Raising a family is expensive. Baby gear, activities, saving for college; it all adds up fast, but did you know that a baby’s birth cost may be the largest bill in some mamas lives? Why does birth cost so much? And what can we do about it? We’ll unpack that all in this post.

How much does birth cost? Midwifery care vs. OB care

An analysis done by The New York Times showed that insurance companies in the U.S. agreed to an amount of about $10,000 for a vaginal birth and $15,000 for a c-section at a hospital. It’s important to note that the amount insurance companies agreed to is NOT the same as the amount hospitals charged, which was closer to $15,000 for a vaginal delivery and $30,000 for a c-section.

These birth cost averages can fluctuate greatly between states and hospitals.

Midwifery care, on the other hand, puts birth cost at about $2000-$4000 depending on where you live. This price includes prenatal care and often, a home visit after birth. You usually have to pay for extra interventions out of pocket but this also means you aren’t forced to pay for things you don’t want or need.

Yep, that’s right. Choosing a hospital birth basically means you (or your insurance company) are forced to pay for things like: hospital grade personal care products, hospital logo merchandise, parenting DVDs and pamphlets, disposable diapers, formula, etc. That’s why the nurses load you up with “free” stuff when you leave, because you’ve already paid for it. Many mamas would rather choose their own products anyway.

Birth cost around the world

To put this birth cost in perspective, France, Switzerland, Britain, Chile, Netherlands, and South Africa all pay less than $5000 for vaginal deliveries in hospital and $7000 for c-sections (in some cases much less). These countries do not, however, have poorer maternity care or infant and mother health outcomes.

In fact, infant mortality rates in the U.S. are much higher, sometimes twice as high, as those in other developed nations. Many would argue this is because the U.S. has great preterm infant care. Because of this, babies who would otherwise be stillborn can survive birth but may die later because of complications of preterm birth.

However, for babies born after 37 weeks gestation the U.S. ranks last in infant mortality rates compared to most European countries, Australia, and New Zealand, showing that preterm birth does not skew the numbers.

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So why the huge discrepancy in birth cost when outcomes aren’t better?

Most European countries pay a package birth cost for maternity care while in the U.S. women pay per service. Some would argue that the exorbitant expense of maternity care is because hospitals are incentivized to offer services that aren’t needed like ultrasounds for for posterity’s sake or blood tests “just to be safe”, which drive up birth cost.

Another possibility for our high birth cost is that OBs pay hundreds of thousands of dollars in malpractice insurance each year. So they are more likely to charge more for their services as well as offer tests and procedures “just in case”.

The astronomical costs of birth in the United States aren’t much different than other aspects of healthcare. Physicians and other healthcare providers are paid for the services they render, which means that they don’t get compensated for keeping people well. In the case of pregnancy and birth, some have proposed that physicians and midwives should be compensated more generously for vaginal deliveries versus cesarean deliveries, to help reduce the cesarean rate.

Will insurance cover our birth cost?

The good news is – under the affordable care act (ACA) maternity care is required to be fully covered even if you are pregnant when applying for coverage.

The bad news is, since the ACA was signed into law, insurance deductibles and premiums have risen dramatically. Many women have found that the cost of midwifery care is significantly lower than their yearly deductible. In this case or in the case of not having insurance, midwifery care is still the least expensive option for maternity care.

However, if you have private insurance through your employer and don’t pay a high deductible, out of pocket costs between hospital birth and midwifery care may be similar.

If midwifery care is not covered under your insurance, you may pay less or a similar fee for a hospital birth. Keep in mind that when looking for providers covered by your insurance plan, it may be possible to deliver with a midwife who bills under collaborating OB-GYNs, which may drive your birth cost down.

How can I reduce my birth cost?

Pregnancy and birth is an expensive time in a mamas life but there are things you can do to lower your birth cost.

Choose midwifery care

Midwifery care is usually the least expensive option for childbirth. Whether you have insurance or not midwifery care is usually still less expensive. Many women chose a home birth to keep costs low and to have a more natural, relaxed birth experience. If you want midwifery care but don’t want a home birth, a birth center is a great alternative and it usually doesn’t cost you any more. A birth center has many of the comforts of home while being closer to a hospital if one is needed. If you have a large co-insurance or a high-deductible plan, choosing a midwife and avoiding interventions (like an expensive cesarean birth) and a costly hospital stay may be particularly important to you.

Shop around for the best prices

Though getting a quote from a hospital is not easy, it’s worth a try. Teaching hospitals usually charge more while state hospitals charge less. You’ll want to also consider the hospitals c-section rates, morbidity rates, and policies on birth interventions before making a decision.

Midwives fees don’t fluctuate as much but it’s always worth comparing prices. Consider whether the midwife does a home visit after birth, which is a wonderful resource for new moms.

In general, midwives that practice at community hospitals tend to have much lower birth cost rates than those that practice at large teaching facilities.

Choose to go natural

Obviously, if you need an intervention, you should not refuse it based on cost alone. However, assuming you are a low-risk pregnancy, chose a natural birth. There are so many incredible benefits for baby and mama! This will also keep your birth cost low avoiding unnecessary tests, ultrasounds and interventions. In the U.S., maternity care is charged piecemeal so skipping the epidural, for example, can save you around $1000.

Hire a doula

It is well documented that having a doula at your side during labor reduces your risk of c-section significantly. Yes, hiring a doula costs money but a few hundred dollars for a doula is much less than the thousands of dollars a c-section would cost you if you’re uninsured (not to mention the emotional cost). Find out more about doulas and where to find one here.  If you have a flexible spending account (FSA) or health savings account (HSA) through your insurance, it will very likely cover the doula’s fees.

Negotiate

Hospitals are also required to give a certain amount of free care yearly. Ask the hospital if you qualify for a fee reduction or elimination based on income.

How about you?

How much did your birth cost you?

 

References

  • https://www.webmd.com/baby/features/cost-of-having-a-baby?page=3
  • https://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?nl=.20.todaysheadlines&emc=edit_th_20130701&_r=3&
  • https://consumer.healthday.com/public-health-information-30/centers-for-disease-control-news-120/u-s-still-lags-in-infant-mortality-rates-report-finds-692044.html
  • https://rewire.news/article/2013/07/02/why-on-earth-do-u-s-families-pay-more-for-maternity-care-than-anywhere-else/