Flying with a Baby

Having recently completed two international airplane journeys with our infant, I thought I'd throw out some long-haul travel ideas. Before we left for our second trip I was encouraged by some moms to get something like Benadryl to "encourage" the baby to sleep. I considered it for a while because our first experience had been pretty rough, but wasn't sure what to do. I finally decided to buy some in case I was really desperate, but to try to get by without it. Well, the decision was made when I discovered that neither of the drugstores I visited would sell anything like that for use on a child under six years old. I was really surprised! Just as well as I've since read recent studies that strongly discourage anything of the kind.

So, the following are some practical, natural (as in, non-medical) tips for helping you and your baby cope with a long flight, both for sleeping and for trying to stay occupied and relatively quiet while you travel.

1. Bassinet: If your baby is 22 pounds or less request a bassinet. This can be an invaluable way to free up your tired, sweaty arms, especially if you're traveling alone. It's basically just a little bed that hooks into the wall in front of you. In order to use one, you have to be sitting in the front of a section, so make sure when you make your reservations, that you choose your seat carefully. It may be worth a phone call to the airline to see if they can arrange it for you. Also, make sure you verify it when you check in.

2. Sleep Prop: Before you travel, choose an item for your baby to sleep with and work toward creating a sleep association. This could be a blanket, stuffed animal, pacifier or anything soft or cuddly that's safe to sleep with. (If you don't let your baby sleep with anything for safety reasons, disregard this point.) Make sure you only give the item to your baby when it's time to sleep. Then, when you are on the plane and your baby finds himself in a new environment, he will be able to understand that it's time to sleep when you pull out the sleeping prop. This worked wonderfully for us on our most recent trip.

3. Cheerios: If your baby is old enough for solids, I strongly recommend an investment in a box of Cheerios. They're not just food, they're interesting to play with (prior to eating, of course), make a relatively small and easy to clean up mess, and take a long time to eat. Put one at a time in your hand and make your baby pick it up for himself. This should be good for at least 30 minutes of entertainment!

4. Nurse/Bottlefeed: Of course, there's the conventional wisdom about nursing during takeoff and landing to help those little ears pop. Also good for keeping baby quiet and occupied for a few minutes.

5. Goody Bag: Assemble a little bag of never-before-seen items for your baby to play with. DO NOT take toys that your child is used to playing with. Save your precious space for new things that will keep baby occupied much longer. But, before you run out to the store to buy a bunch of new toys, do a walk around your house and see what kinds of safe, interesting household objects you have that might enthrall your baby for hours. Here are a couple of ideas from our recent trip with an 8 month old: a new toothbrush (this was a BIG hit). (Make sure it's a soft-bristled brush to avoid chaffing his little gums); a well-washed silicon pastry brush; a rubber spatula; a brightly colored ribbon; a Tupperware lid; half of a wooden clothes pin (without the spring, of course). I kept this odd assortment of things in a little zip up bag--like a toiletries bag--that he could also play with. That way everything was contained and I didn't have kitchen gadgets roaming free through my diaper bag. Speaking of diaper bags...

6. Organize your Diaper Bag: This is essential. The temptation when traveling is to let carry-ons become the dumping spot for everything that didn't fit elsewhere. As a result you end up with bulging, disorganized bags and it's impossible to find what you want when you want it. There's nothing worse when traveling with a baby. If you possibly can, ensure that the diaper bag is carrying only baby's things and that they are only things that are absolutely necessary. For instance, does he really need three changes of clothes? Ten diapers and a whole container of wipes? Six jars of baby food? Are bigger toys really better than small? Think carefully through every item you place in the bag and your ride will be much more pleasant for all.

Reflections on the UK Health System

I have talked to several Americans who've had really horrible experiences with the UK's National Health Service. Others have been full of praise and thoroughly surprised by the level of attentive care they were given. Here are my general reflections about how you might find the care over here, especially as it differs from the American system. I realize being totally unbiased is not possible, but I'll do the best I can.

The fundamental thing to remember about the NHS is that because they are a branch of the government, they do not function like the American private practice system. In short, their primary aim is not to please you. Health care workers have little incentive to make concessions, do things your way or bend over backwards for you. This is because their livelihood does not depend on your satisfaction with their work--they are paid by the government, not by you. This is not to say, of course, that health care professionals in the UK are heartless and lazy. I cringe just typing that sentence. I have had some wonderful doctors here who have worked hard on my behalf and shown a great deal of care about me and my family. I have also had some who nearly put me in tears because of their calloused, unconcerned and unmotivated air. The funny thing is, I could say the same thing about doctors I've had in the US. The difference is, in the US, you have the choice to leave and go find a doctor you like better. Your options here are much more limited, often non-existent.

As a result of this foundational difference, here are some things you might face (based on my experience and that of friends):

Negatives:

1. Dead ends: You may feel that your doctor in the UK will not try as hard you think he/she could to find solutions to your health concerns, particularly if the problem is complicated. For instance, a friend in his 30's, after snapping the arch in his foot, was told by his UK doctor that he would never walk again. He was offered no further assistance. He flew back to the US to see his doctor at home and was walking again within a week.

2. Rigid Compliance to Rules: You may feel your health care provider cares more about the rules or the system than about your needs. We recently had a friend whose NHS prenatal classes were completely canceled. When she asked her midwife how to proceed, i.e., how/where to get the replacement classes, she was told she'd just have to go without because the other classes were full. Another friend was forced to leave her doctor's appointment after 10 minutes because her time was up. They didn't care that she had more questions and concerns to discuss.

3. Limited Options: As I said above, your choice of a health care provider will likely be somewhat limited. If you don't like the practice you're at, changing practices will not necessarily be a sinch if it's possible at all. In my experience, you are only permitted to register at the practice that is nearest where you live. The exception is if there is a practice that generally accomodates the University students, though these practices often have heavy burdens placed on their resources and you may find better care at the one closer to home.

Positive:

Remember, it's free. Whenever I face something unpleasant, I remind myself that the care I'm getting is 100% free. I was talking to a friend in the US last week who's about to have a baby. Adding herself and the new baby to her husband's insurance plan is going to cost them $700/month. Having the baby, even with insurance, will cost them several thousand dollars. Sometimes I can hardly believe we don't have to think about those enormous expenses!

Having a Baby in the UK: What to Expect for Delivery and Recovery

I already posted on what you might be able to expect from the antenatal (prenatal) maternity care in the UK. Here are some thoughts on the delivery side of things.

1. The NHS midwives generally give you the option to have your baby in the hospital or in your own home under their care. Some areas also have birthing centres.

2. Your antenatal midwife will almost certainly not be the one to deliver your baby. Antenatal midwives and birthing midwives typically have distinct and separate jobs here.

3. If you choose to have your baby in the hospital, you will be given a private room for delivery. After delivery you will be transferred to a recovery room. Recovery rooms are typically shared with up to three other postnatal women and their babies.

4. Your baby will typically be left with you after delivery and throughout recovery, not taken to a nursery.

5. I think it's fair to say that the midwives treat delivery in a less medical way than it is often treated in the States. It will not be normal for you to be strapped down with IV's and other tubes connected to you. You should be a be able to move about freely during labor if you want to.

6. In my experience, your husband will not be allowed to stay at the hospital with you overnight.

Things you might not have expected to have to take to the hospital, but probably should:

1. A gown or something you don't mind giving birth in. That's right, the hospital does not typically provide you with a hospital gown to wear.

2. Nappies/Diapers. The hospital staff will expect you to have brought your own supply. They may send your husband to the store to buy some if you haven't.

3. Flip flops. Without going into too much detail, just remember you may be sharing a shower with up to three other post-natal women.

How to Get a UK Visa for a Foreign Baby, Born in the UK

Did you know that if you and your spouse are foreigners, your baby has no right to live in the UK, even if he/she was born there? That's what we were told by the border patrol agent at the Glasgow Airport after making a weekend trip to Paris when our son was two months old. Oops! We figured that after getting his passport, we were good to go. We were wrong. The border patrol agent VERY kindly let us back into the UK with the stern warning that he had the authority to put our son in detention and have him put on the next plane to the US without us (now, the logistics of doing this with a nursing infant would have been interesting, but nevertheless, he did a good job of scaring us). He stamped our son's passport with a six month tourist visa and told us we needed to apply for a proper dependent visa as soon as possible. Below I'll share with you what we learned about this process. As usual, though I'm writing from an American point of view, this information would likely pertain to other nationalities as well.

First of all, we found the citizen's advice bureaus to be very helpful. "The Citizens Advice service helps people resolve their legal, money and other problems by providing free, independent and confidential advice..." They are non-profit organizations and they are happy to help people like you and me with just these sorts of questions. I highly recommend giving them a call if you need help with anything.

The other folks to contact are the people at your regional Public Enquiry Office. Actually, the phone number on the website can be incredibly difficult to get through on, but it is possible. They are the people with the definitive answers, so it's good to double check any advice you get with them.

Basically, though, the form we were directed to complete to apply for our son's visa from within the UK is called the FLR(O) form (Further Leave to Remain (Other)). Note, this form is only applicable if you are trying to apply while in the UK. While it may not seem like the right form, it is. It's basically a left-overs sort of form for all the people who don't fit into other categories. Also note (this is important), your child will be the main applicant--don't be confused and add yourself as the main applicant and your child as the child of the main applicant. You will have to add a note explaining your particular circumstances, i.e., that the main applicant is a child.

Also, you will see on the application, that it is expensive. The current price is £465 if applying by mail and £665 if applying in person. Yikes! We had to remind ourselves that we didn't have a hospital bill for this kid! One final thing, the wait-time on this application if you mail it in is 4-14 weeks. The more expensive in-person appointments are processed same-day, but you often need to book your appointment a month in advance. You do this by calling the Public Enquiry Office mentioned above.

The other option, of course, would just be to go home to the US (or wherever you have citizenship) to make the application. If you do this, you would need to follow the procedures for applying for a dependent visa from the US per http://www.ukvisas.gov.uk/en/. The difficulty you might run into with this is knowing when to book your return tickets to the UK, since the visa application process can take several weeks and you are not permitted to apply without being on US soil. However, the price for the actual visa is currently around $230. The price difference may almost pay for your plane ticket to go home. Also note, biometric data is NOT currently required for children under the age of five years.

American Passport for your Baby Born in the UK

One of the first things you'll need to take care of after your baby is born (and you're feeling up to snuff) is to apply for your baby's passport. This is not something you can do by mail or online. You will be required to go in person either to the embassy or your nearest consulate. Here's a little step-by-step guide from the website of the US Embassy in London. This site will give you the up-to-date info on what you need to bring with you to the appointment depending on where you live. For visa info for your baby, see the next post.

Notes:

You will be asked to show a marriage certificate. If you do not have a copy with you, you should be able to obtain one from the county you were married in for a minimal fee and have it mailed to you.

You will be asked to show a "long copy" of your baby's birth certificate. This must be obtained at a register office within 3 weeks (Scotland) or 6 weeks (England/Wales) of your baby's birth. This website should provide all the information you need. The "long copy" is referring to the copy you have to pay for, as opposed to the "short copy" you receive for free.

The application for your child's passport will automatically include the application for a Social Security Number and a Consular Report of Birth Abroad. You don't have to make any additional appointments.

General Info About UK Maternity Care

Here's a little general info about the antenatal (prenatal) maternity care I received in the UK.

1. Generally, all maternity care is handled by midwives, not doctors. If you have complications, doctors will likely take a more active role. Otherwise, you may see a doctor only at the very beginning and very end (38 weeks) of your pregnancy.

2. I had appointments every four weeks with the midwife, 36 weeks being my last visit. As I said, I saw the GP at 38 weeks.

3. Last year in Edinburgh, pregnant women were only entitled to one scan (ultrasound) during their pregnancy: around 10 weeks. They have just switched it to two scans: around 10 weeks and 22 weeks. I think this probably varies depending on your location. If you want more scans, you would have to go to a private practice and pay for them.

4. Many hospitals/districts have non-disclosure policies about divulging the gender of your baby. You may or may not be able to find out what you're having before-hand depending on your location.

5. There are birthing classes (called "antenatal classes") available, usually through your local GP.

6. It was made clear that epidurals would be an option for delivery only if an anesthesiologist was on duty when I was in labor. No promises. I had a friend, though, who was given more solid assurance that that would be an option.

7. Prescriptions are free of charge during pregnancy and for the 12 months following the birth of your child. So is all dental care.

Questions? Feel free to ask!

Registering with a Doctor: the Gateway to the Healthcare System

One of the first things you will want to do upon your arrival (after you've secured housing) is to register at your local surgery (doctor's office). As you've no doubt heard by now, most health care in the UK is free if you (or your spouse) are studying for more than six months. However, there are some things you need to do in order to be able to access it. Registering with a GP (General Practitioner or Doctor) is the first step. It is important to do this as soon as you have housing because it can take up to several weeks to get the process sorted out. If you are pregnant, or have an ongoing medical condition, those weeks can be really frustrating.

1.) Find the surgery that is nearest to your flat. You can do this online by clicking on the following links. For England click here. For Scotland, click here.

2.) They will need to see:

a. Your proof of address. You MUST take either a copy of your rental agreement or a piece of official mail (such as a phone bill) with you to the GP's. A hand-addressed envelope will not work. Believe me, I tried it.

b. Your passport with visa inside.

c. It's worth mentioning that they will need to see you too. You cannot register for your spouse. Again, tried it.

3.) They will give you paperwork to fill out--nothing too long or scary. You should be able to fill it out while in the office.

4.) If you don't need to see a doctor immediately you’re done. If you do, you can try making an appointment while you’re there.

If you are pregnant or need to see a specialist, there may be a further wait as you will now need a referral from your new doctor.

Here is a timeline from my experience for accessing specialized care:

1.) Two weeks after settling in at our flat, we received our first official piece of mail. (Want a tip for speeding that up? Sign up for a phone and/or internet plan as soon as you move in. The phone company should send you a piece of mail within a couple of days. This will be helpful, especially if you don't receive a copy of your rental agreement right away as proof of address.) As you know from above, official mail meant we could register with the GP which was the first step.

2.) At the time of my registration, I made another appointment with the GP to go over my general medical history. Just more paperwork, really. This was a necessary prerequisite to being referred to the midwife. The first available option for this appointment was a week after initial registration.

3.) Only after this appointment, did my GP make the referral to the midwives. A week and a half later, I got a letter from the midwives offering me an appointment for the following week.

So, I had been in the UK a total of 5 1/2 weeks before I was seen by my midwife. I believe the process would be the same with any specialist, though with some specialists I imagine the wait would be longer.

My point in telling you this is so that you will not arrive in the UK (as I did) with the expectation that you can go right to the doctor. It may be several weeks before you can be seen, especially if you need to see a specialist.

Having a Baby in the UK?

Having recently gone through this experience myself, I would like to offer a couple of posts with advice on what to do if you are planning to have or have had a baby in the UK as a foreigner.

UK Dental Costs for Foreign Students

While the NHS offers free medical care to those who are studying here for more than six months (and their dependents), there are some medical expenses you will have to factor in to your budget. Here's what you need to know about dental expenses.

All NHS dental examinations in Scotland are free of charge. Take note--that's just NHS dental examinations. There are plenty of private dentists around which you would be expected to pay for. If you want a free exam, be sure you make it clear that you want NHS treatment. (Sometimes the same dentist will do both private and NHS treatment. Confusing, I know.)

An examination will NOT NECESSARILY include a cleaning. (We've heard rumors that some have gotten a free cleaning at their exam, but this is not standard.) It will definitely include a general check-up to see that all looks well and is healthy. A standard cleaning fee is around £10. An intensive cleaning might run you £25. If further work is needed, you will be informed and you would need to schedule an appointment which you would be required to pay for. Click here for a sampling of dental prices in Scotland.

In England exams are not free of charge. However, they're not terribly pricey. Click here for a regularly updated list of dental costs in England.

Exceptions exist, however, in both England and Scotland. All children under 18, for instance, receive free dental care. If you are pregnant or have had a baby in the last 12 months, you will also receive free care. There are lots of other exceptions too, but I don't think they would apply to folks like us who have no recourse to public funds.