Pregnancy

If you become pregnant while in the United States, you must locate a provider that is in the Aetna Choice POS II network for all of your prenatal care. 
 
You will most likely see an obstetrician for your prenatal care. This is because doctor-led deliveries are customary in the US, as opposed to midwife-led deliveries. The MOD will fund care received from a midwife rather than an obstetrician, but please be aware that midwives aren’t as readily available as they are in the UK therefore you may experience difficulties locating an in-network midwife. The Defence Medical Services (DMS) also insist that the midwife must be a Certified Nurse Midwife (CNM). Many midwives in the US are not trained to a standard that is equivalent to an NHS midwife (NHS midwives must be qualified nurses); only CNMs are considered to have comparable training in nursing as well as midwifery, therefore for the safety of the mother and baby the MOD will only fund care with a CNM.
 
All routine prenatal visits, scans and tests are automatically authorised, however if your doctor recommends any specialised tests or scans, you will require authorisation from DMS for these (see below for details of routine and specialised tests/scans). 
 
During your initial visit, please ask the obstetrician (or midwife) which hospital(s) they use for deliveries. You will need to ensure that the hospital is also in the Aetna Choice POS II network. 
 
Please also contact the Healthcare Department to make us aware of your impending delivery, providing your expected due date, the name of your chosen obstetrician or midwife and the name of the hospital where you plan to deliver your baby. This is so that we can provide guidance where necessary and note your NHS maternity charge exemption.
 
A Certified Nurse Midwife-led home delivery may be available to you depending on your circumstances. Please contact the Healthcare Department for guidance and authorisation if this is your preference. DMS must authorise funding for home births, and funding will only be approved if a home birth would be offered to you as an option to you in the UK (if there are any potential medical risks (to the mother or baby) involved in a home birth, DMS may not approve funding).
 
Please note that pain relief options during labour differ to those used in the UK. Gas and air (a mixture of oxygen and nitrous oxide) is commonly used in UK hospitals. In the US, it is rarely offered as an option (in 2014, just 19 hospitals in the entire country offered it). Instead, epidurals and injectable drugs are the preferred method of pain relief during labour in the US. The MOD can only fund nitrous oxide if the hospital where you give birth is an authorised administrator of the gas.
 

When you have delivered your baby, you will need to contact the Healthcare Department as soon as possible after the birth to notify us of the baby’s date of birth and their name. This is so that they can be enrolled in the Meritain plan for immediate medical coverage, which includes their stay in the hospital after the birth.

 If you were in the UK receiving care under the NHS, you would have up to 10 appointments if you were expecting your first baby and around seven appointments if you’ve given birth before (under certain circumstances you may have more appointments). The following routine scans and screening tests would be offered to you:
 
Two ultrasound scans: 
  • ‘Dating scan’ at 11-13 weeks to estimate when your baby is due 
  • ‘Anomaly scan’ at 18-21 weeks to check for structural abnormalities (anomalies) in the baby

If you choose to have screening for Down’s, Edwards’ and Patau’s syndromes, a nuchal translucency scan may be carried out at the same time as your dating scan, or it may be carried out as a third, separate scan. See below for further details. 

Blood tests: 
  • to identify blood group and rhesus status 
  • to test for anaemia 
Blood tests to identify infectious diseases: 
  • susceptibility to rubella (German measles) 
  • Syphilis 
  • Hepatitis B 
  • HIV  
Blood tests for inherited blood conditions: 
  • Sickle cell disease
  • Thalassaemia 
Screening for medical conditions: 
  • Diabetes 
  • Spina bifida
Screening for genetic conditions:
  • Down’s syndrome (Trisomy 21)
  • Edwards’ syndrome (Trisomy 18)
  • Patau’s syndrome (Trisomy 13)
Screening for Down’s, Edwards’ and Patau’s syndromes is offered to pregnant women of all ages on the NHS. The screening tests provide information about the chance of your baby having these genetic conditions. 
 
A ‘combined test’ for Trisomies 21, 18 and 13 is available between 10 and 14 weeks of pregnancy. The combined test uses measurements taken from an ultrasound scan (a nuchal translucency scan, which may be carried out at the same time as the dating scan) and blood samples taken from the mother to work out the chance of the baby having these conditions. If the mother is too far along in her pregnancy to have this test, a blood sample can be taken between 14 and 20 weeks of pregnancy to screen for Down’s syndrome.
 
A diagnostic test for these syndromes (amniocentesis or chorionic villus sampling) is only offered to pregnant women if the screening result shows that there is a high risk of the baby having one of these conditions.
In the US, your doctor will schedule a greater number of appointments, even if you have had a baby before. You are likely to be seen by your doctor about once a month for weeks four through to 28, once a fortnight for weeks 28 through to 36, and once a week for weeks 36 through to birth. At each appointment you will probably have a consultation with your obstetrician, have your blood pressure checked and your weight taken, provide a urine sample for analysis and have your abdomen measured. Your doctor may also listen to your baby’s heart rate using an electronic monitor. The MOD will fund appointments at these intervals. These are automatically authorised. If your US doctor recommends appointments at more frequent intevals (for example, if you have a medical condition that requires close monitoring during your pregnancy), please contact the Healthcare and Education Coordinators to request authorisation for the additional appointments.
 
The following scans and screening tests are also automatically authorised:
 
First trimester:
 
  • A blood test (HCG) levels to confirm the pregnancy
  • A ‘dating’ ultrasound scan (sonogram) to estimate when your baby is due (this may be carried out earlier than it would be in the UK)
  • Blood tests to identify blood group and rhesus status and to test for anemia
  • Blood tests to identify infectious diseases including rubella (German measles), syphilis, Chlamydia, hepatitis B, HIV and varicella
  • A pelvic exam, including a pap smear if you have not had one in the last three years

Optional screening for genetic conditions:

  • First timester screening for birth defects such as Down’s , Edwards’ and Patau’s syndromes
The first trimester screening is equivalent to the ‘combined test’ in the UK, and uses measurements taken from a nuchal translucency ultrasound scan and blood samples taken from the mother to work out the chance of the baby having these conditions.
 
In addition to the nuchal translucency scan and blood tests, you may also be offered a ‘Non-invasive Prenatal Testing (NIPT)’ blood test, which include the ‘MaterniT21’, ‘Harmony’, ‘Verifi’ and ‘Panorama’ brands. Similar tests, known as ‘Cell-free fetal DNA’, are becoming available in the UK; therefore the MOD will fund an NIPT test in the US if you wish to have one. However, please note that many of these tests offer offer the option of X & Y sex screening. This optional element of the test will not be funded by the MOD.
 
A diagnostic test for these genetic conditions (amniocentesis or chorionic villus sampling) is only funded by the MOD if the screening result shows that there is a high risk of your baby having one of these conditions. It is not automatically authorised (please see ‘Specialised prenatal testing’ below).
 
Second trimester:
 
  • ‘Anomaly scan’ at 18-21 weeks to check for structural abnormalities (anomalies) in the baby
  • A ‘Glucose Tolerance Test’ to test for gestational diabetes
Optional screening for genetic conditions:
 
  • Second trimester screening for birth defects such as Down’s syndrome and spina bifida
The second trimester screening for birth defects is a maternal serum triple or quad blood test, carried out between weeks 15 and 20.
 
Third trimester:
 
  • Group B streptococcus screening
Your US doctor may recommend additional ultrasound scans, especially later on in your pregnancy, along with other tests including additional genetic screening. Any tests and scans that are not listed under ‘Routine prenatal appointments and screening’ above will only be funded by the MOD under certain circumstances, as they are not routinely available on the NHS. These include: 
 
  • Amniocentesis 
  • Chorionic villus sampling (CVS) 
  • Screening for cystic fibrosis 
  • Screening for Turner’s syndrome (Monosomy X) 
  • Screening for spinal muscular atrophy 
  • Carrier screening and genetic screening/testing and counselling 
  • Testing for Hepatitis C 
If your doctor recommends that you have any of these tests (or any other tests or scans not mentioned under ‘Routine prenatal appointments and screening’ above), you must contact the Healthcare Department to receive authorisation before having them. Approval for the tests is required from the Defence Medical Services (DMS) in the UK. 
 
You will need to provide documentation from your doctor stating the reason for your requirement for the tests. DMS will then determine if the testing is appropriate and would be available to you on the NHS. They are usually quick to come back with an answer (within 48 hours), which the Healthcare and Education Coordinators will inform you of (by email). 
 

Gender screening (tests to determine the X & Y sex chromosomes) will not be funded by the MOD under any circumstances.

Prescription prenatal vitamins are only available in very limited circumstances in England. Instead, women must purchase them over the counter.

In the US, doctors often prescribe prenatal vitamins to pregnant women; however they are also available to buy over the counter in pharmacies and supermarkets.

The MOD will not fund prescriptions for prenatal vitamins in the US. If you try to fill a prescription for prenatal vitamins at a pharmacy, you will be charged the full price of the drug rather than just a co-pay.

If you believe you would be entitled to prescription vitamins in the UK, please contact the Healthcare and Education Department. We will confirm your entitlement with DMS and fund the prescription if necessary. 

In the UK, all pregnant women are offered a vaccination to protect about pertussis (whooping cough) when they are 28-38 weeks pregnant. If you choose to have this vaccination in the US, it will be funded by the MOD.

The vaccination is not offered to spouses/partners of pregnant women in the UK. If the spouse/partner chooses to have the vaccination in the US, it will not be funded by the MOD and all costs will be a personal expense. 

Certain prenatal classes are available to expectant mothers on the NHS in the UK. The topics include: 
 
  • Health in pregnancy 
  • What happens during labour and the birth 
  • Pain relief and relaxation 
  • Information about different kinds of birth and interventions 
  • Emotions and feelings during pregnancy, birth and after 
  • Breast feeding 
  • Caring for your baby 
New (first time) fathers/spouses/partners may also be offered a session on how they can help during labour and delivery. 
 
If you wish to take these classes, in the first instance you should ask if the hospital can bill your insurance (Meritain Health) for the cost of the classes. 
 

If it is not their policy to bill through a patient’s insurance, please contact the Healthcare and Education Department for authorisation to claim the cost of the courses through the Claims Processing Centre at the British Embassy before attending any classes. 

Please note that the MOD will only fund medically necessary or emergency caesarean sections. Elective or scheduled caesarean sections that are not medically necessary are not covered and are a personal expense. 
 
If you have been told by your doctor that your baby needs to be delivered by caesarean, or you have an emergency caesarean section, please inform the Healthcare and Education Department. 

If your baby is delivered early, please inform the Healthcare and Education Department in case authorisation is required for any medical treatment or to claim for any medical supplies. 

While pregnant and for 12 months following your delivery, you will be exempt NHS prescription and dental charges. 
 
Please note your dental treatment entitlement does not change whilst you are exempt NHS charges, and you must still follow the approvals process for any treatment recommended by your dentist.
 
The Defence Dental Services have stated that there is no specific NHS policy on the issue of more frequent check-ups and cleanings than normal for pregnant women. In many cases it would depend on the capacity within the NHS practice that the patient was registered with. They have stated that MOD policy remains as an annual check-up and cleaning, and that any requests for more frequent appointments must be assessed on a case-by-case basis.
 

See ‘Maternity exemption’ under Dental Care for further details. 

A post-natal (postpartum) check-up is automatically authorised for new mothers.
 
Post-natal home visits by a nurse or midwife will not be funded by the MOD. It is common practice for parents to visit a clinic in person with their newborn in person for pediatric care in the US.
 
Paediatric care is most likely to be received from a pediatrician, although parents can choose to use a GP at a family practice.
 

The MOD will fund six routine wellness exams for your child in the 1st 12 months of life, in addition to all vaccinations recommended by the US Centers for Disease Control and Prevention. Exams and vaccinations must be received from a paediatrician or family GP in the Aetna Choice POS II network. Please see the healthcare guidance applicable to children of UKBCs for further information, including the most widely recommended exam schedule within this entitlement.

For information on allowances, US and UK passports and other registration matters, please see the Birth Registration page. 

Children Born in the US – Tax Issues

Parents expecting a child to be born in the US during their tour in the US, should consider the implications of a child with dual nationality in regards to US tax implications for the child when they reach an age where they earn an income. Being a dual citizen of the UK and the US can have significant tax implications, including any investments that the person holds (including ISAs), any inheritance that they receive from a US citizen (such as pensions), have sold or re mortgaged a UK property or simply if their income is over $100,000.

 As a dual citizen the child, when they reach employment age, must by US law file a US tax return, even if they live in the UK. If they don’t, the fines can be significant and the IRS will be alerted when they next renew their passport if not before, or if they travel to the US. The only way around this would be to renounce their US citizenship.

However, whether they will pay any US tax is a more complex question. They will get credit against their US tax bill for the tax they pay in the UK. If you’ve paid more tax in the UK than their US tax bill, there’ll be nothing further to pay. But it should be noted that things are taxable in the US differently than in the UK (e.g. different rules on house sales and pension contributions) and you get different deductions so it isn’t as easy as just seeing which rate is higher. 

As Tax is a personal issue, MOD cannot offer guidance, but parents should seek appropriate advice on this issue if the child retains dual citizenship. HMRC provide a useful assessment guide for dual residents and the US IRS also provides an information fact sheet.

Should parents wish to consider the option of having their child in the UK to negate the dual nationality issue, then they should engage early in the pregnancy with the BDSUS health team to review the options available.

The MOD will fully fund termination of pregnancy. Clinics offering terminations of pregnancy are not widely available in the US. If you need to terminate your pregnancy, please contact the Healthcare and Education Department for guidance and assistance

Last Updated: Oct 3, 2021 @ 3:20 pm

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