While many FS moms choose to give birth right at post, and I have several friends who did so at my current post, State MED actually recommends that mothers to be come back to the US to give birth regardless of where one might be posted. I chose to come back to the US to give birth for a couple of reasons. First and foremost, I had my middle daughter, J, while I was still on active duty stationed in northern Japan. She ended up being an emergency induction meaning that all of our carefully laid plans when out the window. We had no childcare, so my husband had to leave me alone in the hospital while he searched for alternate care for our oldest child. It was also the middle of the day in Japan, which meant it was the middle of the night back in the US, so I could not get a hold of anyone in my family to let them know what was going on. What that all added up to was me, alone, scared to death about what was happening to my baby, did I mention all alone? Of course everything ended up working out ok. J was born with fully developed lungs and only spent a few days in the hospital, but it was still one of the scariest moments of my life and was not an experience I would ever want to repeat. Additionally, we were due to PCS (move, that is) back to the US in May anyway so that I could start language training.* I had already been worrying about how to transition the kids during such an inopportune time (2 months left of school, especially for a freshman!!??), so with the baby due in January it seemed like December break would be the perfect time to transition the kids' to a new school in the US.
FS moms and any children they bring along on medevac are eligible for per diem for 45 days prior and 45 days after the birth (sorry dads, you get zippo). Per diem is quite generous. Moms are eligible for the 100% rate (check GSA per diem rates as it changes by location and month), kids over 12 get 75%, and kids under 12 get 50%. Additionally, after the baby is born, the baby also gets per diem at the 50% rate. Of course, this doesn't mean you automatically get this huge amount of per diem money. The lodging rate covers housing expenses only, so if you don't spend it then it will not be reimbursed to you. The meals and incidentals (M&IE) is yours to keep, but if you're maintaining two households it really doesn't end up being all that much.
There are a couple of ways to make this work. The State Dept has direct bill contracts with housing companies like Oakwood (where we stayed when we first joined the Dept), and if you can make this work for you, I would highly recommend it. The direct bill program means you don't have to worry about paying out any money from your own pocket since the housing company will simply bill the State Dept directly, so all you have to do is file your travel vouchers for your M&IE. Super easy. Another option is to find your own housing, which is what we did. With 3 (sometimes 5) children already, plus a cat and a dog, even the largest offering from Oakwood (a 3-bedroom apartment) is waaay too small for us. We spent a year in Oakwood with 5 kids, and I thought we'd never get out alive! Adding another kid into the mix meant I needed to find more space if only for my own sanity! It was not easy finding housing! I tried reaching out to rental units through the usual methods (Craigslist, realtors, property management companies, referrals from other FS friends), but it was impossible to find something suitable. Luckily, there are several online communities for FS-affiliated folks, and I posted to the two groups I belong to: a yahoo group known as Livelines and a Facebook group called Trailing Houses.** I posted an ad stating what we were looking for (4 bedrooms, yard, proximity to FSI, good schools, etc.), and I was contacted right away by someone looking to rent out their property. This was a real benefit because trying to explain our unusual per diem situation and how the lease has to be structured was almost impossible, so finding someone already familiar with Dept requirements was a lifesaver.***
If it is at all possible, I cannot stress enough how much I recommend the direct bill program. It is so much easier than trying to get reimbursed. But, if you do choose the private rental route for the love of all that is holy take the maximum advance possible! The Department allows someone going on pregnancy medevac to take up to 80% of the potential per diem. I say potential because if the baby comes early the pre-baby per diem clock stops and you only get the 45 days postpartum per diem. For example, say you medevac at 8 weeks before baby comes, but the baby is born a month early. You will only be reimbursed for 2 weeks of pre-baby per diem (per diem starts at 45 days before baby is born). This is the potential trap because if you take a large advance and then lose those per diem days you will still be responsible for paying back the entire advance amount to the Department. But, wait, Pu, you still recommend taking the maximum amount of per diem possible? Why? Because, my friends, the opposite also holds true. If you don't take the advance you can count on not having your request for reimbursement paid out in time for you to pay your rent! For example, I took an advance of $10K. That combined with our liquid savings was plenty to cover our first month and a half of rent (half of Dec, all of January) with the idea that I would file my voucher and get reimbursed in time to pay our second months rent. Hahahahahaha. I forgot who I was dealing with. It is particularly silly because I have worked for the federal government my entire adult life, so you think I would know the cardinal rule of getting paid. When you owe the government expect that the debt will be paid in full immediately even if it leaves you with a $0 paycheck (as happened to me once when AF Finance realized it had been overpaying me and immediately rectified the issue). When the government owes you, you better take out another line of credit because you are going to get paid in their own sweet time. I have been waiting for 8 weeks to get paid for my second voucher (my first voucher was misallocated to pay back the entire advance leaving me with no cash to spare). God only knows when my third voucher will get paid out.
A pregnancy medevac can cost as much as $50K or higher (per diem amounts will vary depending on location and time of the year, as well as any dependent children you might be bringing with you). Trust me when I say it is better to roll the dice and take the advance than it is to be stuck explaining to your landlord how you don't have the money to pay them rent. In our case I was extremely fortunate to have wonderful, loving parents who were in a position to be able to lend us a large amount of cash, but it was an extreme measure that I really did not want to have to take. Regardless of what you decide, the Department will eventually have your back.
*We had hoped to have the baby during home leave between departing post and arriving at language training, but I got pregnant far more quickly than we had anticipated!
**You must be a member of AAFSW to join Livelines and a member of the FS to join Trailing Houses.
***If you do decide to find a rental option with a landlord unfamiliar with per diem lease requirements, there are also sample leases listed under the files section of the Livelines yahoo group.