US vs. UK maternity leave

[Pennsylvanian]

Hello everyone,

This is my first post, and it's being written in Michael Moore-induced distress. Yes, my British husband and I just watched Sicko for the first time last weekend, and I couldn't quite believe what I saw (although I know I should take Moore with a grain of salt). We are recently married and currently living in the UK, but I always assumed that we'd move to the States when we'd start having kids so that I can be close to my mom, family, and friends, among other things. But now that I've learned about the tremendous maternity leave (that they actually PAY you while you're on maternity leave here!) and fully covered pre- and post-natal and birthing costs in the UK, it seems to make less "sense" to plan to go back to the States when we're ready for babies.

I guess my question is: how do pregnant women in the States do it? Is it possible to have a baby (and pay for its birth and the additional costs it incurs) and take a proper maternity leave (living on just a husband's pay) and still get by? What were your experiences of US maternity leave like with your employers (in terms of length, pay, support)?

It breaks my heart to consider not giving birth at home, but it seems the situation in the UK is so much more considerate toward new families...

[andrea922]

While I won't comment on Michael Moore or Sicko I do think one thing you need to consider is how it differs having a baby in the UK vs the US. Here in the UK everything is midwife led care, which I really liked, but I never once saw a doctor during my entire pregnancy. There are many tests that they don't give that are norm in the US because the NHS can't justify paying for the costs involved.

I was induced, at night, and my husband wasn't allowed to stay with me. Instead I was in a ward with 3 other women, and wasn't taken down to the delivery floor until 9 hours later, when I was 6 cm dialated and BEGGING for some sort of pain relief. Only then was my husband allowed to come in. My son was born 3 hours later, fortunately healthy.

We stayed that night in another ward with 3 other women and all of our babies, so I had no sleep at all. There is no nursery, and no one came to check on me except when I first got up there and before I left the next day. My husband was not allowed to stay with me.

Was it all free? Sure, which was fabulous. However, it came at the expense of me being alone during my labor. I know this isn't everyone's story, but it was mine, and I will never have another baby in the UK again!

Also, we are moving back to the US in 43 days and I will not be returning to work, we will be living on my husband's salary and hopefully having another one down the road. It is doable, it depends on how you choose to live and spend your money. There is no doubt that maternity leave is better in the UK, it is unfortunate that the US doesn't hold a candle to almost every other country in the world in this respect. But it is doable to stay at home, if you choose.

[Pennsylvanian]

Thanks, Andrea! It's really helpful to hear more about the different delivery methods, too. There are so many factors we have to take into account before we make up our minds that we haven't even started thinking about, it seems...

[wildcatsarah]

When I was pregnant with my first baby I came back to the US to be with my sister while she gave birth. She gave birth in an amazing hospital and the room was like a hotel! But because she doesn't have health insurance they had to pay $10000 for the whole of pre and post natal costs. I went back to the UK and when it came time to give birth I did think the hospital wasn't as nice and I agree with Andrea that it sucks when they won't let you have your husband there if you aren't in established labour and kick them out after visiting hours. I was also induced with my first and to be honest I don't think it would have mattered where I was in the world being induced is horrible. My husband was with me for the whole time once I was moved to the delivery room though so at least he was there.
I also agree with Andrea that I really liked the midwife run aspect of the whole thing. When I was with my sister I was ready to slap her OB because he was like a freakin' cheerleader chanting "GOOD! GOOD! GOOD!" while she was pushing. I was annoyed with him so I can't imagine how she felt!

I have many friends that have had complications of sorts during pregnancy and they have all received decent care and are refered to an OB if there is anything slightly concerning about their pregnancies. My second and third children were born in a Maternity Unity that was completely midwife run not a dr in sight and it was lovely. Much more relaxed than a hospital and as I was the only person there giving birth both times I was almost spoilt by the midwives. I didn't have any pain relief or anything with those births although I had everything going with the first. I absolutely loved my midwife I had with my baby. SHe was absolutely wonderful and I don't think any DR could have rivaled her abilities at delivering a baby and helping me not need stitches! (sorry if too much info!!!)

THe only thing I would change about any ofmy births is that none of my family have ever been able to be there for any of the births (except my mom was in the UK for the first one and because I was so overdue she had to leave a few days after the birth ) and I would have loved to share the experience with them.

I personally don't think that you get inferior care so to speak over here and if getting paid maternity leave can help you and you can get some of your family over than I say why not have them in the UK.

[lplkemc]

On the maternity pay - your company only pays you a few weeks at full pay, and then it is statutory maternity pay for the rest. Maybe £100 or so a week.

[Frances]

Federal law states that (eligible) employees are able to take up to 12 weeks off from their job within a 12 month period (unpaid) without risk of loosing their job (they must be allowed to return to the same or similar position).

http://www.dol.gov/esa/whd/fmla/

State laws add more to that basic law, so you'll want to check with the state you are moving to.

Many people use their sick and vacation pay during those 12 weeks. Some companies have great "deals" that pay the employee during the whole time; some allow for "flexi" schedules so that you can be home for 2-4 months but still work part-time. You may want to think about those benefits when looking at jobs.

The federal law is for a long list of "family leave" reasons - caring for an ailing family member, the birth of a child, or the placement of a child for foster care or adoption. I will be taking family leave (hopefully soon?) when we adopt our children. As the working mom, I may not take a full 12 weeks (hubby is the stay-at-home/work-from-home one in our family) so I can use the rest of the time off later. To do it financially, I've been saving my vacation days (I get about 25 days a year) and I also have a bit tucked away in the sick bank if needed. We've also been preparing financially because if I need to take unpaid time there's no income - but funnily enough, the bank will still expect a mortgage payment!

In summary: check the state laws and check company benefits for organizations you may be interested in working for/with.

Good luck!

[elfinmom]

I guess my question is: how do pregnant women in the States do it? Is it possible to have a baby (and pay for its birth and the additional costs it incurs) and take a proper maternity leave (living on just a husband's pay) and still get by? What were your experiences of US maternity leave like with your employers (in terms of length, pay, support)?

It breaks my heart to consider not giving birth at home, but it seems the situation in the UK is so much more considerate toward new families...

In my experience it is much more expensive to have a baby Stateside than in UK - not only for the medical care, but even just getting baby equipment. I don't know the situation with maternity leave too well but I think in UK you get much more time. Another thing to consider is that once the baby is born in US, there is no system like that of having the health visitor come and help etc and it may be harder in US to go for a more natural birth plan if that is your preference. That is the down side.
The up side is that so long as you have insurance that covers you (and some companies won't cover maternity until you have been with them for a certain period of time )
the care seems to be very much more consistent. I have never had to fight to get a scan or wait for any additional treatment in the case where I was worried about anything and I feel a lot more confident about the cleanliness and monitoring in the hospitals. I think you might go a bit crazy if you keep comparing the two, because it can vary from region to region anyway. For me, the bottom line is, choose what you feel will give you the best outcome.

I feel a bit more confident with the actual care I am receiving here than I ever did in UK, but I do miss the fact that in UK it was free and a bit more long lasting in terms of aftercare and options. It's a bit more clinical here - but in my case that is what we needed this time. The insurance coverage side of things (a la Sicko) is always a bit of a worry and rather a big hassle often as you have to do a lot of phoning around, chasing things up, making sure you are covered ( and that is after you have a plan )... it really is half a dozen of one and six of the other.

Here, it IS harder financially. Over in UK, it probably depends on the area you are in and what their standard of care is like. I had a mixed experience, both the best and the very very worst. Here, my care has been great so far, although it took me a while to find and then get in with an OBGYN that I like (that was a rigmarole).

Overall, in conclusion, I think it is much easier in UK.

[Margotdarko]

While I'm attracted to a lot of the aspects of having a baby in the UK, because my mom is in here in Michigan, I knew I could never do it. Where your personal support system is should be a very big factor in the decision. Having a baby in the UK would have made it so hard on my mom which would have made it even harder on me.

We're in the US now and we're going to wait until we're more financially stable. Being financially stable is usually what you'd wait for in either country, and normally being financially stable in the US and having good health insurance come hand in hand. The plan through my husband's current job is really good. My husband even said it was kind of like being back on the NHS!

[Liddy]

I am not a mum--but have lived in both countries and pay attention to the rules and regs so that I am prepared for when we do have a little one. Been through enough friends having babies that I feel I've seen a lot (on both sides).

As Frances wrote, there are some differences as far as policy by state, which you could check, if you have an idea as to where you'll live. A lot of health care/leave etc is being dealt with at state level.

The biggest difference in terms of benefit is that the US does not have a national policy. Benefit is generally employer based, and this varies broadly. My company gives women 6 weeks paid, up to 12 weeks unpaid (per FMLA, family medical leave act) and we can use vacation time and disabilty pay/leave, too. Most women at my company take 3-6 months off, but of course most of that is unpaid leave. Many come back part-time, work from home, etc. My UK company (same company) did not allow the part-time return, work from home, it was all or nothing. Much less flexibility.

We have very good insurance coverage: ante-natal care is covered, the birth of a child is covered ($200 one-off cost), etc. Also, the area in which we live is very good and has health visitors, etc: my sister had county nurse visits, lactation consultant visits. The next county over does not--it's a local policy that was designed to help those who live in the inner city/have less access to help (some of the 'burbs are also in this county so share the benefit).

That all said, the biggest watch-out is insurance. You'll want to ensure that you understand what is/is not covered, when it becomes effective, etc. You'll find lots of helpful information about insurance elsewhere on this forum. Be sure to read the policies specifically for mention of maternity benefit.

A friend of mine just had a baby and it cost her a $20 co-pay. However, that is not the norm. There are thousands of uninsured who face huge hospital bills--as mentioned above. And, if there are complications then that can all escalate rapidly. There are some programs for the poor/uninsured, but of course these do not cover everyone.

Speaking for me personally, we are in the fortunate situation of having good care and a low cost of living, and if we have a child I will leave my job and stay home. In the UK this was not an option for us--we needed two salaries in London. It is one reason we delayed having a child--the maternity pay would have helped but it would not have been enough.

I've seen examples of good care in both countries and I've seen the opposite. I have friends in the UK who buy all their baby gear and such in the US because they feel it's cheaper/more selection, etc, and I've friends who feel the opposite. Personally I feel like I have more choice/control in the US, but that is because I have good insurance and in the UK we lived within a struggling NHS trust. Again, many have experienced the opposite.

[mdglazerman]

Having found out that we are expecting our first this is something that I've been thinking about more over the last few weeks. With Debs being a teacher she is limited to taking sick days if we were to have the baby during the school year. The great thing though is that if you time it right you can make use of vacations to supplement any sick days you have saved up. She's due April 4th which is about 6 weeks before the end of the school year. She has over 50 sick days saved up so she'll be able to leave just before her due date and then won't have to go back to school until mid August. I know that we're very lucky in that respect.

As for the cost, I don't have anything to compare it to but the insurance plan that she has through school seems to be very comprehensive and after talks with other teachers who have had babies with this insurance, out of pocket expenses are pretty reasonable with regards to delivery and hospital fees.

Mark

[Frances]

And for Mark, of course, the family leave act also allows for the father to take up to 12 weeks of family leave ... baby bonding made easy ;-)

[mdglazerman]

And for Mark, of course, the family leave act also allows for the father to take up to 12 weeks of family leave ... baby bonding made easy ;-)

Really... I'll have to look into that. I was planning on carrying over 5 days of my vacation so I could take 2 weeks when the baby arrives leaving me 1 week for the rest of the year. Not sure If I could afford 12 weeks off but some time would be nice !!

[Sarah]

Something that has yet to be mentioned in this discussion is the availability of Registered Nurse Midwives (RNM) and Licensed / Certified Professional Midwives (LPM / CPM) as well as stand alone and site-supported Birth Centers in the USA. Home births assisted by RNMs and CPMs are becoming increasingly available in the USA as are Birth Center deliveries attended by RNMs and/or CPMs. Birth Centers are either located near hospitals or on the grounds hospitals for quick transfers in case of emergencies, which is a nice compromise for women / families who aren't comfortable with the idea of Home Birth.

For women who aren't insured or don't have adequate insurance, however, they may wish to familiarize themselves with the actual safety records of home and birth center deliveries assisted by midwives in the USA before dismissing them. The costs are significantly less expensive than hospital births. Uncomplicated hospital births often go from $10 - 20k, whereas midwife assisted births at home or at a birth center including all of your prenatal care generally comes in around $3 - 7k.

Women and families are forgetting that there are other options available for their prenatal and delivery care. "Going to the hospital" has become so ingrained in our society's mindset that insurance and babies go hand in hand. If you have low risk pregnancy that doesn't have to be the case. That doesn't have to be the case. You can still receive safe, quality care in this country at an affordable price, even if you are not insured.

I recommend watching The Business of Being Born and finding out if there's a local birth center or registered midwife local to you. You can talk to your birth centers and midwives for free to help you decide what care plan is best for you.

Find a Registered Nurse Midwife: http://www.midwife.org/find.cfm
Find a Certified Professional Midwife: http://cfmidwifery.org/find/#4
Find a Birth Center: http://www.birthcenters.org/find-a-birth-center/

[JoannaV]

When I first moved to the US I started to worry about giving birth. I was used to the idea of midwife-led care and had seen my sister born at home. I had heard some bad things about US maternity care. I started to research and the situation appeared worse than I expected. In many states midwives were illegal and most insurance plans wouldn't cover home birth! But then after more research the situation improved. Virginia had recently legalised CPMs. Insurance might cover CNMs, and I found one in my area. So eventually I stopped worrying and became excited about the prospect of becoming pregnant. Having given birth at home here in America this January the situation is now reversed. I would worry if we ever moved back to the UK! I'm now spoilt by having had the most wonderful midwife alongside me. The only downside was that our insurance paid less than $600 towards the birth and we had to pay $2200 out of pocket. But it was worth it.

Local birth centers are a great option for women who are used to the UK model of maternity care. In my area at least it appears that birth centers are on the rise.

Anyhow, more generally, I think you need to decide where you want to raise your kids. Wherever that is, you will find a way to make pregnancy and birth work for you :-)