my two cents

How Much Does It Actually Cost to Give Birth?

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Dealing with your hospital bills after childbirth could be compared to delivering a baby all over again. If that sounds like a stretch, consider the parallels: Despite careful planning, you can't possibly anticipate all the details. You will be confused by jargon. You will encounter deeply troubling aspects of our medical system. You will be overwhelmed. You will hear about how they "do it better in Europe." And you will wonder how on earth 86 percent of American women deal with these same issues at least once in their lifetimes and somehow power through.

I don't know any mother who fully understood the bills that showed up in the mail after she gave birth. Many people, especially those who can afford to pay, don't bother trying to parse the line items — they've got their hands full, after all. But the charges are worth checking. One friend of mine saw a $5,000 "room and board" charge for the day after she left the hospital and, once she flagged it, was told it was an "error" — oops! Another friend encountered an $11,000 "nursery fee," which her health insurance wouldn't cover because they deemed it an "optional" expense. She had no idea what it was for until she realized that one of the nurses had whisked her newborn son out of the room for about 20 minutes to check his hearing, which was done in the aforementioned "nursery" and definitely not presented as an "option." She's still in the process of contesting the charge.

Most women have low-risk pregnancies, healthy fetuses, and uncomplicated childbirths. Even still, the combined costs for intrapartum care (just the birth part, not including prenatal and postpartum care) make up the most expensive hospital treatment they will ever receive. About half of American births are currently paid for by Medicaid, while the rest (with very rare exceptions) are covered by commercial insurance.

Here's how these bills work: Hospitals have a list of fixed prices for their services called the "chargemaster." Whoever made up that absurd name for it had a good sense of humor, because the numbers are equally ridiculous, sometimes marked up to more than three times the procedure's actual cost. That rate is what shows up on your bill and scares the pants (or maternity leggings) right off of you. Then your health insurance steps in, works its black magic, and conjures up the "allowed cost" — an adjusted number negotiated for its plan-holders. Your insurance provider will then cover a large chunk, leaving you with out-of-pocket costs that are a fraction of the original (but still nothing to sniff at).

So, don't freak out over those five-digit bills, initially. "Those commercial charges are basically a ruse," says Carol Sakala, the director of Childbirth Connection programs at the National Partnership for Women & Families. "Our research found that hospitals charged over $32,000 for a vaginal birth, on average, but the actual amount paid by the insurance company, the mother, and any other third parties added up to about $18,000. Meanwhile, the out-of-pocket cost is much, much less."

One major factor in the cost of delivery is, of course, how you go about it. A C-section, being a serious operation and all, costs about 50 percent more than a typical vaginal delivery (although its average out-of-pocket cost winds up being about $400 higher). However, a vaginal birth with complications can quickly surpass the cost of a routine cesarean. If your baby has to go to the NICU, that could also add thousands to your bottom line. In short, a lot of expensive things can happen during labor, delivery, and its aftermath.

So, given that amorphous lack of information, how can you make smart decisions before and during childbirth that are best for your health and your baby's without getting slapped with mysterious and unnecessary charges? Are you supposed to wave around your health-insurance card between contractions and make sure everything is covered before it happens? If a nurse hands you a Dixie cup with pills in it, do you demand to know the price tag on each one?

Here's a better idea: Talk to your doctor beforehand, says John Hargraves, a senior researcher at the Health Care Cost Institute. "Women often feel embarrassed to bring up the cost of care, but that's an important discussion," he explains. "When choosing a hospital, ask your doctor if any of their other patients have had issues with expenses, or if he or she can recommend someone for you to talk to about it."

Also, don't be shy about consulting your insurance provider, as annoying as that sounds. Most insurance companies now offer relatively user-friendly portals that allow you to research the approximate prices of services in your area without having to get on the phone and wait on hold for half the day. "A lot of people don't know about the transparency tools offered by their insurance, and as a result, they're underutilized," says Hargraves. "They're a good resource when you're dealing with procedures with a lot of price variation, and childbirth definitely falls under that category." Some health insurance companies even have apps you can use to find local providers and see what out-of-pocket costs you might expect.

And finally, if you're medically low-risk, it's worth looking into non-hospital alternatives, says Sakala. "We strongly encourage healthy women to consider a birth center instead of a hospital ward because the costs are much lower, they're less procedure-intensive, and there's a high degree of patient satisfaction," she says. "Research has shown amazing results from birth centers, and they offer a much better return on investment for everyone involved." Under the Affordable Care Act, insurance companies are required to cover birth centers that are licensed by the state; some birth centers are even affiliated or located within hospitals, so you can be transferred easily if the need arises. Meanwhile, a little under 1 percent of women choose to have a midwife-assisted home birth, although it isn't legal in all states and usually won't be covered by insurance, so the costs are tough to track.

Still, the vast majority of women give birth the most expensive way: in a hospital. If you plan to be one of them, here's a run-down of information, advice, and resources if you'd prefer to avoid unnecessary charges, especially now that you've got diapers to buy. (Please note that all figures were taken from a widely cited 2013 study by Truven Health Analytics. They apply to women with commercial health insurance, not Medicaid.)

Vaginal delivery

Average total cost for prenatal, intrapartum, and postpartum care: $22,734

Average cost for intrapartum care: $16,165

Average out-of-pocket intrapartum cost: $1,686

What you're paying for: With vaginal births, you may still pay hefty fees for anesthesiology (think: epidurals) and professional services, but your facility fees will be much lower because you won't be in an operating room.

What to watch out for: Interventions to speed up the delivery, like labor induction and C-sections that aren't medically necessary. One way to lower your chances of getting a C-section is to hire a doula, a licensed professional who functions as your advocate during labor. Research has found that women who hire doulas have significantly lower C-section rates — between 28 percent and 56 percent. Depending on where you live and what services you want, doulas can cost between $500 and $3,500. Some insurance plans will reimburse you; if yours doesn't, hiring a doula might not actually save you money, but it will likely make the birth process go more smoothly.

Caesarean section

Average nationwide cost for prenatal, intrapartum, and postpartum care: $32,062

Average cost for intrapartum care: $24,572

Average out-of-pocket cost: $1,948

What you're paying for: Higher facility fees (hospital equipment, operating space, etc.) and anesthesiology. Otherwise, your pharmacy and professional services fees are about the same as if you were to have a vaginal birth.

What to watch out for: The anesthesiologist. Sometimes different doctors, even ones in the same hospital, will take different types of insurance, and the anesthesiologist on duty might be out of your network. "That will trigger an additional charge that you may not know about until you get a surprise on your bill," says Sakala.

Newborn care after vaginal birth

Average cost: $5,809

Average out-of-pocket cost: $558

What you're paying for: Yes, surprise! Your newborn baby gets their own bill. It will mostly consist of professional services — the standard newborn baby checks like hearing, eyesight, counting fingers and toes — and facility fees.

What to watch out for: Different levels of nursery care. "Sometimes a baby is taken to a nursery for 'observation,' and medical professionals won't tell the parents that they're keeping an eye on a particular issue because they're not sure if it's cause for concern yet," says Sakala. "Some nursery care bills can really add up — and even more so if the baby is taken to the NICU."

Newborn care after cesarean birth

Average cost: $11,193

Average out-of-pocket cost: $721

What you're paying for: If you have a C-section, your baby will have higher facility fees because it will be born in an operating room.

What to watch out for: The same things, regarding nursery care. Be sure to ask if something is optional or not.

How Much Does It Actually Cost to Give Birth?