Costs of pregnancy and childbirth have risen sharply in the past decade. How can families anticipate and attempt to control those costs?

When my first daughter was born in 2007, nearly everything that could go wrong did; I ended up with an unscheduled C-section, a four day hospital stay, and – thank goodness – a healthy baby girl. My husband and I didn’t think much about what the birth would cost us; I’d asked my insurance company about the potential costs, and had gotten back a bunch of insurance-speak that I didn’t understand. So, when the bills started rolling in, and they totaled more than $7000 for myself and my daughter, even after our insurance paid. I was shocked and horrified.

When I was pregnant with our second daughter, my husband and I debated for a long time and finally decided to try for a home birth, which was a legally protected option in our state. One of the many things that attracted me to using a midwife was that they told me all the costs up front for my prenatal care and birth. My husband and I had nine months to prepare to pay the $4500, and although it took me almost a year, I did get my insurance company to reimburse about $1300 of that. There might have been additional costs if we’d need to be transferred to a hospital,  but my second daughter was born at home, with no complications.

The Cost of Pregnancy and Childbirth Varies Widely

Unlike many procedures or hospitalizations, where the insurance company is charged a flat fee, during maternity care, each item is billed separately, from the epidural Mom may choose for pain relief, to the disposable diapers supplied to her on the maternity floor. According to the Boston Globe; the cost of pregnancy and childbirth has risen about 49% for vaginal births, and 41% for C-sections, between 2004 and 2010. The average price for a vaginal delivery is now about $30,000, and about $50,000 for a C-section.

For comparison, in most developed countries, women don’t pay anything directly to the hospital for maternity care (although clearly their costs are subsidized by taxes). They often stay in the hospital for a week or more, where dedicated lactation consultants help them learn to breastfeed. American Moms usually leave the hospital after a maximum of 2 days for a vaginal birth, 4 days for a C-section. And yet, depending on who's numbers you believe, American mothers have worse health outcomes than other developed nations, despite paying much more.

It’s Possible to Try and Control Your Costs, But There Are No Guarantees.

If you’re looking to control costs for your own pregnancy and childbirth, there are a few things you can do. As a general statement, the fewer interventions you have during pregnancy and childbirth, the less expensive it will be. Some things that are usually considered medically necessary – like ultrasounds at every prenatal appointment, or continuous fetal monitoring while in labor – have been denounced by the World Health Organization as not having any noticeable health benefits. If you want to curb costs, you'll have to constantly bring up these things with your provider. There's also lots of steps you can take on your own, like learning pain management techniques while you’re pregnant and avoiding an epidural, which may help you avoid a C-section.

If you do get a shocking bill, like I did, don’t panic. The first thing to do is to call the hospital. Many hospitals understand that bills like that aren't something that can be paid overnight, and will set up a payment plan for you. If even that isn't affordable, you can apply for “charity care” or “patient assistance.” Many states also extend their Medicaid programs to pregnant women at higher income levels than normal. If you think you might qualify, apply; sometimes, women who are medically needy can qualify by showing their medical expenses, even if they are initially over income.

Starting in 2014, the Affordable Care Act requires all health plans to include coverage for maternity services. The vast majority of employer-sponsored plans already included this, but some budget oriented individual plans did not. The law does not specify, however, what services will need to be covered; it is possible that we could continue to see situations where women are very limited in the providers that they can choose, or where an insurance company could determine some services to be non-essential during labor, and therefore refuse to cover those items.

Some hospitals and providers are now choosing to take the mystery out maternity care costs by charging a flat fee for uncomplicated deliveries. This is closer to the European model, and how my best friend paid for her son’s birth a few years ago. The way she described it was very refreshing; she went into her birth knowing that her bill was paid in full, and not having to worry. That sounds better to me than spending your labor worrying about the price tag of everything in sight.

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