Expecting Abroad – What to Expect

Moving and adjusting to life in a foreign country has its ups and downs for any newcomer, never mind a pregnant one. Pregnancy is a time of profound psychological as well as physical change. Remember, your pregnancy will progress in the same way, regardless of where you are living. You will experience the same physical changes and discomforts. Yet, your pregnancy abroad will be an intense time of personal growth and discovery. We have 5 tips to help you survive and thrive when you are expecting abroad.

Survive and Thrive While Pregnant and Living Abroad: 5 Tips

  1. Learn about your health insurance coverage. Make friends with your insurance agent.
  2. Sign up for pregnancy-related activities, groups, and classes in your native language whenever or wherever you can.
  3. Find a doctor or midwife who speaks your language.
  4. Hire a doula or native-speaking companion to join you for all prenatal appointments.
  5. Plan for family or friends to visit.

Homesickness or Morning Sickness?

Something about realizing we are going to become mothers ourselves makes us all yearn for home. Expecting abroad can intensify the homesickness and loneliness many ex-pats normally feel. At first, the thought of becoming a parent anywhere other than home can feel disorienting and terrifying. This is a good time to take a deep breath. Try to shift your perspective to focus on your pregnancy abroad as an opportunity for personal growth.

For women living abroad, far from family and friends, the physical, physiological, and psychological effects of pregnancy can be even more difficult to cope with. You may feel more depressed or lonely. You may doubt yourself or lose your sense of identity. Depending on whether or not you are working while living abroad, this loneliness, loss of your sense of self, and boredom may challenge your ability to cope.  If, on the other hand, it was your career that brought you to a foreign country, pregnancy may stir up uncertainties about your job security, maternity leave, or your ability to juggle professional responsibilities once you become a mom.

We know that emotional stress can make some pregnancy discomforts, such as morning sickness or high blood pressure worse. Many ex-pat moms suggest finding a therapist, counselor, or mental health provider who speaks your language early on in pregnancy to boost your ability to cope with pregnancy challenges when expecting abroad. With exploding telehealth options, you may even be able to schedule regular Zoom sessions with your counselor from home.  Having an established, positive relationship with a trusted therapist before pregnancy can help protect you from postpartum depression after your baby is born.

Navigating the Language Barrier

Not speaking the language can be the most difficult aspect of being pregnant and giving birth abroad. Even if you are able to find a doctor or midwife who speaks English, nurses, hospital support staff, or office staff may not. Scheduling appointments, laboratory or ultrasound screenings, and completing the requisite bureaucratic paperwork add additional layers of mental exhaustion for the non-native-speaking mamas. Finding a bilingual doula or fluent friend with some medical knowledge willing to help translate and navigate will go a long way towards lowering your stress levels.

The Biggest Questions: Where to Give Birth and With Whom?

Deciding whether to stay in your current abroad location for your entire pregnancy and delivery or fly home to your home country for your birth will be one of your biggest decisions. Some considerations to think about are:

  • Do you have maternity health care insurance and will it cover your care in multiple countries?
  • Can you find an ob-gyn or midwife who will deliver your baby even if they did not care for you throughout your pregnancy?
  • How advanced is your local medical care? Where would you deliver? How close is specialty care if your pregnancy became high-risk or you needed neonatal care?
  • How late in your pregnancy will you be able to fly and how late will your doctor clear you to fly?
  • Will you and your partner be able to work remotely or take 2-3 months off from work and your overseas home to be able to deliver in your home country?
  • Would you feel comfortable traveling with a newborn? Would you plan to vaccinate your baby before traveling?
  • How hard will it be for you to be away from family and support?

Your decision will also be determined by whether you want your provider to be an ob-gyn or a midwife, and where you want to give birth, at home, at a birth center, or in a hospital. The particular country you will be giving birth in may impact your decision: In the Netherlands, 30% of women give birth at home, and midwives deliver 40% of all babies. In Germany, the law requires a midwife to be present at birth and doctors are optional.

Finding Your Provider

Many women struggle with choosing their provider even in their native country and first language, so be kind to yourself. Make sure to consider important sources of information as you make your decision:

  1. Other ex-pat moms
  2. Your healthcare insurance company
  3. Professional licensing organizations such as The American College of Obstetricians and Gynecologists (ACOG) or The American College of Nurse-Midwives (ACNM).

When deciding on your birth provider, consider asking some of these questions:

  1. Where do you treat patients? Where do your patients deliver?
  2. Do your partners or backup providers when you are not on call speak my language?
  3. How many ex-pat patients have you cared for?
  4. How do you work with doulas or other birth attendants at deliveries?

Your choice of doctor, prenatal testing, place of delivery (birth center, home, or hospital), and other aspects of your pregnancy journey may all be determined somewhat by your insurance. Like in the U.S., your insurance agency can be one place to find recommendations for doctors or midwives who speak your language. You want to make sure that whichever provider you choose is covered by your insurance plan or residency status. That is why it is really important, right from the start, that you find a person at your insurance company or in your company’s human resource department who speaks your language and who can explain your full maternity benefits package to you.

Another wrinkle to giving birth abroad is the question of citizenship for your child. Different countries have different residency requirements. The United States requires you to report your child’s birth to the nearest U.S. embassy or consulate as soon as possible so that “so that a Consular Report of Birth Abroad (CRBA) can be issued as an official record of the child’s claim to U.S. citizenship or nationality.” This is where having a bilingual doula who has worked with expat couples before can come in handy. They may be able to offer you assistance in filling out the necessary paperwork, especially if you will be traveling early on in your child’s life to visit family and friends.

Exploring the Birth Culture

When you are expecting abroad, even if it is your first pregnancy, you will quickly notice that each country has its own unique birth culture. As you navigate a foreign healthcare system, possibly with foreign doctors, midwives, and nurses you will adapt to subtle as well as overt differences in pregnancy and birth traditions.

Part of your learning assignment of pregnancy will be to flex your assertiveness muscles. Become your own advocate. Learn how to be very clear about what you want and saying what you need in order to get it. The virtual midwife, Karen Wilmot, offers specific suggestions in her guide Giving Birth Abroad: The Essential Guide for Expats Expecting for how to examine your own beliefs and expectations about birth. Other ex-pat moms who have previously given birth in your current home are great information sources as well.  Birth culture can encompass how medicalized birth is in terms of rates of interventions, labor inductions, epidural rates, and cesarean-section rates.

Traveling while Pregnant if You Are Expecting Abroad

Many seasoned ex-pat moms recommend either returning home for a pre-baby visit or planning for postpartum friends and family meet-the-babe visits.  Remember that it might be hard to get travel insurance while pregnant. This means that if something happens with your pregnancy while you are traveling, you might be stuck with some or all of the medical bills.

Different airlines have different restrictions about flying when pregnant. Make sure to investigate your health insurance policies for out-of-country coverage.  The American College of Obstetricians and Gynecologists states that “in most cases, pregnant women can travel safely until close to their due dates. But travel may not be recommended for women who have pregnancy complications.” The problem is that you can’t know about possible complications when making travel plans. Research airline policies regarding pregnant travelers before purchasing tickets. Many airlines won’t let pregnant women fly after 36 weeks (or 32 weeks if you are having multiples) because they are afraid you might go into labor during the flight. You may need a doctor’s note before being allowed to fly.

Finding Your Mama Tribe

Becoming a mother is an exciting and deeply emotional time for women- one of self-discovery and self-questioning. Living abroad at such a life-changing time in our lives can feel lonely and scary. Many women feel more vulnerable and anxious while pregnant, even when they are in their familiar home country. The best way to ensure a happy and healthy pregnancy, with as little stress as possible is to build your own support team. 

One of the best ways to get the support and information you need is to connect with other pregnant women. Yoga classes, childbirth education classes, or parenting groups are all great places to meet other pregnant women. Joining or creating a “mothers-to-be” group is a great way to alleviate feelings of loneliness.

Having a support group of ex-pat moms experiencing the same pregnancy issues and rollercoaster of emotions may also help you to navigate the difficult postpartum period, a low point for many moms. Lack of social support is one of the biggest risks for postpartum depression. This is especially important for women living away from their cultural home. You may be adjusting to the huge life-changing event of becoming a mother, without your regular network of family and friends. 

Make Sure to Consider a Doula

A doula is a trained birth attendant who provides continuous physical, emotional, and informational support to a couple before, during, and after childbirth. DONA International explains the various types of doulas and how to hire a doula. A bilingual doula can be an invaluable resource in helping you understands both the language and the birth culture of the country where you are giving birth.  An experienced doula who has attended previous births in your birth setting will help ensure nothing is lost in translation, even if your provider speaks your native language fluently. If you do decide to hire a doula for your delivery, definitely ask whether the hospital and your provider allow doulas. For example, not all hospitals in Barcelona allow doulas, and not all Spanish gynecologists approve of working alongside doulas.

Your Postpartum Abroad Survival Plan

Having a baby in a foreign country is a bit like starting a business in that you have to put together the right team. The pregnancy-abroad-business also requires some serious research and comparative shopping. Start-ups don’t do it alone, and neither should you. Early on in pregnancy, start assembling your own “dream team” of people to turn to for help. Beyond a doula, consider hiring a nanny, night nurse, breastfeeding consultant, childbirth educator, therapist or mental health provider, physical therapist, massage therapist, and cleaning or cooking help. Depending on where you are living, you may find that some of this household help or medical care is much more affordable.

Give yourself permission to call in extra help and let go of the guilt. Extra night-time care can be a sanity-saver as you establish breastfeeding and sleep routines, especially if one partner has to resume work travel.

Remember, You Can Do This

Just keep repeating this to yourself, taking lots of deep breaths in between your pregnancy abroad mantra “I Can Do This.” Pregnancy is a fascinating, daunting, and hugely rewarding process whichever country you are in.

While it easy to be overwhelmed when expecting abroad, remind yourself of the amazing opportunity before you. Living the process of navigating language and cultural differences, assembling your own healthcare and social support team, you’ll become an empowered, strong mother. You will be able to advocate for yourself and your family, no matter where on the globe you raise your family. As Erika Villanova, a trilingual doula working in Barcelona reflects: “You have to be a very different type of person to be willing to pack up and have your baby in a different country.” Think of your pregnancy as the first chapter in your evolution into a strong mother.

Amy Harris
Amy Harris is a certified nurse-midwife with a Master's Degree in Maternal and Child Health from Harvard Chan School of Public Health. Her passions are health literacy and women's reproductive health. A recent two-year sabbatical with her family in Spain was the impetus for becoming a freelance women's health writer. An exercise nut, she is happiest outdoors and on adventures abroad.

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