United States – Maternity and Giving Birth

What maternity care options are available in the United States?

Unlike nations such as Canada or the United Kingdom, which operate universal public maternity services open to all residents, the United States has no single national framework for maternity care. Instead, the system is built around a combination of private health insurance, employer-provided plans, and public programmes including Medicaid and the Children’s Health Insurance Program (CHIP). For the majority of expats, what care they can access will be determined almost entirely by their insurance arrangements.

Prenatal care typically begins with an initial appointment as early as possible in the first trimester. The American College of Obstetricians and Gynecologists (ACOG) recommends that a thorough initial assessment — covering full medical and reproductive history — ideally take place before 10 weeks of gestation. Historically, routine antenatal care in the US has involved 12 to 14 in-person visits over the course of a pregnancy, though updated guidance increasingly favours adjusting visit frequency to match each patient’s individual risk profile. Care is most often led by an obstetrician-gynaecologist (OB-GYN), though certified nurse-midwives, general midwives, and family medicine physicians are also integral to the system.

Routine prenatal care encompasses regular ultrasound scans, blood pressure checks, blood and urine testing, and screening for conditions such as gestational diabetes and pre-eclampsia. Telehealth-based prenatal consultations, group antenatal care models, and other innovative approaches are becoming more widely available and are increasingly encouraged as part of a more personalised prenatal care framework. For expats who are still getting settled in a new location, the option of remote appointments can be particularly valuable.

Hospital birth attended by an OB-GYN remains the dominant model across the country. Nevertheless, alternatives are available. Birth centres provide a more intimate, homelike setting under midwifery-led care and are a well-regarded choice for low-risk pregnancies; some insurance plans partially cover their costs. Home births attended by licensed midwives are also legally permitted in most states, though the applicable legal frameworks and insurance coverage differ considerably between states.

Medicaid is the primary public safety net for those with limited financial means. Together, Medicaid and CHIP fund more than 40 percent of all births in the United States. Eligibility is generally assessed on the basis of income and residency, but immigration status is also a factor — expats holding most non-immigrant visa categories are typically ineligible for federal Medicaid until they have maintained a qualifying immigration status for at least five years. Undocumented residents are generally limited to emergency Medicaid only. Rules vary between states, and expats should verify their specific eligibility with their state Medicaid office in light of their visa category.

Access to maternity services is far from uniform across the country. More than 35% of US counties have no maternity care providers at all, and 56% of rural counties lack any such services entirely. For expats planning to settle away from large cities, researching local provision early in pregnancy is essential. Telehealth is emerging as a meaningful way to extend access — enabling remote consultations, monitoring, and perinatal education — particularly in underserved rural communities.

How much does it cost to give birth in the United States?

Childbirth in the US ranks among the most expensive in the world, with total costs varying widely depending on the type of delivery, geographic location, hospital, and insurance arrangement. For expats lacking adequate coverage, financial exposure can be severe. Arranging comprehensive maternity insurance before conceiving is strongly recommended.

A 2025 Peterson-KFF Health System Tracker report found that the overall average healthcare expenditure for pregnancy and childbirth in the United States is $20,416, with patients on employer-sponsored insurance paying an average of $2,743 out of pocket. These figures, however, conceal significant variation. Caesarean sections cost roughly $13,000 more in total healthcare spending than vaginal deliveries and around $500 more in out-of-pocket expenses.

FAIR Health data from 2024 places the median in-network cost of a vaginal delivery at $15,178, while the average C-section reaches $19,292. For uninsured individuals, the costs are considerably steeper: a routine vaginal birth without coverage averages $13,024, and a C-section can exceed $22,647, particularly if complications arise or a longer hospital stay is needed.

The choice of birth setting also shapes the final bill. Hospital births are the most common but carry the highest price due to facility fees, continuous staffing, and immediate access to surgical intervention if necessary — typically ranging from $14,000 to $27,000. A birth centre is a more economical alternative at around $7,240. A home birth is the least costly at approximately $4,650, though insurance often provides limited reimbursement, and any complications requiring emergency hospital transfer can drive costs sharply higher.

Geography is another major variable. An equivalent delivery that costs $8,000 in Arkansas might run to $19,000 in California, with urban areas tending towards higher costs owing to hospital pricing, local cost of living, and provider availability. State-level out-of-pocket costs vary by nearly $1,700 — from around $974 in Michigan to $2,685 in Nebraska, based on 2020 claims data.

For expats obtaining insurance through the ACA Marketplace, in-network out-of-pocket maximums are capped at $9,200 per person for 2025. All non-grandfathered health plans must fully cover breastfeeding support, counselling, and equipment, including a breast pump, at no cost to the patient. Many international health insurance policies can be used within the US, but waiting periods of 10 to 12 months before maternity benefits become active are common. It is essential to read the specific terms of any policy before relying on it for maternity coverage.

Medicaid and CHIP shoulder a substantial proportion of birth-related costs for lower-income residents and often provide more generous coverage than private plans. As noted above, however, most newly arrived expats will not immediately qualify. The Healthcare.gov Marketplace and your state’s Medicaid office are the most useful starting points for understanding your options.

What is the standard of maternity and neonatal care in the United States?

The United States is home to some of the most sophisticated neonatal and high-risk obstetric facilities anywhere in the world, and its leading academic medical centres and private hospitals deliver outstanding specialist care. At the same time, average national outcomes — including maternal mortality rates — compare unfavourably with those of many other high-income nations, and access to high-quality services is distributed unevenly across the country.

Prestigious hospitals and academic medical centres in cities such as Boston, New York, Houston, and Los Angeles offer world-class neonatal intensive care units (NICUs), maternal-foetal medicine teams, and advanced obstetric surgical capability. Private hospitals tend to emphasise patient amenity — individual rooms, dedicated labour-and-delivery suites, and greater continuity of care with a preferred provider. Clinical standards at accredited institutions are overseen by bodies such as The Joint Commission.

Significant segments of the population face meaningful barriers to maternity care, and these gaps are associated with rising rates of maternal and infant morbidity and mortality, especially in rural regions and among historically marginalised communities. Factors such as hospital closures, clinician shortages, and gaps in insurance coverage have contributed to delays in prenatal care, elevated preterm birth rates, and worsening maternal mortality statistics in some areas.

Expats moving to rural locations should make it a priority to investigate local maternity care availability early in pregnancy. Midwifery-led care offers safe, patient-centred options for low-risk births, yet growth in this workforce is hampered in some states by restrictive licensing frameworks and limited training infrastructure.

Language access is a legally protected right in US healthcare settings that receive federal funding. Under Title VI of the Civil Rights Act, hospitals and clinics are obliged to provide interpreter services free of charge to patients with limited English proficiency. The quality of this provision varies in practice, and it is worth confirming interpreter availability — whether in-person or by telephone — with your chosen provider well before your due date. Many large urban hospitals employ multilingual staff and patient advocates to support non-English-speaking patients throughout the birth process.

What should expats know about maternity rights and leave in the United States?

By international standards, maternity and parental leave entitlements in the United States are quite limited. There is no federal right to paid maternity leave, and the combination of federal and state rules means that what an individual is actually entitled to depends heavily on their employer, their occupation, and the state in which they live and work.

The primary federal framework governing maternity leave is the Family and Medical Leave Act (FMLA), which entitles eligible employees to up to 12 weeks of unpaid, job-protected leave per year for the birth or adoption of a child. FMLA applies to employers with 50 or more staff. To qualify, an employee must also have worked for the same employer for a minimum of 12 months and have accrued at least 1,250 hours of work during the preceding year.

The United States has no national paid maternity leave mandate. As of 2025, the jurisdictions that have enacted their own paid parental leave programmes include California, Colorado, Connecticut, Delaware, Maryland, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Washington, and the District of Columbia. Employees in states without such programmes may need to rely on accrued paid time off, short-term disability insurance, or other employer-specific benefits to replace any income during leave.

Several states — including California, New Jersey, New York, Rhode Island, and Washington — operate paid family leave systems that encompass maternity leave and provide partial wage replacement, making it more feasible for employees to take time away from work to bond with a newborn. California’s Paid Family Leave programme, for instance, allows eligible recipients to claim benefits for up to eight weeks at approximately 60 to 70 percent of their usual weekly earnings.

FMLA applies equally to foreign nationals working legally in the United States, provided the standard eligibility criteria are met — employer size, duration of employment, and hours worked. Federal law does not extend FMLA or equivalent protections to self-employed individuals or independent contractors following the birth of a child. Some employers may nonetheless offer contractual leave provisions for freelancers and contractors, so it is always worthwhile reviewing your contract or raising the question with HR.

For authoritative and current guidance on your entitlements, consult the US Department of Labor’s FMLA page and the relevant state labour authority. Where a state paid family leave programme exists, it will also have its own eligibility criteria and application process that you will need to follow.

How do you register a birth in the United States?

Birth registration in the United States is administered at the state level by each state’s vital statistics office. The process is largely coordinated by the hospital, making it considerably more straightforward than in many other countries. The typical steps are as follows:

1. Complete the birth registration worksheet: Shortly after the birth, hospital staff will present parents with a birth registration worksheet — sometimes referred to as a certificate of live birth worksheet or worksheet of facts. Both parents are asked to fill in their personal details, the child’s chosen name, and other relevant information.
2. Provide required documents: You will generally need to show valid, government-issued photo identification for both parents, along with a marriage certificate where applicable. Some states additionally request immigration documents from non-citizen parents.
3. Hospital submits the registration: The hospital registrar transmits the completed birth registration data electronically to the state’s vital statistics office, usually within a few days of the birth. Most states require registration within 10 days of delivery, though both the deadline and the precise process vary from state to state.
4. Receive the birth certificate: The state vital statistics office then issues an official birth certificate. Note that any commemorative birth certificate provided by the hospital is not a legal document. To obtain a certified copy of the official certificate, parents must submit a request to the state vital statistics office — typically online, by post, or in person.
5. Pay the fee: Certified copy fees vary by state, typically falling in the range of $10–$30 per copy as of 2025. Check your state’s vital statistics office website for the current amount, as these figures are subject to change.

For births occurring outside a hospital — at home or in a birth centre — the attending midwife or physician is generally responsible for filing the birth registration with the state. It is the responsibility of the parent or midwife to ensure this is done within the state-mandated timeframe. Your state’s vital statistics office can provide specific guidance; a directory is available through the CDC’s National Center for Health Statistics.

As an expat, there are additional steps to complete. Once the US birth certificate is in hand, you will typically need to register the birth with your home country’s embassy or consulate in the United States in order to obtain citizenship documentation for your child. You will also need to apply for a passport for your newborn — both a US passport (where applicable; see the nationality section below) and one from your home country. Contact your embassy promptly after the birth, as requirements and timeframes vary. You will generally need to present the original US birth certificate, both parents’ passports, and any supporting evidence of citizenship by descent.

What nationality will my child have if born in the United States?

The United States applies a robust jus soli (birthright citizenship) principle, codified in the 14th Amendment to the Constitution. Under this principle, the vast majority of children born on US soil acquire US citizenship automatically, regardless of their parents’ nationality or immigration status.

This has historically placed the United States among the most permissive countries in the world when it comes to birthright citizenship. While many European nations rely primarily on jus sanguinis — citizenship inherited through a parent’s nationality — the US grants citizenship by virtue of the place of birth. A child born in the United States to two foreign national parents, whether they hold temporary visas, permanent residency, or any other status, is generally entitled to US citizenship from the moment of birth. It should be noted that there is active legal and political debate regarding the precise scope of birthright citizenship, and parents should keep abreast of any developments through official government channels.

To establish and make use of your newborn’s US citizenship, you will need to obtain a US birth certificate and then apply for a US passport for the child. A Consular Report of Birth Abroad (CRBA) is not applicable in this context, as that document is for children born outside the United States to American citizen parents. Application forms and step-by-step guidance are available through the US Department of State.

In addition to US citizenship, your child may be entitled to citizenship of your home country, depending on whether that country grants nationality to children born abroad to a national parent (jus sanguinis). Many countries allow such registration. You should contact your home country’s embassy or consulate in the United States as soon as possible after the birth to begin this process. Requirements differ markedly between countries — some impose strict deadlines, requiring registration within a set number of months from the date of birth.

Questions of nationality can become legally complex, particularly where dual or multiple citizenships are involved. Always verify your child’s specific circumstances with the relevant embassy or consulate and, where necessary, seek advice from a qualified legal professional with expertise in immigration or nationality law.

What are the laws and attitudes around abortion in the United States?

The legal landscape around abortion in the United States underwent a fundamental shift in June 2022, when the Supreme Court issued its ruling in Dobbs v. Jackson Women’s Health Organization, overturning the federal constitutional right to abortion that had been established in 1973. As of 2025, there is no federal statute governing abortion access, and the legal situation varies dramatically across states.

A number of states — including California, Colorado, Illinois, and New York, among others — have passed legislation that broadly protects abortion access, with few or no gestational restrictions. At the other end of the spectrum, states including Alabama, Arkansas, Missouri, Oklahoma, and Texas have introduced near-total or complete bans, with limited exceptions in cases of medical emergency or, in some instances, rape or incest. Many other states have imposed gestational limits — commonly at 6 weeks (frequently before a pregnancy is even detected), 12 weeks, or 15 weeks — with varying exceptions depending on the state.

In states where abortion remains legally accessible, services can typically be obtained through dedicated reproductive health clinics such as Planned Parenthood, private gynaecology practices, and some hospital settings. Federal Medicaid funding is generally not available to cover abortion costs under the Hyde Amendment, although some states direct their own funds towards coverage. Where abortion is accessible, medication abortion in the first trimester may cost anywhere from nothing (for those insured in a state that mandates coverage) to several hundred dollars at a clinic; surgical procedures are more expensive and costs rise with gestational age. Specifics vary considerably — it is advisable to contact providers directly in the relevant state for current information.

Expats relocating from countries where abortion is broadly available — such as most of Western Europe, Canada, or Australia — may find the US environment in 2025 considerably more restrictive than what they are accustomed to, with outcomes entirely dependent on the state of residence. Individuals in states with restrictive legislation sometimes travel to neighbouring states where access remains available, though this comes with logistical and financial challenges of its own.

For the most up-to-date information on the legal position in any specific state, refer to the Guttmacher Institute’s state policy tracker or the relevant state health department website. For personal medical advice, consult a licensed healthcare provider.

Frequently asked questions about having a baby in the United States

Can I use the public healthcare system (Medicaid) for maternity care as an expat?

Most expats holding non-immigrant visas — such as work or student visas — are ineligible for federal Medicaid until they have held a qualifying immigration status for at least five years. Some states extend emergency Medicaid to cover labour and delivery for residents who do not otherwise qualify, including undocumented individuals. Your eligibility will depend on your visa category, income level, and state of residence. Contact your state’s Medicaid office for a definitive assessment based on your individual circumstances.

Do I need special health insurance to cover having a baby in the US?

Yes. Without insurance, maternity care in the US is extremely costly. You should confirm that your health plan includes maternity benefits before you become pregnant. Plans purchased through the ACA Marketplace are legally required to include maternity and newborn care as an essential health benefit. Many international insurance policies carry waiting periods of 10 to 12 months before maternity coverage becomes active, so advance planning and careful policy review are essential.

How much will I pay out of pocket to give birth in the US with insurance?

As of 2025, individuals enrolled in employer-sponsored health insurance pay an average of approximately $2,743 out of pocket for the entire pregnancy and birth episode. However, this figure varies based on your plan’s design, your state, and the type of delivery. Those on high-deductible plans or with complicated pregnancies may pay considerably more. Out-of-pocket maximums on ACA Marketplace plans are capped at $9,200 for in-network care in 2025.

Is my baby automatically a US citizen if born in the United States?

In most cases, yes. The United States grants birthright citizenship under the 14th Amendment, meaning that most children born on US soil are US citizens from birth, irrespective of their parents’ nationality or immigration status. To make use of that citizenship, you will need to obtain an official US birth certificate and apply for a US passport for your child. There is ongoing legal debate surrounding the precise boundaries of this right, so it is worth monitoring official government communications for any updates.

Can my baby have dual nationality — both US and my home country’s citizenship?

Possibly, depending on your home country’s laws. Many countries confer citizenship on children born abroad to a national parent through jus sanguinis. To pursue this, you would need to register the birth with your home country’s embassy or consulate in the US and apply for your child’s passport. Some countries limit or prohibit dual nationality, so it is important to check with your embassy and consult a qualified legal adviser if the situation is complex.

How do I register my baby’s birth in the US?

The hospital typically manages the majority of this process on your behalf. Shortly after the birth, staff will ask you to complete a birth registration worksheet, which the hospital’s registrar then forwards electronically to the state vital statistics office. You subsequently request certified copies of the birth certificate directly from the state. Fees are generally $10–$30 per copy as of 2025, varying by state. For births outside a hospital, the attending midwife or physician is responsible for submitting the registration. Your state’s vital statistics office can provide specific guidance on local requirements.

What maternity leave am I entitled to if I work legally in the US?

Provided you work for an employer with 50 or more employees and have completed at least 12 months of employment with a minimum of 1,250 hours in the past year, you are entitled to 12 weeks of unpaid, job-protected leave under the federal FMLA — on the same terms as any other employee, regardless of nationality. There is no federal mandate for paid maternity leave, but a number of states — including California, New York, Massachusetts, and others — operate paid family leave programmes that provide partial wage replacement. Consult the US Department of Labor website and your state labour authority for current details on your entitlements.

What are my options if I need an abortion while living in the United States?

Your options depend entirely on the state in which you reside. Since the Supreme Court’s 2022 Dobbs decision, some states have broadly protected abortion access while others have imposed near-total bans. Where abortion remains legal, services are available through reproductive health clinics and some private providers, with costs and gestational limits that vary by state and provider. For current state-by-state information, consult the Guttmacher Institute’s state policy tracker or the relevant state health department. For personal medical guidance, speak with a licensed healthcare provider.