forward, but what if you’re in China or Thailand or somewhere else where you can’t read the labels? Go to an OB and get a prescription. It won’t be expensive and they’ll make sure you get the right vitamin.
Visas, Residency and Passports
I wrote a bit about getting Mexican citizenship for my second child, Stella. Since she was born in Mexico, she automatically gets dual citizenship — US citizenship from her parents, and Mexican citizenship from her place of birth. Now Mexico has a 6 month tourist visa, and it can be renewed by doing a visa run — leaving the country for even one day, then returning. So we didn’t pay for residency permits, but her citizenship would have made it very easy for us to stay in Mexico long-term. The same was true when I looked into Argentina. So if you want to have a baby overseas and then stay in that country for a few years, you need to look for places that have Jus Soli — citizenship that is given to everyone born in that country. That’s mostly the Americas but you can find a full list here.
If you have read about my troubles getting the paperwork for Stella, you already know what I’m about to say. Don’t wait! Also, plan ahead… you will probably need a copy of your marriage certificate (or if you’re not married, the birth certificates of both parents). They should be certified, but they may want an apostille, an official letter from the Secretary of State in your state that certifies the authenticity of the documents. Your doctor should know what they need to give you — but in our case we had a certified letter from our pediatrician with our daughter’s photo glued to it. We also had our marriage certificate translated into Spanish and notarized in Mexico. Documents! These things are easy to get, it just takes time to have them mailed overseas. AND the process — at least for us — was ever shifting and changing — so the only way to know what you need is to march down to the civil registry in your country and ask. That’s why waiting is a bad idea, because they WILL invent things for you to get, that you never read on any website. Or it could be super fast and easy — you never know.
After you deal with the in-country birth certificate and all those paperwork details, you will need to go to the US embassy (make an appointment as soon as possible) and get a Consular Report of Birth Abroad. This is your child’s birth certificate (you will never have a US birth certificate because your kid wasn’t born there). At the same time, you can also apply for the child’s US passport. It can take between 2-3 weeks if you get it rushed, or up to 10 weeks. There are websites for the embassies in each country with their requirements and directions on how to make an appointment (even within Mexico there were different rules, in Puerto Vallarta we had to show up in person, in Guadalajara there was an online scheduling form and Mexico City required you send the completed application via email and they responded with your appointment date – mind you this is all still the US government you’re dealing with, there just isn’t a standard as far as I can tell).
What’s it like to give birth overseas?
Well, for me, it was my second so I was more relaxed. However I did play Dr. Google with everything my OB said, because I was a little nervous. She said, “Well we can try for a VBAC but honestly, I think there’s only a small chance it will succeed.” Of course, I was like “oh no you didn’t”. But then I looked it up and for someone with a baby who has not descended, who has never had a vaginal birth, and has other complications like high blood pressure (pre-eclampsia) — and I’m over 35 (advanced maternal age) — do you know what Harvard Medical school says my chances are? Less than 10%. So she was right, but she still let me attempt it because it was relatively low risk, and hey if it’s works, great. But she was honest and always 100% accurate on the things she was telling me. So that’s sort of the psychology. Even though I know babies are born every day around the globe, I have this vague internalized sense that the US medical system is really great, and giving birth overseas is getting bad medical care. But the thing is, even if the US medical system is better than say, Mexico as a whole, you can’t compare it that way. A private hospital with the best doctor in Mexico, is very similar to the private hospital in Oregon and their doctors — you know what I’m saying? You have to compare specifics, not the general population as a whole. From my experience this was true, even the hospital room was nicer than in the US. I had more time with my doctor in Mexico. She was more like a midwife, not rushing through my appointment but talking to me. There’s a lot of benefits because in the US doctors are rushed and there are insurance issues and so on. My experience in Mexico was perfect: the care is great, it’s personalized and many of these doctors were trained in the US or UK anyway.
However, there are cultural things to be aware of… I mentioned about breastfeeding, well in the US there’s a huge push to encourage moms to do it, in Mexico it wasn’t that big of a deal. They just give babies formula. They will respect your wishes, but if you have any specific designs on how you want to handle your birth or the period after you give birth, you should talk to your OB about it and figure out how to deal with it. We just called our OB on her personal cell phone (she was so awesome, she always answered unless she was in surgery and would take care of anything) and she talked to the nurses for us. So there might be some cultural things to navigate, just something to think about. On the other hand, if they did slip my baby some formula, it is truly not the end of the world. You do have to let some things go — like they bundled my baby in so many layers of clothes, she used her entire layette on the first day. They gave her — I swear — like three baths a day — until I realized that the nurses rarely see a blue-eyed baby and they were just taking her out to play with her.
By the way, if your sole reason for having a baby overseas is the insane cost of birth in the US — you can negotiate with some US hospitals for a cash-payment rate that’s cheaper. I know a lot of insurances won’t cover pregnancy until you’ve been under their plan for a year, which usually costs more than the birth itself. Here’s the reality: Medicaid only pays the hospital about $1,000 for births, including the hospital stay — so because of this, hospitals make up the difference by charging private insurance outrageous rates. The system is screwed up. You don’t need to pay that super high rate they charge the private insurance companies (like the $20,000 the hospital billed my insurance — and I don’t think the insurance even paid it all, they adjusted the amount and paid according to their contract with the hospital). So if you look at what the price is for something, remember that not even the insurance companies are paying that much, it all gets adjusted down. If you go to their admin offices they usually have a cash discount or other financial counseling (you may be eligible for Medicaid if you’re pregnant). You might have to look at a couple of hospitals, but you can be a smart shopper for your birth, especially if you are paying out-of-pocket.
Share your experience
Have you given birth overseas? If you’re willing to share your experience, how much it cost, what you liked or didn’t like about or any other tips, please leave a comment. I get tons of emails about this, so hopefully this will be a good jumping off point for people considering having a baby overseas.