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The cost of pregnancy and childbirth

Jill

Holy cow is a lot, according to this New York Times feature. In fact, it’s more than any other nation in the world, but our health outcomes aren’t substantially better.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

The entire article is well worth a read, but this deserves emphasizing: “In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.”

44 thoughts on The cost of pregnancy and childbirth

  1. I was just talking to my mother the other day about how when she gave birth to me (uncomplicated, vaginal delivery), the medical bills were so high, because the University of Chicago’s health insurance didn’t cover pregnancy in its grad students at that time, that she and my father could not pay them off without appealing to family for help. And the bills weren’t nearly as high as $30k – they were just uncovered.

    1. The US medical systems seems out-and-out barbaric to people from most other wealthy nations.

      I’ve had children born in both Germany and Norway, including a set of early-born twins needing a week in a pediatric intensive-care-unit.

      Total out-of-pocket cost for both pregnancies and childbirths ? Zero.

      What baffles me is that support for any of the measures that might actually help fix your system seems slim to nonexistant. Why is that ? Socialism-is-evil knee-jerk reactions ?

      1. Partially. And partially because of corporate control of politics and mass propaganda media systems that promote that mindset.

      2. There are stories coming out now about how some doctors and hospitals are actually doing things to induce complications for various medical procedures and surgeries, because they make more money that way. I haven’t heard of it specifically in cases of pregnancy, but it wouldn’t surprise me.

        Also, the USA needs to spend a great deal of money to drone-murder people all over the world, spy on everybody everywhere, hijack the planes carrying other sovereign nations’ leaders. etc. And we’re doing it all out of the goodness of our hearts, for the benefit of you Dogless, socialist, dirty-fking-hippies in Europe!!! How do you expect us to have any money left over to pay for our own health care?

        1. I’ve never heard of that…I can understand hospitals and doctors who order unnecessary tests and procedures and bill for things they didn’t do, but I want to believe that the vast majority of people who go into healthcare work would be ethical enough to intentionally “induce complications” for money (see Tuskegee Experiments). I can’t see hospital administrators being okay with this either, because of the risk of a massive lawsuit and possible jail time if these “complications” ended badly for a patient.

    2. Just piggy backing on your comment about the university’s insurance not covering insurance: did you know that pregnancy is a “pre-existing condition” and you will get denied outright if you try to purchase health insurance while pregnant? I didn’t! I learned that the hard way when my husband almost lost his job when I was 6 weeks pregnant. I tried to buy a policy for us, nope! Can’t do it until 2014!

      1. When I purchased a maternity rider to my health insurance, it didn’t go into effect for 10 months.

  2. I wonder if this is exclusive to maternity care. I did read the Steven Brill article “A Bitter Pill” (seriously, go read it) and that seems to argue that medical care in the US overall is super expensive (oftentimes ridiculously so). The NYT piece is certainly accurate, but I do have to wonder whether this is because of special attributes of maternity care or whether this is simply an extension of super-expensive medical care in general. I am really only curious because I can see how an argument about costs of maternity care could be co-opted quite easily into arguing how women’s choices drive the cost up – when, if the costs could be better controlled through other means, the question of personal choices really shouldn’t enter into the equation.

    1. The women’s choices issue is possible, but a lot of the ‘luxury’ choices actually drive the cost of birthing down – water births require specialised equipment, but reduce the requirement for surgical intervention, that sort of thing. It’s a lot cheaper to heat up a tub and flush the water than it is to perform a Cesar.

      I believe I had to pay for medication that I went home with – I’m not sure because I was really freaking sick – but living in Australia I had the following for free in the public system:

      * A birthing suite with a water birth facility, the ability to control all lights, sensory information, etc.
      * Nitrous oxide in the suite provided whenever desired.
      * Attending midwife providing backrubs, etc.
      * Transfer to a maternity ward.
      * Epidural.
      * Four doctors + the same midwife who came as an advocate for my rights.
      * Full monitoring.
      * Two hours of emergency surgery including the services of a famous specialist who was luckily touring the hospital.
      * Three nights stay, painkillers, lactation consultant.
      * Six units of blood in transfusion.

      A read of that probably makes it clear Things Didn’t Go Well (it does happen, alas) but my total out of pocket costs were for the medication I went home with – I recall it as being ‘very expensive’ which was about $60. The system included a number of maternal visits by nurses, and a visit that later picked up Post-Partum Psychosis and PTSD and provided referals and seven free psychologist visits.

      For most people the stats are different – provide certain luxuries ‘out of the box’ – darkened room, control of the environment, various options for birthing position, attendance by trusted specialists and family – and you reduce intervention. I suspect I’m preaching to the choir though 😀

      Even in a really awful case like mine, though, they dealt with it pretty well, though I admit I remain angry that no one valued my call for a Cesarian until it was too late to give me one.

    2. From the point of view of someone visiting and needing travel insurance, medical bills generally in the US are scary. It says enough that insurance companies here emphasise that you need to choose unlimited cover when travelling. Not a few thousand, not a million – unlimited.

      Though I’d bet the maternity costs are in a field of their own too, yeah. Combination of medicalising/pathologising so many things and a “serves you right for being pregnant you sinful wretch” mentality, maybe?
      /snark

  3. But but but! I thought the GAYS are the biggest threat to the traditional family, not crushing debt!!

    If we actually wanted a family-friendly society, these numbers would be unacceptable. (Ignore the man named privatized reproduction behind the curtain)

    1. But no! Actually these jaw-drop-causing costs show just how much we truly value motherhood!

      Or, um, something.

      1. Oddly enough, that’s close to the pushback I get from the relatives mentioned in my comment below. When I say I can’t afford to have children, they say things like “oh, you love them so much it doesn’t matter!” or some variation on “where there’s a will, there’s a way!”

        I never even thought of it this way before, but these attitudes must be related. Family values, indeed!

        1. When I say I can’t afford to have children, they say things like “oh, you love them so much it doesn’t matter!”

          Yes, because being unable to feed, clothe, house, and educate potential kids, or even just give birth to them reasonably safely, just doesn’t count beside loving them so much. O_o

          It’s another no-win thing, isn’t it? Know you can’t afford to bear/raise kids and it’s all “oh but that doesn’t matter, HAVE BAYBEEEZ.” Bring children into the world when you don’t have the resources (whether you choose to have the child or it was unplanned) and you’re a leech, a welfare parasite, irresponsible, a burden on society, etc, etc.

        2. You love them so much that it…doesn’t matter that…You can’t afford to provide for them?

          How is this not advocating child abuse?

          Not accusing you, Violet. Just…Gobsmacked.

        3. With these people in particular it’s really just middle-class cluelessness blinkers in full operation. These are the same people who think that going to a state school costs the same as it did in the late 60’s, and for whom cutting back financially for children involved trading in the sportscar and not going out to dinner in the city four nights a week (and my generation is just lazy, donchaknow?).

          No less crappy, of course.

  4. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section

    I…I’m boggling. I really am. Look, in terms of purchasing power, the conversion’s like $1=10 rupees. And it cost my aunt 50K rupees to get a private suite and two-day stay with her second child at a pretty good hospital, ffs. How is anyone expected to afford this!?

    1. I don’t think we are expected to afford it. And yet, my USian relatives still get pissed off when I frame my financial inability to give birth without insurance while not qualifying for low-income programs as “I can’t have children,” as opposed to not wanting children.

      I once tried to explain to one of my great aunts in Portugal how much it cost to give birth here. She started laughing, assuming I was pulling her leg. And this is the branch of the family that had dirt floors and outhouses until the 70’s out on the Azores. It just did not compute.

      but hey, who needs socialized medicine and the decriminalization of addiction, as long as we’re not some socialist hellhole like Portugal!

      1. And yet, my USian relatives still get pissed off when I frame my financial inability to give birth without insurance while not qualifying for low-income programs as “I can’t have children,” as opposed to not wanting children.

        Of course, if you have a baby while in debt you’re a horrible parent-person anyway, so I guess you’re fucked no matter what you do.

        Ugh. People.

    2. One USD is more like 60 rupees, so yeah…a little over $800. Versus more than I make in a year.

      1. Oh, I know the direct conversion’s more like 60 rupees, I was referring more to purchasing power parity.

        But yeah, as horrific as it sounds, it actually is cheaper for a low-income person to fly to India first-class for delivery/aftercare at a posh hospital than stay in the US and do it in their town hospital! What kind of sense does that make?!

  5. And if you can’t afford it, you shouldn’t be giving birth! Except there’s no birth control! Wait what. My brain hurts.

        1. I actually asked this question of the Pentecostal child in my Women’s Lit class last semester. “So okay,” I said. “We can’t use the pill or the IUD, because they cause abortions — under your rules. We know other kinds of birth control, like condoms and natural family planning, have high failure rates, and you’re opposed to abortions as backups. Your religion also says you have to submit to your husbands, and it’s wrong to say no when he wants sex. Right?”

          “Well, it’s wrong for him to say no when I want sex,” she said sweetly. “That’s true too.”

          “Yes, obviously,” I said. (I was raised Pentecostal myself.) “Your religion also says any other sex except copulatory sex –if you’re following me — is sodomy. Yes?”

          She stared at me, seeing where this was going. (She isn’t stupid, just thoroughly enculturated.)

          “I’m just not sure,” I told her, “in that case, what exactly you expect women who can’t afford or don’t want ten or twelve children to do.”

          She kept staring at me: it was obvious she had never thought of it this way before.

          “And I’m not sure how you expect me to believe this is not a system for keeping women pregnant and burdened with children. I mean,” I spread my hands, “if it’s not designed to be that system, it’s a great imitation.”

          It was after class — we often had these discussion after class, me and six or seven of the other women — and she said she had to get to work, so I don’t know if she heard me or not.

      2. Actually, the solution is poor women should have abortions or adoption plans (because the nice adoption agencies will cover prenatal care, labor and delivery costs) because the only people who should be raising children are rich people.

        The day abortions become free/cheaper, maternity care will be ridiculously higher.

  6. It sickens me to see these kinds of numbers–five-digit figures–attached to any form of health procedure.

    I recently read about a lady’s co-workers who were having a bowling tournament to raise money for her cancer treatment. I appreciate what they’re trying to do, but…a bowling tournament? Yeah, that’ll make an admirable little dent in her bills.

    I’ve recently decided to leave the U.S. I have the money, the means, and the methods, so I’m not staying on a sinking ship. How’s the ole jingle go? I don’t need your war machines / I don’t need your ghetto scenes / Colored lights can hypnotize / Sparkle someone else’s eyes.

    Come 2014, I’m Audi 5000, G. And in all honesty, do you blame me?

  7. It looks like most of the people here have missed a couple of points.
    1. Doctors in the US take a heck of a lot of years and anywhere from $200,000 to $500,000 dollars in debt to put MD after their names. Which has to be paid back in full plus extra! And since they are school loans they have to be paid back.
    2. Lawyers sueing said doctors, hospitals and other medical personal at a drop of a hat for anything at all. Of course they get x amount of the suit afterwards.
    3. And since doctors just like most of us don’t like getting sued take steps. Steps like up to a dozen highly trained people helping with the birth, Plus all sorts of equipment (also costly!) which means that money has to come from somewhere.
    4. Since insurance companies, like all companies have to have profits to stay in business work to keep the costs down, which means making sure that they don’t have to pay out when sued, and since they want to keep down the costs of the doctors, hospitals and others. They make rules for their gain not ours.
    5. I would guess that most of the other countries don’t have and do not allow our lawsuits.
    6. Those of us who pay taxes, have jobs and insurance will have to pay for those who don’t.
    7. The ACA doesn’t really do a dang thing for this. It has neither the increase of highly trained medical personel needed for Full Federal Heath Care, nor does it have limits on lawsuits which is needed and mostly is so full of loopholes (which have been put in by lawyers who want to keep getting paid the big bucks!) so the only thing that has been changed is how much all of it costs and how much it will cost even more as time goes on!

    1. So the USA-ian system is broken. You don’t need to justify it. You can change it through the political system, however slowly. Other countries have functioning government, democracy and capitalism without the populace being one accident (or pregnancy) away from bankruptcy.

      See: Australia, Canada and others.

    2. Excellent points.

      Except: where is the need for $30,000 worth of equipment in care when many healthy babies are born OUTSIDE of hospitals without any sort of trained medical professional to help? Honestly, a woman with a fully functional and healthy set of female reproductive organs has a less than 1% chance of needing anything other than basic assistance delivering a child UNLESS she is opting for pain medication.

      Obviously if the pregnancy, labor and delivery actually requires a bunch of specialists and extensive care then the cost should be commiserate with that. But 30K for a healthy woman, with healthy naturally fertile reproductive organs carrying a healthy fetus and having a normal healthy pregnancy is a RIPOFF.

      1. The problem is that sometimes the hospital equipment becomes necessary awfully quickly, and without much warning. Presumably there is a higher base cost for having a baby in a hospital rather than at home, but that is no reason in and of itself to discourage hospital birth. That healthy woman with the healthy baby and healthy pregnancy can turn into an emergency quicker than she can make it to the hospital. And opting for pain medication isn’t an unusual choice. I heavily dislike the idea that pain medication is somehow an extra or a luxury. There is nothing else that painful that we expect people to go through without pain medication. Labor usually hurts a lot.
        I’m all for reducing the costs of pregnancy and delivery, but I don’t think moving birth away from hospitals is the best way to do it. Interventions only when proven to improve outcomes, yes, certainly.

    3. Okay, so the post-secondary education system is broken then too if it costs that bloody much to train to be a doctor.. Not only does that result in exhorbitant medical costs but also doctor shortages since it greatly limits who can and will go into medicine as a career.

      But as someone up thread pointed out, other countries make it work..

      1. I think it’s necessary to point out that other countries get health outcomes that are at least as good, at much (much, much) less cost. But it’s not sufficient. Those other countries got there the way they got there. The US will have to get there the way the US will get there — which is how, exactly? The Affordable Care Act is all kinds of imperfect, and it took the US 50 years to get even that.

  8. I wonder if there are any comparisons over time. I know that when I was born, nearly 30 years ago, my parents weren’t well off though my mom did have insurance through Kaiser through her job. And I know that, in addition to just the actual birth, I was in the NICU for some time (a couple weeks, I think?). And my mother says they paid maybe $400 total. Which was more money then, but still, nothing on the scale of today.

  9. For comparison’s sake: my grandmother developed cancer in 2005. She had to have brain surgery to remove her tumor. The cost for the surgery was about $25,000.

    Of course, I’m betting oncologists and neurosurgeons pay far less in malpractice insurance premiums than obstetricians do, which would lessen the costs passed on to the patient.

  10. All health care in the USA is expensive, the protections that are meant to provide consumers continuity of care exclude maternity coverage. Pregnancy is a pre existing condition. So is a c-section. Even if a customer always has coverage a new policy may not cover a pregnancy that started under and old policy. In California until very recently maternity care wasn’t trying covered on the private market at all, except for riders which cost several hundred a month and only pay 3000 or so for hosptial birth.

    I tried to buy a policy on the private market from 2004 to 2007. I was athelitic, in my early 20s, didnt smoke, barely drank, and had an ideal BMI according to the insurance company charts. I couldn’t get a policy that would cover hospital bill for me, or any newborn I might have, for any amount of money. There were plenty of policies for cis men, but not one that would cover essential medical care for me or protect me from bankruptcy. No, I didn’t plan on getting pregnant but you don’t buy insurance for what you PLAN on happening and unplanned pregnancies are not exactly the rarest thing in world. Plus I don’t like funding bigots.

    This is a seperate issue but the cheaper methods of maternity care, like midwives, water, or emotional support and doing counter pressure on a woman’s back aren’t generally used in the USA. Most mothers don’t need a top notch surgeon to have a baby, a skilled nurse practitioner would be fine. And while I strongly support a woman’s right to use drugs for pain relief, counter pressure on a womans back, heat, and positioning and emotional support are also effective and a doula is much cheaper than an anesthesiologist. I paid $250 out of pocket for a child birth class that taught my husband how to act like a doula. That wasn’t covered by insurance. The epidural would have been $1500 but the insurance would cover it. Is there any reason to only cover the most expensive (and invasive) options?

    Also physically there is no way my nurse could have done counter pressure on my back or stayed with me one on one. She was amazing but she had to many other patients, and at least one had dangerous complications.

  11. $30000 cost of birth is an outrage.
    Hey! I thought the republicans wanted to cut the debt, yet it would seem shutting down women’s health services are allllll they ever do. Way to be “conservative” forcing poor women to go without Planned Parenthood. Making it so that a poor woman has no access to reproductive planning directly impacts the likelihood of the state funding a crapload of $30000 births when it should have only cost us $30 for birth control pills from the clinic. Not to mention the foster care rolls will go up with more unwanted children the state will now be funding. So basically, my comment is that republicans can no longer claim “fiscal responsibility” while forcing us to pay for births that cost $30000.

  12. Attempting to provide the absolute highest standard of care and ALSO to provide the legal means to bring a valuable lawsuit if those standards are breached, raises expenses disproportionately to cost.

    At the time of birth, most folks have the opportunity to get care in many ways. You can birth at home; or a birthing center; or a small hospital; or a large hospital; or a specialized large hospital complete with infant-specific and delivery-specific nurses, staffers, equipment, ICUs, and specialists.

    With the exception of the extreme endpoints, within those things you have even more variation:
    Do you want your family doctor (who trained in OB) to do the delivery? Or do you want an OB specialist who does nothing but deliver babies all day, year ’round? Do you mind getting a basic pain reliever? Or do you want a spinal? If you get a spinal or if you go under anesthesia for a section, do you want a nurse or an anesthesiologist? And so on.

    Unsurprisingly, the cost increases as you go up the scale. And the higher up the scale you go, the more than you end up with very small marginal improvements which have a very high marginal cost.

    However, in the US we are socially intolerant of even minor risks. Especially when it comes to very young infants.

    Our neonatal rate (combined pre and post birth) is about 0.6%. (link here: http://www.cdc.gov/nchs/data/databriefs/db120.htm )

    Look at all the people who freak out about eating a piece of Brie and ask yourself how they would answer the offer if you made it:

    “We can give you birth care for $4000 and not $20,000. But you’d have a 5% increase in risk of neonatal death. Your effective rate of neonatal death would increase from 0.6% to 0.63%.”

    Or, look at all the people who sue when things go wrong, and ask yourself how they would answer the offer if you made it:

    “We can lower the costs of medical care if you give up your right to sue for much. But things DO go wrong occasionally. Birth is one of the single most dangerous things you’ll do in your life, both for you and for your baby. We can’t promise that everything will be go well, and if you want the “cheap” option then you won’t be able to recover much if things go wrong.”

    I don’t think that US society is willing to make the tradeoffs.

    1. I would just like to note that for many of the things you mention I was not given this choice. If I wanted my birth covered by my insurance then it needed to be in one specific hospital (no other hospitals, let alone birth centers or home birth), and therefore with an OB practice with admitting privileges there (there are also two nurse midwives with privileges there – they do not accept my insurance). There were two medical pain treatment options – narcotics (which have proven ambiguously effective for labor pain) or epidural done by anesthesiologist. No nitrous oxide for instance.

      I had “good” insurance and a completely intervention free birth, my son did not need any special care and we went home in a day and a half from the hospital. I paid several thousand dollars total, mostly for prenatal tests (20% copays, not included in lump sum for prenatal checkups) and for the birth itself. Part of the problem was the plan year resetting during my prenatal care (likely to occur in general, what with pregnancy being 9-10 months), requiring me to pay the deductible twice, and resetting my max out of pocket amount for the year.

      1. Oh right, and like someone else mentioned, billing for my hospital stay and the baby’s separately, which meant not only more charges but a separate deductible etc.

  13. Bottom line do you prefer to have a child without medical assistance but you need to pay, or do you want to have a child without any supervision and hope that there won’t be complications…
    Your choice personally I don’t see it as a hard one.

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