Giving Birth Abroad? Here Are 7 Things To Consider

When American writer Nafeesah Allen gave birth in South Africa she expected differences but her experience was still surprising. Here's what she wants new parents to know.

Every parent wants the best for their children and sometimes the best care starts at birth. Giving birth overseas can be safer and more affordable than in the U.S., and it may provide birth parents more postpartum support. Whether surrounded by extended family or for the purpose of citizenship, giving birth abroad has many pros and cons to consider.

When I decided to give birth in South Africa, I knew that things would be different from my first birth experience in the United States, but I didn’t realize how much. Not only were the costs much more reasonable, but I also got much more personalized care from a single provider. Unlike the big hospital practices in most U.S. cities, the midwifery practice I selected in Johannesburg was run by one female provider (although she had backup providers available). She only took on the number of pregnant people she felt she could attend through the length of their birth journey.

There were no students or nurses at our prenatal appointments. My primary care provider answered questions on WhatsApp, was there at my birth, and came to my home for postpartum visits. The personalized care exceeded my expectations. The downsides, however, came with navigating the administrative burdens after birth. Knowing where to get the birth certificate, extending visas, and securing childcare for my older kid proved more complicated than I imagined.

Of course, all’s well that ends well, but there are lots of things I wish I had anticipated before the big birthday came. Everything from crib side paperwork to visits from relatives came as an afterthought. For parents already residing in a foreign country, the process might be simpler to manage. But if you’re planning to travel to a new destination just for the birth, here are the top 7 things to ask yourself before you go.

Can you work remotely?

Most employers offer paid maternity and paternity leave, but not all do. So, before embarking on an overseas birth journey, it is important to know how you’ll fund the experience. Most medical providers may want you to be in the country about 4-8 weeks before birth and at least 6 weeks after. This means you’ll be floating your travel and medical expenses for around 3 months.

Thankfully, some jobs will let you work remotely, and you don’t have to worry about losing wages. But not all employers allow you to work outside the country or for that length of time. If giving birth outside of the U.S. is really a consideration, you’ll want to talk with the human resources office at your job to understand if you can work remotely, receive paid parental leave, or some combination of both.

Who else is coming with you?

Rarely will a birth mother travel alone for the experience. Not only would she need or want a birth companion, but all new mothers need postpartum support. In short, this is not the time to be a superwoman. Decide who is coming with you. Account for partners, parents, and even older kids.

Emma Jameson, a U.S. mom who birthed in Mexico in 2018, said one perk of being so close to the U.S. was that her mom was present for the birth, too. Delivering outside of your home country doesn’t mean leaving loved ones out of the process.

So consider the arrangements you need to make to ensure they are comfortable in the new country. This consideration affects everything from where you stay (a normal hotel or a whole house), to childcare for older kids (babysitting or enrolling them in a local school), to the overall budget (add a translator or doula as a line item). So don’t leave travel companion planning to the last minute.

What to expect during birth?

Andrea Thornton is a U.S. mom who has only delivered her kids abroad; first, in a private hospital in New Delhi in 2017, then another private hospital in Guangzhou, China in 2019, and last in a public hospital in Tel Aviv in 2022. “Regardless of where you plan on delivering your baby, make sure you do your research and that you understand what the local practices are,” she says. “Find out what the hospital standard practice is for labor, birth, and directly after birth.”

Each country was different. In India, she had to provide everything: baby diapers, cloth wraps, pads, and even slippers that fit a larger, Western foot size. She also found that the portion sizes for meals were smaller than expected for a nursing person. Also, while her doctors spoke English, much of the cleaning and support staff didn’t. That made it hard to communicate boundaries on entering the room and asking for help.

In China, she got unexpected perks like a birth photographer, and her spouse had a dedicated bed in the recovery room.

And in Tel Aviv, she was surprised to find that all births take place in public hospitals. Despite the promise of a private room, if occupancy is high, most women are in a shared room. Following her unexpected C-section, she was surprised that she didn’t get to see or touch her baby for 6 hours. “They wait until the mother is fully recovered from the drugs,” before allowing skin-to-skin contact, she said. Thornton adds that this affected her daughter’s breathing and latching for her entire first year.

While Thornton doesn’t think she experienced anything worse abroad than she would have in the U.S., she counsels other birthing people to always do their research. The Cesarian rate or willingness to introduce interventions can vary significantly by country.

Assume nothing about patient advocacy, birthing rooms & supplies, and support from non-physicians working in the hospital. Often, families are so focused on the doctor and the baby that it’s easy to forget the policies and practices that will affect the entire birthing ecosystem and care for the birthing person. Local doulas can be a particularly useful resource to help you prepare mentally and emotionally for all that’s to come and to advocate for you (in the local language) when situations exceed your comfort level.

How will you pay?

“I knew going into it that it would just be so much cheaper than giving birth in the U.S., but in the U.S. I would've had my insurance pay first; in Mexico, I had to basically put the whole thing on a credit card and get reimbursed by my U.S. insurance,” Jameson explains. Luckily, the costs were affordable enough to do this, but it is normal for birth abroad to be paid out of pocket and upfront. Some hospitals may not allow the new parent or baby to be discharged until the bill is covered in full.

In many places, parents can pre-pay for a certain type of care package—private, semi-private, or shared room - and delivery type - natural, planned C-section, birth center, home birth, medicated hospital, etc. Knowing these costs in advance can help you prepare to have cash in local currency or access to sufficient credit. You can also run estimated invoices by your insurance company for pre-approval. Last, you’ll want to inform your credit card company that you’ll be making large payments in another country so that transactions aren’t blocked for security reasons.

Aside from basic medical insurance, it’s always a good idea to have emergency medical evacuation insurance should the worst-case scenario occur. With the right coverage, the new parent and baby could be safely and affordably airlifted to the U.S. or a third country with better medical facilities.

What are your options for emergency care?

Once you have decided on the country where you want to give birth, make sure you understand how care will escalate if things go sideways. This is particularly important if you do not speak the local language.

Familiarize yourself with the country's medical facilities and birthing practices before you come. Be in touch with your chosen provider well before the trip and ask some key questions, like “What is the quality of emergency care in the worst-case scenario? Can your partner come into the delivery or surgery area? Can you have a doula or birth advocate with you? What is the ICU like for you and your baby? Does the hospital have a NICU or will the baby need to be transferred elsewhere?”

Talk to other expats who have given birth in that country to learn about their experiences and recommendations.

Remember, not all U.S.-based health insurance plans will offer global coverage. Travel abroad for birth may be viewed as elective. It is important to make sure that your insurance company will cover or reimburse for normal birth expenses, as well as any emergencies that could arise for the new parent and baby. Call ahead to be sure. Consult with insurance companies that cater to world travelers to ask about the cost of medical evacuation coverage for the worst-case scenario.

What paperwork do I need to take and receive throughout the process?

When babies are born, you’d be surprised by how much paperwork comes along with welcoming them into the world. Before giving birth abroad, you may need to request medical visas that show that you can afford the process. That could entail proof of bank balances, financial statements, as well as confirmations of your accommodation throughout the stay.

And there may be documentation that your doctor or local hospital expects you to have on hand even before the baby is born—usually a marriage certificate for biological parents, as well as passport copies.

U.S. citizens will also need to get a Consular Report of Birth Abroad (CRBA, or Form FS-240) before applying for the baby’s U.S. passport. All of that requires paperwork, too. If you and your spouse are citizens of another country, there may be similar or duplicate birth registration processes needed at those embassies or consulates, too.

It is important to note that, in many cases, being born in a foreign country doesn’t automatically guarantee your baby citizenship there. The 'right of soil,' which means that children born abroad are automatically recognized as citizens of the country of birth (regardless of the parents' citizenship), is applied to varying degrees in around 64 countries. The paperwork to secure that is also one more thing on parents’ long list of to-dos.

The timing to complete all these administrative processes can affect how long you’ll need to stay in the country after the baby is born.

Where will you get birth and postpartum supplies?

Disposable underwear is likely the last thing on your mind, but it becomes a much more urgent necessity as birth approaches. The same is true for nursing bras, compression socks, breast pads, nipple creams, and breast pumps. Not to mention, the baby needs a car seat, bassinet, baby formula, and diaper rash creams, too. The question is, will you bring them with you or buy them locally?

Create a budget and compare prices. Don’t forget the electrical voltage compatibility, so you don’t blow out your beloved bottle warmers and breast pumps. Many places will have these supplies at the ready in department stores and pharmacies, but they may not be exactly like what you can get at home. Again, not all hospitals will supply some of the basics that you might be able to nab in U.S. hospitals.

When it comes to essentials, bring a few with you and be prepared to make a switch to local brands and products until you can make your way back home.

All the little things…

No matter where you birth, having a baby is a difficult task. There are many unknowns and lots of stressors along the way, especially for the birthing person. If you feel comfortable with a birth team abroad, then consider how realistic it is to spend 3-4 months immersed in their care and to truly build trust. While it might be more affordable, there can be administrative burdens and culture shocks to contend with. Traveling abroad may sound like a great idea, but it comes with its own level of uncertainty.

Carefully consider where the new parent and baby will get the best overall care. Don’t leave the birthing person's care (especially postpartum support) to chance. By the second trimester, you’ll want to know for sure where you plan to give birth, all the steps needed to make it happen, and all the postpartum arrangements that will support the entire family on this journey. Most airlines do not authorize pregnant people to fly after 34 weeks, so it’s best to weigh all options well before then.

Last, remember to take medical records with you–in hard copy and electronically–as most physicians will expect patients, not previous care providers, to transfer vital medical information from one country to another.

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