The True Cost of Childbirth

Beyond some nausea during her first trimester, Jessica had what she called a "straightforward" pregnancy. But that didn't mean the birth of her first child, a son, was cheap. Two early screenings—one for genetic testing on the fetus, one to make sure she wasn't a carrier for any genetic disorders—cost $249 each and, through some quirk in the system and a cash-pay discount, were cheaper to pay directly than to submit through insurance. Jessica opted for the blood tests rather than a covered amniocentesis because the latter screening carries a risk of miscarriage. Her insurance would foot the bill for the blood tests only if she was age 35 or older or had specific risk factors, and she was only 34 at the time.

Jessica's highest copay, $150, was for a fetal movement check close to her delivery date, when she was worried because she hadn't felt her son stir in a while. All turned out to be fine.

After doing her research, Jessica planned to have an unmedicated birth in the birth center attached to the hospital. She signed up for the available doula program for $450, which covered an initial consultation and 10 hours in the delivery room and was less expensive than trying to find a doula privately. Hiring a midwife or opting for a birthing center can generally lower overall costs, in part because women who utilize these services are less likely to receive pain-relief medications or undergo a C-section, according to the American Pregnancy Association. Home births using a midwife reduced costs by an average of $2,541 (in Canadian dollars) when compared to physician-assisted hospital births, a 2015 study published in Plos One found. And a 2018 New York Times article noted that "the cost of a birth center delivery is roughly half that of an uncomplicated hospital birth."

Jessica eventually opted for an epidural following nearly 24 hours of active labor. In total, her insurance carrier was charged almost $44,000 for the birth alone, for which Jessica paid around $1,500. One of the most significant charges, after the hospital fee, was $7,770 for an out-of-network anesthesiologist. This occurred even though she was at an in-network hospital.

"How was I supposed to check if the anesthesiologist they sent in—when I was 8 centimeters dilated and had been having contractions every five minutes for 24 hours and finally gave up trying to go sans meds—was in-network?" said Jessica, who wound up paying $255 after insurance for the anesthesiologist's services.

This practice is known as surprise billing, when a patient is charged for out-of-network care at an in-network facility. Close to 1 in 5 privately insured families receive one or more of these bills for mother or newborn care, per research published in JAMA Health Forum. The maternity-related service most often associated with surprise charges is anesthesia, as it was in Jessica's case, though she paid less than the $744 median estimated liability that researchers uncovered.

"You will encounter sky-high fees from somebody who doesn't happen to be in your network or in your plan, and you didn't have any choice because you didn't engage that person—that was the person who happened to be at the hospital that day," Sakala said.

The No Surprises Act was introduced in Congress in 2019 to stop this type of charge. It passed at the end of 2020 and goes into effect on January 1, 2022.

Jessica couldn't check for any other odd charges on her bills because nothing was itemized, she said. Not that she had the time to dig too deeply once they started arriving—both she and her husband were back at work full-time while trying to care for a newborn.

In 2018, however, one father in West Virginia did manage to track down detailed charges. He published an essay in the Conversation outlining the fees, which included everything from a pair of Tylenol tablets ($25) to 48 hours of room and board for his wife ($3,100) and son ($1,500), to a baby hearing test ($260).

In 2016, following his wife's C-section, another father posted a bill on Reddit that included a $39.35 fee for "skin-to-skin" contact post-delivery.

Jessica ended up paying almost $2,750 for all of her pregnancy- and birth-related medical bills. She and her husband both maxed out their flexible spending accounts (FSAs) when they found out they were pregnant, which helped cover a lot of the expenses without draining their bank accounts.

"I was honestly more surprised by how little we had to pay for, which I think is just a result of having good insurance," she said. "We're very lucky that none of this was a super financial burden on us."

In 2014, Kate was pregnant with her first child and having a pretty easy go of it. She went on daily runs and attended weekly yoga. So she was startled when she suddenly started gaining extra weight—her hands and wrists were also painfully achy. At her 32-week appointment, the OB-GYN diagnosed Kate with high blood pressure. (Though they utilized the same health insurance carrier, Jessica's prenatal visits were covered, while Kate paid $25 to $50 in copays each time.)

She was taken across the street to a hospital, where she remained for a couple of days before being advised to self-monitor at home. A specialist to whom Kate was referred diagnosed her a few days later with preeclampsia, a condition that can be life-threatening for both moms and babies. It was all so stressful that Kate soon had her husband drive her back to the hospital so professionals could keep an eye on her and the baby.

At 35 weeks, Kate underwent an emergency C-section. Her son weighed less than 4 pounds when he was born. He stayed in the NICU for three weeks before they were able to head home. During that time, he needed light treatment for jaundice and craniosacral therapy, which cost between $75 and $100 for each of the four or so sessions.

Kate recalled that her total hospital bill was around $200,000. She paid close to $8,000 to meet the family deductible, plus an additional $25 per night for the separate wing she moved into for almost three weeks to stay close while her son was in intensive care.

Families should remember that pregnancies often span two health plan years, Sakala noted, so the deductible owed may be twice as much as originally expected.

Kate's bill was particularly high because of the extended stays for her and her son. The facility fee for the mom's hospital stay is the single-largest charge throughout pregnancy, Sakala said. About four out of five of all dollars paid on behalf of the mother and the baby across this whole time frame, from discovering you're pregnant through eight weeks postpartum, are going into that small window of one to two days women spend in the hospital, she said, adding that care for the baby alone accounts for more than one-third of all the costs paid.

As C-sections have become more common in recent years, they've also become more costly. In 2019, the Centers for Disease Control and Prevention (CDC) reported that C-sections account for nearly one-third of U.S. births. Sakala said payments for C-section deliveries are about 50 percent higher than those for vaginal births. Moniz's study found the average out-of-pocket C-section cost for women with employer insurance was $5,161, nearly $1,000 more than for vaginal deliveries.

Kate was surprised by her final bill and said she never realized how expensive it was to have a baby.

"I remember my mom being like, 'What? It cost $5 to have a baby [when I had you],'" she said. "It was pretty shocking."