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Having a Baby Overseas: What Military Spouses Should Know

baby in hospital bassinette

What Should You Know Before Having a Baby Overseas? Here’s What Military Spouses Shared

Guest post by Danielle Keech. Many thanks to all the military moms who shared their overseas birth experiences for this article to help other military spouses!

With all the questions and uncertainty you may feel about living OCONUS, you might wonder, what is it like to have a baby overseas? 

It’s no secret that healthcare looks a little different when you leave the states. Preemptively, the military requires overseas screening for dependents accompanying their servicemembers to most overseas duty stations. This step in an OCONUS move helps to ensure that the overseas location can provide the healthcare necessary for the incoming families. If proper care isn’t available, the families are often denied area clearance. 

But the screening process doesn’t account for future health needs like having a baby. Once established overseas, you’d expect to receive quality healthcare. And in some cases and locations, it simply isn’t possible. 

Take June 2023, for example:

The Kadena Medical Clinic in Okinawa, Japan, announced on their social media page that they were diverting care for expectant mothers off island due to a staff shortage. Parents would have to choose between going to another off-island military facility or hope to be seen at a local birthing clinic. Just as you’d expect, the notice incited fear and anger among all military branches and left moms wondering what they would do with their children if they had to leave the island to finish out the pregnancy. Mom and baby wouldn’t be able to return to the island without a passport and area clearance, not to mention the cost of living while waiting. 

Fortunately and, unfortunately, that message was accurate, but only for a niche of expectant mothers. It should not have reached the masses, but because it did, the military spouse community banded together, and leadership worked to correct the wrong. In a matter of weeks, medical facilities in Okinawa expedited the hiring process for new hires and received more providers there on temporary duty (TDY). 

I don’t think it matters where you deliver, as you’ll hear both glowing and cringy birth stories about any medical facility. Okinawa is no different. 

new mom and baby right after birth

My Birth Experience in Okinawa, Japan

We recently welcomed our fourth baby at Naval Hospital Okinawa on Camp Foster. Each of our kiddos were born in military hospitals, but this was the first delivered overseas. Like my other pregnancies, I saw the midwives at the hospital. We moved across the island, and the hospital was more convenient for appointments, or I would’ve continued care with family medicine at a small base clinic. 

Things were consistent with what I experienced at the military care facilities stateside until I reached full term. I’ve never sought the all natural, unmedicated childbirth, but I do favor natural timing. I don’t give babies the eviction notice and induce unless the baby’s or my health is at risk. But things were different here.

As my due date neared, they pushed for induction, and I declined each time. Unfortunately, when I went in for a magnesium supplement following my 39-week appointment, we noticed a couple decels in the baby’s heart rate. In response, the OB/GYN on duty wanted to induce right then and there. But the decels were minor and stopped after an additional 90 minutes of monitoring, yet I was discouraged from leaving the hospital. There’s much more to unpack here, but I’ll spare you the book and try to stick to the main point. 

Ultimately, the most significant difference between the care I received here and stateside was the need to advocate for myself throughout the delivery. I felt overlooked, unheard, and like a burden to the OB/GYN that day. 

Looking back, I realize that this could be due, in part, to the difference between midwives and OB/GYN’s. My prenatal care was with midwives, but it was an OB/GYN on duty when I delivered. They seem to favor management and control versus natural timing. 

mother and newborn right after birth

What I Learned About Having a Baby in Okinawa

The staff is overworked

They work too many hours, long shifts, and have too many patients. I suspected that the OB/GYN pushed for an induction despite me being low risk, because she wanted to preserve her sleep as our arguing continued into the evening hours. My suspicion was confirmed when I managed to chirp a light-hearted apology between contractions at 12:30 am, and she said, “I knew this would happen.”

The hospital is low capacity

There’s a limited number of beds, and they need to get moms in and out or they won’t be able to offer quality care to every laboring mom. Scheduled labors allow more control than spontaneous ones.  

It’s also under staffed

Unfortunately, you don’t decide who delivers. I’ve never hand-picked the provider that’s delivered my babies in military facilities, but this was the first case where I had an OB/GYN when I preferred a midwife and didn’t have the option. 

They might need to divert care

You could be sent off island for necessary healthcare. There’s an overseas medical clearance for a reason. The facilities and staff here aren’t prepared to handle everything the states can. High-risk pregnancies could fall outside their wheelhouse, landing you on a plane to Tripler Army Medical Center in Honolulu, Hawaii. 

Postpartum care is lacking

The perceived gap in prenatal healthcare extends into postpartum care as well. When asked how their experience in Okinawa was, even moms with positive birthing experiences (believe me, there are plenty of those, too!) expressed concern for follow-up care. Lactation consultants are hard to come by, if at all, and mental health appointments for Postpartum Depression (PPD) are typically booked weeks, even months, out. 

Local care is available to Americans

While it’s not widely advertised, Americans are welcome to apply for local healthcare. The Yui Clinic is a popular option and accepts mothers as their space allows. However, Japan doesn’t offer high level pain management like epidurals, and while they do perform cesarean sections, they will not do VBACs (Vaginal Birth After Cesarean). Having said that, it’s hard to find a negative review of the clinic. They offer exceptional services during labor and are leaps and bounds above military medicine when it comes to postpartum care.  

The paperwork will take longer than you realize

The amount of running around you need to do to make your child a U.S. citizen and get them a passport burns through a significant amount of paternity leave. The resting doesn’t really take place until they’re about a month old.  

new mom and infant with nurse in background

Other Military Moms’ Birth Experiences Around the World 

But Okinawa isn’t the only overseas duty station, of course—Belgium, England, Germany, and Australia are a few others and they each offer different birthing experiences. 

Take Belgium, for example

Chantal was only offered care off base, and had five hospitals from which to choose. She shared,

“The entire process was so much more relaxed. The childbirth was much more natural than medical. The staff only came in when needed. They let me labor without a ton of wires and minimally checked in.” 

Giving Birth in England 

Depending on where you live, military moms seek care locally in England. While one mom shared the woes of navigating TRICARE Overseas, another, Rachel, sought the United Kingdom’s free healthcare but noted the distinctly different approach to childbirth from the U.S. 

“We are utilizing the NHS, the UK’s Free Universal Healthcare while stationed here. That said, for a pregnancy considered low-risk, the options for delivery are either home birth or birthing center. They do not immediately offer any hospital or high level pain relief as an option of birth plan. The standard of care is extremely hands off as they take the approach that women have done this for years. I was confident with this approach as I’ve had the amazing opportunity to birth two babies before. If this had been my first, I would have been treading water based on the lack of information given about nearly everything.”

Having a Baby in Germany 

There is only a base clinic in Stuttgart, Germany, so expectant mothers are limited to choosing care at the local hospital or driving to Landstuhl about 200 km away. But Jessica shared,

“I really enjoyed having my second in Germany, but it was certainly a different experience than delivering in the states. Quality of care was great. There is this misconception that German doctors and nurses are stern and will discourage epidurals and other pain management, and that wasn’t the case. My midwife was wonderful, and she was the one encouraging an epidural.” 

Vastly different from the U.S. is Australia 

While her delivery and care at the local facility were top-notch, thanks to an excellent OB recommendation, Samantha pointed out some significant differences between the two countries. 

First, circumcision is not included in standard care and is heavily discouraged, even earning the term barbaric. If parents seek circumcision for their boys, their options are limited to a specialty provider or a Rabbi. 

“The admin side of things was a bit of a nightmare, though, as TRICARE Overseas required specific authorizations for every aspect of care. And also because the Australian medical/hospital system is very different from the American one that TRICARE operates from. For example, per the Aussie standard, I received individual itemized bills from every provider I came into contact with during my labor and delivery hospital stay— e.g., my OB, my anesthesiologist, and the pediatrician. The standard authorization TRICARE gives covers the hospital stay (because in America, everything else gets billed under that through the hospital). So as a result, I had to spend a not-so-insignificant amount of time on the phone trying to reach TRICARE Overseas (whose phone lines for our region were notoriously down), to get the additional specific referrals for every individual provider, as well as for any lab work needed.” 

baby feet in hospital

FAQ’s About Having a Baby Overseas as a Military Spouse

1. Should I wait till we’re back stateside to expand our family?

While having the support of family nearby can be extremely helpful, most moms shared that they’re grateful for their overseas experience and that it caused them to rely more heavily on the local community and, as a result, strengthened their relationships. 

2. I have a high-risk pregnancy. Can I be seen at my overseas duty station? 

While it’s true that some overseas duty stations divert care to other facilities when needed, others are fully equipped to handle your needs. This decision depends significantly upon your risk level and the facility’s resources. 

3. Will I have the option of pain management for childbirth overseas? 

Pain management varies greatly country to country. While the U.S. offers epidurals, Japan and England are among the countries that don’t. 

RELATED: Do you know about these pregnancy and postpartum supplies covered by TRICARE?

new mom and dad with newborn in hospital

Words of Advice from Military Spouse Mommas 

“Advocate for yourself first. Take it slow and let your life settle after moving, unless you’re showing up pregnant. Use the patient advocates. Seek mental health support as needed. Be kind to yourself. Find other new parents if possible or an outlet where you can connect with others over shared interests/situations.” -Meg

“While not necessarily birth related, I’d encourage considering what the recovery process is like and access to experienced pelvic floor physical therapists to assist with complications from pregnancy and/or delivery.” -Whitney 

“Whether or not you are planning or not planning (that was us!) to expand your family and then receive OCONUS orders, ask those hard questions about what birthing looks like! We had a wildly different experience here. But it was beautiful in its own way. Understanding and appreciating different cultural approaches was extremely helpful.” -Rachel

While being overseas can add another layer of uncertainty when having a baby, it can be an incredible opportunity. But quite often, it’s simply another way to experience the local culture. And when you start to doubt the process, remember many have gone before you, and many of us are willing to point you in the right direction, offer emotional support, and cheer you on when you need it. 

Note: This article is provided for informational purposes only and is based on military spouses’ current experiences. Always check in with your local military medical facility about your birthing options while living overseas.

About the author:

Danielle Keech is a writer and content creator for MilitaryByOwner Advertising, Inc. where she writes on military life topics. She especially enjoys covering financial matters and helping military families exercise financial responsibility to plan for the future. Danielle has been a Marine Corps spouse for ten years (and counting!) and is a momma to four littles and one fur baby. She and her pilot spouse have lived in Virginia, Florida, Texas, California, Hawaii, and, most recently, Okinawa, Japan. And yes, you guessed it, Hawaii is her favorite duty station to date!

Find more of Danielle’s content on MilitaryByOwner.

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Hi, I'm Jen!

As a military spouse of three decades and now the mom of an active duty son, my hope is to support you in your own military life. You’ll find help for your military marriage, deployments, PCS moves, and more!