Healthcare Cost of Pregnancy

The Cost of Having a Baby in the United States

Having a child is a big decision. Parents welcoming their new baby anticipate the cost of everything from babysitting to birthday parties. Today, raising a child to the age of 17 costs a two-parent middle-income family about $233,610.

In recent years, a less obvious cost of having a child has been brought into the spotlight: the cost of pregnancy and childbirth. In the United States, medical bills from prenatal care and delivery in a hospital or birthing center are steep, even with insurance. Knowing what to expect can help you plan for, and even reduce the expense.

In the end, though estimates vary, a normal vaginal birth costs an average of nearly $11,000 in the United States. Insurance—if you have it—covers most of that cost, but can still leave parents with as much as $4,500 to pay out of pocket. That figure does not include costs related to prenatal and postnatal care.

Common prenatal care costs:

• Monthly checkups, which become weekly closer to your due date
• Prenatal vitamins
• Tests and imaging, like blood tests, ultrasounds, DNA testing, and diabetes testing
• Birthing classes
• Additional doctor’s visits for high-risk pregnancies (mothers who are over 35, overweight, have medical conditions like diabetes, or who are having twins)

Hospitals have fixed prices for their services and will charge you for everything individually unless you buy a flat fee maternity package. When it’s time to deliver your baby, the hospital may charge you for the following:

• Anesthesiology (i.e. epidurals) and pain medication
• Your OB/GYN doctor
• Medical supplies
• Your room and board
• A doula or midwife
• Induction
• C-section (which requires an operating room, more anesthesia, and additional supplies)

Costs after you have given birth:

• Standard checks on the baby
• Any additional care due to complications

Of course, if you have insurance, you’re not paying for the total cost of all these services out of pocket. Instead, you’re paying copays, deductibles, coinsurance, and for anything that isn’t covered by your insurance or that is out-of-network.

Copays are standard charges for healthcare. You might pay $10 for every prescription, for example, or $20 every time you go to the doctor.

A deductible is an amount of money that you need to pay before your insurance takes over. If your deductible is $1,000, you’ll pay $1,000 out of pocket throughout the year before your insurance starts to pay.

Finally, coinsurance is the percentage of your bill that you pay for after your deductible has been met. You might pay 10% of each subsequent medical bill, for example, with your insurance covering the remaining 90%.

Unforeseen Expenses

While some c-sections are planned, others are performed when an emergency arises during birth. C-sections cost more than vaginal births—around 60% more. Doctors can use c-sections to save the lives of mothers and their babies.

However, c-sections are being performed with concerning frequency. According to a 2019 US News report, cesareans have risen by 500% since the 1970s, with no effect on the rate of survival and brain injury of full-term babies. Importantly, the ratio of c-sections to vaginal births depends on the hospital. Some are more equipped than others to deliver a baby without the need for a cesarean. You can research your hospital’s ratio when planning your delivery.

Unfortunately, complications do rarely occur during and after childbirth that affect the mother and child. The more severe the complications are, the more expensive they become. Babies born prematurely, for example, require more medical attention. Extended stays in the hospital mean more bills, but also more time away from work, not to mention the emotional toll. It is important to advocate for yourself, especially if you are a person of color, if something seems wrong.

Bills sneak up on parents when they are charged for services that their insurance doesn’t cover. Some tests and services may not be covered by your insurance. And, it’s likely that not all hospitals and doctors in your area are within your insurance network. Check with your doctors, healthcare facilities, and insurance provider before going in for care and clarify with your insurance if you become unsure about coverage along the way.

Sometimes, unexpected charges on your bill may just be mistakes. It pays to review the bill line by line so that you’re not paying for services you didn’t receive. Nobody knows for sure just what percentage of medical bills in the US contain errors, but it’s certainly more common than people suspect.

Recently, high deductible plans have been encouraged in order to reduce health care spending, since people with high deductibles are more cautious when seeking care. However, high deductibles can result in people skipping care that they need and having to pay more out of pocket for things like childbirth.

It’s not just deductibles that make for large hospital bills. Even though a 20% copay may seem low, 20% of a hefty price is still a big number. So, because of the way that insurance works, parents can still be left with large bills.

Strategies to Reduce Your Costs

The best thing you can do is speak with your hospital, doctor, and, most importantly, your insurance to discuss costs and coverage. In the throes of childbirth, you won’t be thinking about insurance. That’s why it’s so important to do the research in advance to avoid surprise medical bills. If you are planning your pregnancy and have the time, you may consider shopping for insurance with pregnancy in mind.

You should ask the following questions:

• Are the doctors and the healthcare facilities I plan on using within my insurance provider’s network?
• What specifically does my insurance cover and not cover? Which prenatal, labor, and delivery services are covered, how long can I stay in the hospital, and can I request a private room?
• Do I need referrals?

Some of the most common things that drive up the price of childbirth are mistakes on the bill, nursery fees, and anesthesiology. A baby might be taken to the nursery for observation or to allow both parents and baby to rest. You may have a choice in this, and it’s worth asking. Even within the same hospital, your anesthesiologist might take different insurance than your OB. If you can, determine if the anesthesiologist treating you is in-network.

Birthing centers are an alternative to hospitals for low-risk pregnancies. Birthing centers can be less expensive, but only if they are covered by your insurance. And, if you have to transfer to a hospital, you will be charged by both facilities.

Inductions and c-sections are not always medically necessary. If your insurance covers it, having a doula present during birth reduces the use of c-sections.

Finally, to lessen the financial strain of medical bills, hospitals often offer payment plans. Importantly, if you don’t have insurance, you can negotiate the price of your services with the hospital.